Assessing the epidemiological impact on cervical cancer of switching from 4-valent to 9-valent HPV vaccine within a gender-neutral vaccination programme in Switzerland

Abstract

Background: An infection with high-risk human papillomavirus (HPV) is the obligatory aetiological factor for the development of cervical cancer. In Switzerland, the prevention strategy for cervical cancer is based on primary prevention via HPV vaccination and secondary prevention with an opportunistic screening programme for precancerous lesions. Vaccination is recommended to 11-26 years old male and female persons. The objective of the study was to assess the epidemiological impact on cervical cancer of switching from the currently implemented programme with the 4-valent vaccine to the 9-valent vaccine, in an 11-26 years old gender-neutral vaccination programme in Switzerland. Methods: A previously validated dynamic transmission model of HPV infections was adapted and calibrated to the Swiss setting assuming an 80% coverage rate in HPV-vaccination and lifelong vaccine type-specific protection. A gender-neutral vaccination programme (males and females) for 11-26 years old with a 9-valent HPV vaccine was compared with the current 11-26 years old gender-neutral 4-valent vaccination programme. Sensitivity analyses were conducted in order to test the impact of lower vaccination coverage rates and a shorter duration of protection on the model outcomes. Results: In Switzerland, a 9-valent gender-neutral vaccination programme would result in an additional prevention of 2979 cervical cancer cases, 13,862 CIN3 and 15,000 CIN2 cases, compared with the 4-valent gender-neutral vaccination programme over 100 years. These additional disease cases avoided would correspond to a 24, 36 and 48% cumulative incidence decrease in cervical cancer, CIN3 and CIN2 cases, respectively. It would also prevent additional 741 cervical cancer-related deaths over 100 years. A substantial additional reduction in cervical cancer and precancerous lesions burden is still observed when varying the vaccination coverage rate from 30 to 60% or reducing the duration of protection from lifelong to 20 years.

Respective prevalence of high‐risk HPVgenotypes in cervical neoplasia in Senegal

“…14 The other genotypes identified in our population of Senegalese patients were HPV33, 35, 31 39, and 56, found at a low frequency of 0.3%-1.9% each, a range similar to that observed in other populations. 14 It is to underline that, in spite of the variations observed in prevalence for some genotypes, most of the HPV high-risk genotypes identified in our population are covered by the 9-valent HPV vaccine. In our case series of 207 cervical neoplasias cases, only two (0.96%) were related to viral genotypes not represented in the 9-valent vaccine, namely HPV39 and HPV56.…”

“…In our population of patients, the prevalence for HPV16/18 was 71.3%, a rate similar to that observed worldwide 14 . However, this rate is higher than the one reported by Ndiaye et al on ICC samples collected in Senegal and Mali from 2006 to 2010 despite a similar proportion of HPV positivity (85.9% vs. 86.8%) 20 .…”

“…A substantial improvement in the prevention of CIN and invasive cervical cancer using this 9-valent vaccine should be achieved. [12][13][14][15] In a recent modeling analysis, the impact of HPV vaccination of girls only in low-income and lower-middle-income countries was predicted to reduce cervical cancer incidence from 19.8 to 2.1 cases per 100.000 women-year over the next century. 16 However, the effectiveness of vaccination remains largely dependent on the molecular epidemiology of HPV strains present in a given region.…”

US Cancer Screening Recommendations: Developments and the Impact of COVID-19

“…A study of the Swedish health registry found that from 2006–2017, the incidence of invasive cervical cancer was reduced by 88% for women receiving the quadrivalent HPV vaccine before the age of 17 and reduced by 53% in those vaccinated above 17 [ 27 ]. A prospective model in Switzerland found that the transition to the nine-valent HPV vaccine for 11–26 year old men and women would result in a further 24% reduction in cervical cancer incidence over the quadrivalent vaccine [ 28 ]. About 75.1% of US teens had received at least one dose of the HPV vaccine in 2020, which is projected to contribute to the continued decrease in cervical and head and neck cancer incidence [ 29 ].…”

Health Impact and Cost-Effectiveness of Implementing Gender-Neutral Vaccination With the 9-Valent Human Papillomavirus Vaccine in Belgium

“…A previously validated and published HPV-type transmission dynamic model simulating the natural history of HPV infections and estimating the cost associated with HPV-related diseases in women has been extended to include all HPV-related diseases in both sexes (Elbasha et al, 2007;Elbasha & Dasbach, 2010;Boiron et al, 2016;Largeron et al, 2017;Mennini et al, 2017;Kind et al, 2020;Majed et al, 2021). HPV infection and disease state transitions, lifetime durations of infection-derived immunity, and unvaccinated compartments in this model have been described previously in detail (Elbasha et al, 2007).…”