Long-term Impact of Human Papillomavirus Vaccination on Infection Rates, Cervical Abnormalities, and Cancer Incidence
- 1 July 2011
- journal article
- infectious disease
- Published by Ovid Technologies (Wolters Kluwer Health) in Epidemiology
- Vol. 22 (4), 505-515
- https://doi.org/10.1097/ede.0b013e31821d107b
Abstract
Vaccination against human papillomavirus (HPV) types 16/18 is being implemented in many countries. There may be indirect benefit of HPV vaccination to nonvaccinated women, who may experience a reduced risk of infection with vaccine-preventable types (herd immunity). We attempt to disentangle the direct and indirect effects of HPV vaccination, while accounting for 14 oncogenic HPV types in a dynamic modeling framework. On the basis of vaccine uptake among preadolescent girls in the Netherlands, we calculated how heterosexual transmission of HPV-16/18 is expected to change as a result of vaccination, and used these predictions in an individual-based simulation model of cervical carcinogenesis that considers 14 high-risk HPV types. Models were parameterized to match prevaccine data on type-specific HPV infection and cervical disease. At 50% vaccine coverage, the estimated lifetime infection risk in nonvaccinated women dropped from 0.46 (95% credible interval = 0.35-0.54) to 0.37 (0.26-0.46) for HPV-16, and from 0.40 (0.32-0.46) to 0.31 (0.22-0.36) [corrected] for HPV-18. For the whole population, we calculated an eventual 47% reduction in cervical cancer incidence, with 1 in 4 cases prevented among nonvaccinated women. The number of indirectly averted cancer cases was highest with vaccine coverage between 50% and 70%, approximating 70 cases per 100,000 women born from 2010 onward. HPV-16/18 vaccination of preadolescent girls will markedly lower infection rates among nonvaccinated women. Reduced transmission of vaccine-preventable HPV becomes a prominent aspect of cervical cancer control, especially in populations with moderate vaccine coverage.Keywords
This publication has 37 references indexed in Scilit:
- Human papillomavirus type distribution in 30,848 invasive cervical cancers worldwide: Variation by geographical region, histological type and year of publicationInternational Journal of Cancer, 2010
- Efficacy of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA): final analysis of a double-blind, randomised study in young womenThe Lancet, 2009
- Cost-Effectiveness Analysis of Human Papillomavirus Vaccination in the NetherlandsJNCI Journal of the National Cancer Institute, 2009
- HPV16/18 vaccination to prevent cervical cancer in The Netherlands: Model‐based cost‐effectivenessInternational Journal of Cancer, 2008
- Human papillomavirus and cervical cancerThe Lancet, 2007
- Assessing the introduction of universal human papillomavirus vaccination for preadolescent girls in The NetherlandsVaccine, 2007
- Effect of prophylactic human papillomavirus L1 virus-like-particle vaccine on risk of cervical intraepithelial neoplasia grade 2, grade 3, and adenocarcinoma in situ: a combined analysis of four randomised clinical trialsThe Lancet, 2007
- Epidemiologic Classification of Human Papillomavirus Types Associated with Cervical CancerNew England Journal of Medicine, 2003
- The causal relation between human papillomavirus and cervical cancerJournal of Clinical Pathology, 2002
- Human papillomavirus is a necessary cause of invasive cervical cancer worldwideThe Journal of Pathology, 1999