Public Health Benefits of Routine Human Papillomavirus Vaccination for Adults in the Netherlands: A Mathematical Modeling Study

Abstract

Offering vaccination to adults, especially at cervical cancer screening visits (for women) and during STI consultations (for both sexes), would substantially reduce HPV incidence and would be an efficient policy option to improve HPV prevention and subsequently avert cervical and possibly male HPV-related cancers.

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

“…5 Epidemiological impact of two vaccination strategies on HPV16/18/31/33/45/52/58 related incidence of CIN3 over 100 years only vaccination programme [46]. Other European epidemiological-focused published models in Germany [47], in Italy [48], in the Netherlands [49], and in Finland [50] have shown the positive epidemiological impact of gender-neutral HPV 2-valent and/or 4-valent vaccination. Besides, several cost-effectiveness studies recently published in Europe reported findings on the epidemiological impact of switching from a 4-valent vaccination to a 9-valent vaccination programme in a gender-neutral context [22][23][24].…”

The health impact of human papillomavirus vaccination in the situation of primary human papillomavirus screening: A mathematical modeling study

“…We used largely the same assumptions to model the impact of HPV vaccination as in our previous studies [7, 9]. Briefly, we modeled the current vaccination strategy and observed vaccination uptake in the Netherlands: i.e.…”

“…For the adult vaccination strategies, we assumed an efficacy of 77.4% against both HPV-types for women older than 24 years [34]. For men older than 24 years, vaccine efficacy was assumed to be 64.5% for HPV-16 and 80.6% for HPV-18 [9, 34]. In the last strategy, where the vaccine is offered to both sexes during STI consultations, routine vaccination for boys is included as well.…”

“…We recently estimated that HPV-16 and HPV-18 incidence in the Netherlands will substantially decline by about 60% under continuation of the current girls-only vaccination program [7]. Alternative vaccination strategies, such as efforts to increase vaccination coverage among girls, the inclusion of boys, or vaccinating men at sexual health clinics, have also been explored and in some countries even implemented [8, 9]. Finally, the cervical cancer screening program in the Netherlands was renewed in 2017 by offering primary HPV screening instead of cytology to women starting at age 30, and by offering fewer lifetime screens [10].…”

“…However, in order to accurately estimate the impact of vaccination, including herd-immunity and the complexity of cervical cancer disease development, a comprehensive modeling approach that combines a sexual network model for accurately predicting vaccination effects on HPV transmission and a detailed model of cervical disease natural history and screening is crucial. Most models used did not simulate HPV transmission through a sexual network [11–20], and therefore cannot properly capture herd immunity effects, or did not specifically capture the complexity of cervical cancer disease progression and screening [9]. …”