Comparison of the long‐term impact and clinical outcomes of fewer doses and standard doses of human papillomavirus vaccine in the United States: A database study

Abstract

Background Human papillomavirus (HPV)–related disease remains a significant source of morbidity and mortality, and this underscores the need to increase HPV vaccination to reduce the burden of the disease. The objective of this study was to examine the association between the number of HPV vaccine doses and the risk of histologically confirmed preinvasive cervical disease and high‐grade cytology. Methods This retrospective matched cohort study used administrative data from Optum's Clinformatics DataMart Database to identify females aged 9 to 26 years who received 1 or more quadrivalent HPV vaccine doses between January 2006 and June 2015. Cases and controls were matched on region, age, sexually transmitted disease history, and pregnancy. All had a Papanicolaou test ≥1 year after the date of the matched case's final dose. Cox proportional hazards models were used to examine the association between the number of HPV vaccine doses and the incidence of preinvasive cervical disease and high‐grade cytology. The Kaplan‐Meier method was used to estimate the cumulative incidence rate at the 5‐year follow‐up. Results The study included 133,082 females (66,541 vaccinated and 66,541 unvaccinated) stratified by the number of HPV vaccine doses and the vaccine initiation age. Among those aged 15 to 19 years, the hazard ratio (HR) for high‐grade cytology for the 3‐dose group was 0.84 (95% confidence interval [CI], 0.73‐0.97), whereas the HRs for histologically confirmed preinvasive cervical disease for 1, 2, and 3 doses were 0.64 (95% CI, 0.47‐0.88), 0.72 (95% CI, 0.54‐0.95), and 0.66 (95% CI, 0.55‐0.80), respectively. Conclusions The receipt of 1, 2, or 3 doses of an HPV vaccine by females aged 15 to 19 years was associated with a lower incidence of preinvasive cervical disease in comparison with unvaccinated females, and this supports the use of any HPV vaccination in reducing the burden of the disease.

Protecting people with multiple sclerosis through vaccination

“…A recent study in the US showed that just one dose of human papillomavirus vaccine is associated with a significant reduction in cervical disease. 65 In clinical practice, physicians and people with MS must decide on whether the potential benefit of human papillomavirus vaccination outweighs the risks of delaying treatment at the individual patient level. Vaccination against human papillomavirus should be particularly considered before starting fingolimod, and other emerging sphingosine-1-phosphate–receptor modulators, which may result in impaired intrinsic cancer immunosurveillance.…”

Human Vaccines & Immunotherapeutics: news

“…Another study suggests that a single dose of HPV vaccine might be sufficient A single dose of HPV vaccine was comparable with twoand three-dose regimens in preventing preinvasive cervical disease in a retrospective study that looked at medical records of 133,000 U.S. women between 2006 and 2015. 7 The three regimens reduced the risk of disease by 36, 28 and 34 percnt, respectively, compared to unvaccinated subjects. It remains to be determined whether long-term immunogenicity is comparable for all regimens as well.…”

Human papillomavirus vaccination 2020 guideline update: American Cancer Society guideline adaptation

“…HPV vaccination is most effective in early adolescence, with effectiveness decreasing dramatically by age 18 years and minimal benefit noted by age 20 or 21 years. 3,35 Although HPV vaccination is safe for adults aged 27 to 45 years, there would be limited public health benefits from vaccinating people in this age range. 12,36,37 Compared with vaccination through age 26 years, vaccination of adults through age 45 years was estimated, using models that assumed low uptake of the vaccine by individuals in this age range, to prevent only an additional 0.5% cases of cancer, 0.4% cases of cervical precancer, and 0.3% cases of genital warts over the next 100 years.…”