Public health paradoxes and the epidemiological impact of an HPV vaccine

Garnett, Geoff P.; Waddell, Heather

doi:10.1016/s1386-6532(00)00129-3

Cited by 64 publications

(45 citation statements)

References 22 publications

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“…Mathematical modelling of the effect of HPV L1 VLP vaccine introduction on cervical cancer rates is ongoing 57,103,104 , and the accuracy of the predictions will improve as we know more of the variables, such as long-term efficacy and the breadth of coverage. Although the HPV vaccine has the potential to be a dramatic public-health success, this depends on societal acceptance through education 102 and logistic factors that influence the coverage of immunization.…”

Section: Future Directionsmentioning

confidence: 99%

How will HPV vaccines affect cervical cancer?

2006

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Cancer of the uterine cervix is the second largest cause of cancer deaths in women, and its toll is greatest in populations that lack screening programmes to detect precursor lesions. Persistent infection with 'high risk' genotypes of human papillomavirus (HPV) is necessary, although not sufficient, to cause cervical carcinoma. Therefore, HPV vaccination provides an opportunity to profoundly affect cervical cancer incidence worldwide. A recently licensed HPV subunit vaccine protects women from a high proportion of precursor lesions of cervical carcinoma and most genital warts. Here we examine the ramifications and remaining questions that surround preventive HPV vaccines.Epidemiological and laboratory studies overwhelmingly support a necessary role for persistent human papillomavirus (HPV) infection and transcription in cervical carcinogenesis 1,2 (BOX 1). Importantly, HPV infection alone is not sufficient for cervical carcinogenesis, and additional steps occur over one or two decades. HPV is probably the most common sexually transmitted disease. It is estimated that the worldwide agestandardized prevalence of current HPV infection is 10.5% (95% CI 9.9-11.0) of women; the prevalence varies about 20-fold between different regions, from 1.4% (95% CI 0.5-2.2) in Spain to , although adenocarcinomas of the cervix are more challenging to detect with this approach. Progression to cancer can usually be prevented by the ablation or surgical removal of high-grade precursor lesions (HSIL or CIN2/3). In 2005, more than 60 million Pap smears were performed in the United States, and it is estimated that such screening programmes and intervention have reduced the incidence of cervical cancer by ~80% in the United States, but at a cost of more than US$6 billion a year.Despite this success, many women do not have access to screening. This problem is most acute in disadvantaged minorities in developed nations, in cultures that do not accept the screening process and in countries that are remote and lack the resources for screening programmes. Consequently, the impact of cervical cancer is greatest in these countries; the latest global estimates (from 2002) are 493,000 new cervical cancer cases each year, and 274,000 deaths, 80% of which occur in developing countries 8 .Vaccination traditionally represents the most cost-effective approach to combat infectious disease. Two approaches to vaccination, or a combination of both, can be considered: prophylactic (preventive) and therapeutic immunization. Prophylactic vaccination of healthy individuals against the aetiological agent protects against acquisition of the disease, but confers some risk to otherwise healthy patients and requires massive programmes to vaccinate a significant fraction of the population. Comprehensive prophylactic vaccination has historically proven most successful in disease reduction. The US Food and Drug Administration (FDA) approved a preventive HPV vaccine on 8 June 2006 for the immunization of women between 9-26 years of age 9 , and a second vacci...

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Section: Future Directionsmentioning

confidence: 99%

How will HPV vaccines affect cervical cancer?

2006

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“…In constructing this model, we reviewed other relevant previous models and incorporated some of their structures and inputs. These included cervical cancer screening cohort models (Eddy, 1980(Eddy, , 1990Fahs et al, 1992;McCrory et al, 1999;Myers et al, 2000;Kim et al, 2002), HPV vaccination cohort models (Stratton et al, 2000;Sanders and Taira, 2003;Kulasingam and Myers, 2003;Goldie et al, 2003Goldie et al, , 2004, and HPV vaccination dynamic models (Hughes et al, 2002;Garnett and Waddell, 2000;Barnabas and Garnett, 2004;Elbasha and Galvani, 2005). This model differs from its predecessors in several ways.…”

Section: Introductionmentioning

confidence: 99%

A Multi-Type HPV Transmission Model

2008

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A prophylactic quadrivalent (types 6/11/16/18) vaccine against oncogenic and warts-causing genital Human papillomavirus (HPV) types was approved by the US Food and Drug Administration in 2006. This paper presents a nonlinear, deterministic, age-structured, mathematical model of the transmission dynamics of HPV and disease occurrence in a US population stratified by gender and sexual activity group. The model can assess both the epidemiologic consequences and cost effectiveness of alternative vaccination strategies in a setting of organized cervical cancer screening in the United States. Inputs for the model were obtained from public data sources, published literature, and analyses of clinical trial data. The results suggest that a prophylactic quadrivalent HPV vaccine can: (i) substantially reduce the incidence of disease, (ii) increase survival among females, (iii) improve quality of life for both males and females, (iv) be cost-effective when administered to females age 12-24 years, and (v) be cost-effective when implemented as a strategy that combines vaccination of both females and males before age 12 vaccination with a 12 to 24 years of age catch-up vaccination program.

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“…105,106,[144][145][146][147][148][149][150] In the absence of data on vaccine effect, duration, cost, and behavior of nontargeted HPV types over time, different assumptions were made for the base case analysis in each. While these model-based analyses differ in their objectives, and thus in their choice of model structure, the majority intended to be exploratory, aiming to provide qualitative insight while awaiting better data.…”

Section: Cost-effectiveness Analysesmentioning

confidence: 99%

American Cancer Society Guideline for Human Papillomavirus (HPV) Vaccine Use to Prevent Cervical Cancer and Its Precursors

Saslow

Castle

Cox

et al. 2007

CA: A Cancer Journal for Clinicians

443

320

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The American Cancer Society (ACS) has developed guidelines for the use of the prophylactic human papillomavirus (HPV) vaccine for the prevention of cervical intraepithelial neoplasia and cervical cancer. These recommendations are based on a formal review of the available evidence. They address the use of prophylactic HPV vaccines, including who should be vaccinated and at what age, as well as a summary of policy and implementation issues.

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Public health paradoxes and the epidemiological impact of an HPV vaccine

Cited by 64 publications

References 22 publications

How will HPV vaccines affect cervical cancer?

How will HPV vaccines affect cervical cancer?

A Multi-Type HPV Transmission Model

American Cancer Society Guideline for Human Papillomavirus (HPV) Vaccine Use to Prevent Cervical Cancer and Its Precursors

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