Early effect of bivalent human papillomavirus vaccination on cytology outcomes in cervical samples among young women in the Netherlands

Klooster, Tessa M Schurink-van 't; Siebers, Albert G.; Hoes, Joske; Kemenade, Folkert J. van; Berkhof, Johannes; Bogaards, Johannes A.; Melker, Hester E. de

doi:10.1002/cam4.5842

Cited by 3 publications

References 15 publications

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Early effect of bivalent human papillomavirus vaccination on cytology outcomes in cervical samples among young women in the Netherlands

Klooster

Siebers²,

Hoes

et al. 2023

Cancer Medicine

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Background The first HPV‐vaccine eligible cohorts in the Netherlands will enter the cervical screening program in 2023. However, a substantial number of young women already have had a cervical sample taken before entry into the regular screening program. This study was initiated to explore early effects of HPV vaccination on detection of cytological abnormalities in cervical samples of women younger than the screening age. Methods Results of cervical samples were obtained from the Dutch National Pathology Databank (PALGA) and were linked to the women's HPV vaccination status from the national vaccination registry (Praeventis) (N = 42,171). Occurrence of low‐grade and high‐grade squamous intraepithelial lesions or worse (LSIL and HSIL+) and high‐risk HPV positive tests (hrHPV) in the first cervical sample were compared between vaccinated and unvaccinated women by multivariable logistic regression analysis, corrected for age at cervical sampling and age of vaccination (12/13 years, ≥ = 14 years). Results For fully vaccinated women (three‐ or two‐dose schedule), statistically significant reductions were seen for all outcomes compared to unvaccinated women (hrHPV: adjusted OR, 0.70, 95% CI, 0.63–0.79; LSIL: 0.70, 0.61–0.80; HSIL+: 0.39, 0.30–0.51). Conclusions By linking nation‐wide registries on pathology and vaccination, we show significant beneficial early effects of HPV‐vaccination on LSIL, HSIL+, CIN3/AIS/carcinoma and hrHPV detection in young women upto 24 years of age who have a cervical sample taken before entry into the cervical cancer screening program.

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Early effect of bivalent human papillomavirus vaccination on cytology outcomes in cervical samples among young women in the Netherlands

Klooster

Siebers²,

Hoes

et al. 2023

Cancer Medicine

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Projected health and economic effects of nonavalent versus bivalent human papillomavirus vaccination in preadolescence in the Netherlands

Sollie,

Berkhof,

Bogaards

2023

Preprint

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BackgroundThe national immunization program in the Netherlands currently uses the bivalent human papillomavirus (HPV) vaccine, targeting HPV genotypes 16 and 18. It is not yet clear whether it is cost-effective to switch to the nonavalent vaccine, targeting an additional seven HPV genotypes. This study compares the health and economic effects of both vaccines for the Dutch setting of sex-neutral vaccination with tender-based procurement and HPV-based screening for cervical cancer.MethodsWe estimated the population effects under bivalent or nonavalent HPV vaccination in a cohort of girls and boys, invited for vaccination at 10 years of age. The differential impact of nonavalent versus bivalent HPV vaccination was obtained by projecting type-specific risk reductions, obtained by an HPV transmission model, onto type-specific outcomes of HPV-based screening, incidence of HPV-related cancers in both men and women, as well as treatment for anogenital warts and recurrent respiratory papillomatosis. Bayesian analysis was applied to translate the uncertainty of the data into credible intervals (CI) for health and economic outcomes, under specific scenarios regarding long-term vaccine uptake, efficacy and cost. The base-case scenario assumed 50% uptake at age 10, life-long vaccine protection with cross-protective efficacy to HPV 31, 33 and 45 from the bivalent vaccine, and an additional cost of EUR 35 per 2-dose vaccination schedule for the nonavalent vaccine.ResultsIn the base-case scenario, nonavalent vaccination is expected to prevent 1090 additional cases of high-grade cervical intraepithelial neoplasia (CIN2/3), 70 additional cases of HPV-related cancer, 34 000 episodes of anogenital warts and 28 onsets of RRP, relative to bivalent vaccination per cohort of 100 000 girls and 100 000 boys. These health effects translate into an incremental cost-effectiveness ratio (ICER) of EUR 2048 (95% CI: 716 to 3141) per life-year gained, under annual discounting of 1.5% and 4% for future health and economic effects, respectively. The ICER remained below the local threshold for cost-effective preventive interventions in all investigated scenarios, except when assuming waning efficacy for non-16/18 oncogenic HPV types with either vaccine or cross-protection to non-31/33/45 types for the bivalent vaccine.ConclusionsSex-neutral vaccination with the nonavalent vaccine is likely to be cost-effective relative to the currently used bivalent vaccine in the Netherlands. Monitoring long-term type-specific vaccine effectiveness is key to update projections on the impact and cost-effectiveness of HPV vaccination.

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Vaccine Effectiveness Of Bivalent HPV Vaccination Against Genital HPV Of A Catch-Up Campaign And 12 Years Routine Vaccination For Girls-Only: A Biennial Repeated Cross-Sectional Study

Kusters,

Loeff,

Benthem

et al. 2024

Preprint

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Background The Netherlands is one of few countries worldwide which has used the bivalent HPV vaccine for girls-only for over a decade. This allows assessment of vaccine effectiveness (VE) against female genital HPV DNA-positivity of this vaccine in an observational post-licensing real-world setting. Additionally, it is unclear whether catch-up vaccination campaigns result in similar VE as routine vaccination. Therefore, type-specific and grouped VE were assessed and compared for women who had been eligible for catch-up vaccination at 13–16 years with those who had been eligible for routine vaccination at 12 years. Methods PASSYON is a Dutch biennial repeated cross-sectional (2011-21) study among sexual health clinic clients aged 16–24 years old. Women provided self-collected vaginal samples, questionnaires on demographics and sexual behaviour were administered, and women self-reported HPV vaccination status. Samples were analysed using a PCR-based assay (SPF10-LiPA25). Type-specific and grouped VE estimates, adjusted with propensity score stratification, were assessed against genital positivity for 14 HPV-types. VE for targeted and non-targeted genotypes were compared between women who had been eligible for the catch-up and those who had been eligible for routine vaccination. Results The study included 4,488 female participants who had been eligible for HPV vaccination and provided genital swabs (1,561 eligible for catch-up, 2,927 for routine vaccination). Very high VE against genital HPV-16 and HPV-18 was observed (resp. 93.5% and 89.5%) and significant cross-protection against six other genotypes (HPV-31/33/35/45/52/58), varying from 18.0% (HPV-52) to 79.6% (HPV-45). VE estimates were comparable between women who had been eligible for the catch-up campaign and those eligible for routine vaccination: VE HPV-16/18: 92.2% (95%CI: 87.9–94.9) vs. 91.8% (95%CI: 86.0-95.2). Conclusions In real-world settings, the VE of bivalent vaccine is high against targeted genotypes, with cross-protection against 6 other genotypes. Catch-up campaigns up to age 16 years can be as effective as routine vaccination at age 12. This may inform countries considering catch-up campaigns when introducing or extending the use of HPV vaccination within their national immunisation programmes.

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Early effect of bivalent human papillomavirus vaccination on cytology outcomes in cervical samples among young women in the Netherlands

Cited by 3 publications

References 15 publications

Early effect of bivalent human papillomavirus vaccination on cytology outcomes in cervical samples among young women in the Netherlands

Early effect of bivalent human papillomavirus vaccination on cytology outcomes in cervical samples among young women in the Netherlands

Projected health and economic effects of nonavalent versus bivalent human papillomavirus vaccination in preadolescence in the Netherlands

Vaccine Effectiveness Of Bivalent HPV Vaccination Against Genital HPV Of A Catch-Up Campaign And 12 Years Routine Vaccination For Girls-Only: A Biennial Repeated Cross-Sectional Study

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