HPV vaccination leads to decrease of anogenital warts and precancerous lesions of the cervix uteri in young women with low vaccination rates: a retrospective cohort analysis.

BACKGROUND: Although the human papillomavirus (HPV) vaccine has been recommended in Germany for girls since 2007, no organised vaccination programme was introduced and HPV vaccine coverage remains low. We investigated the HPV vaccination rates from 2008 to 2018 and the effects of HPV vaccination on anogenital warts and precancerous lesions in young women in Bavaria, Germany, a state with low vaccination rates. METHODS: Retrospective analyses of claims data from the Bavarian Association of Statutory Health Insurance Physicians (KVB) on females born between 1990 and 2009 (9 to 28 years old in 2018) were conducted to calculate vaccination rates by birth cohort, proportion of vaccine types administered and incidence of anogenital warts and precancerous lesions of the cervix uteri. 942 841 Bavarian females 9 to 28 years old with available information on HPV vaccination were included to calculate vaccination rates. For the outcome analyses, data from 433 346 females 19 to 28 years old were analysed. Hazard ratios (HR) were computed from univariable and multivariable Cox regression models comparing vaccinated and unvaccinated women, considering type of vaccine used and contraceptive prescription. RESULTS: 40·9% of 18-year-olds and only 13·3% of 12-year-olds were fully vaccinated in 2018 in Bavaria. Gardasil® and Gardasil9® were most commonly administered. Vaccinated compared to unvaccinated women had a lower incidence of anogenital warts and cervical lesions, however only small differences were detected between fully and partially vaccinated women. Fully vaccinated women had a 63% (HR 0·37 (95% confidence interval (CI) 0·34 to 0·40) and 23% (HR 0·77, 95%CI 0·71 to 0·84) lower risk of anogenital warts and cervical lesions, respectively. Women who were prescribed contraceptives prior to vaccination had a 49% higher risk of developing anogenital warts (HR 1·49, 95%CI 1·25 to 1·79) or cervical lesions (HR 1·49, 95%CI 1·27 to 1·75) compared to vaccinated women without contraceptive prescription. CONCLUSIONS: The evaluation of the effects of HPV vaccination in Bavaria showed a promising decline of anogenital warts and precancerous lesions in vaccinated young women. However, an increase in vaccination rates is necessary to achieve a greater population impact in preventing HPV-related diseases.

Performance of new enzyme-linked fluorescent assays for detection of Epstein-Barr virus specific antibodies in routine diagnostics.

BACKGROUND AND AIMS: Indirect fluorescent antibody assays are still the gold standard for the detection of Epstein-Barr-virus-specific antibodies; however, this technique requires several manual steps and an experienced technician. This retrospective study investigated the performance of the new VIDAS(®) enzyme-linked fluorescent assays for automated qualitative detection of EBV VCA IgM, VCA/EA IgG, and EBNA IgG antibodies in routine diagnostics. METHODS: 174 serum samples were tested first with the gold standard. In context with the clinical status, 60 samples IFA IgG/IgM positive and with clinical symptoms compatible with infectious mononucleosis, 26 samples IFA IgG/IgM negative and missing any clinical symptoms and 88 samples with varying IFA status and without any clinical information were defined. In a second step all samples were retested with the new assays. RESULTS: In the overall agreement between VIDAS(®) and IFA for evaluable results, almost perfect agreement was observed (kappa = 0.91; 95% confidence interval (CI), 0.86-0.97). Estimating all indeterminate VIDAS(®) results as discordant or concordant the observed kappa values were 0.71 (CI 0.63-0.79) and 0.93 (CI 0.88-0.98), respectively. With the new assays 45, 22, and 70 identical results were obtained, respectively. Western blot analysis of the discrepant samples showed a quasi similar performance of both assays. CONCLUSIONS: The new VIDAS(®) assays can be an alternative to IFA testing especially in high-throughput laboratories. Full automation of EBV serological diagnostis by the new VIDAS assays is of major importance for routine diagnostic laboratories.