High prevalence of cervical high-risk human papillomavirus infection mostly covered by Gardasil-9 prophylactic vaccine in adult women living in N'Djamena, Chad.

BACKGROUND: We conducted in 2018 a descriptive, quantitative, population-based, cross-sectional survey estimating the prevalence of cervical high-risk human papillomavirus (HR-HPV) infection and associated risk factors among adult women living in N'Djamena, Chad. METHODS: Five of the 10 districts of N'Djamena were randomly selected for inclusion. Peer educators contacted adult women in community-churches or women association networks to participate in the survey and come to the clinic for women's sexual health "La Renaissance Plus", N'Djamena. Medical, socio-demographical and behavioral informations were collected. HPV DNA was detected and genotyped in endocervical swab using Anyplex II HPV28 genotyping test (Seegene, Seoul, South Korea). RESULTS: 253 women (mean age, 35.0 years; range, 25-65) including 3.5% of HIV-positive women were prospectively enrolled. The prevalence of HPV infection was 22.9%, including 68.9% of HR-HPV infection and 27.6% being infected with multiple genotypes, providing a total HR-HPV prevalence of 15.8% (95% CI%: 11.3-20.3). The most prevalent HR-HPV genotypes were HPV-58, HPV-35, HPV-56, HPV-31, HPV-16, HPV-45, HPV-52 and HPV-18. HPV types targeted by the prophylactic Gardasil-9 vaccine were detected in nearly 70% (67.5%) and HPV-58 was the most frequently detected. HIV infection was a risk factor strongly associated with cervical infection with any HPV [adjusted Odds ratio (aOR): 17.4], multiple types of HPV (aOR: 8.9), HR-HPV (aOR: 13.2) and cervical infection with multiple HR-HPV (aOR: 8.4). CONCLUSION: These observations highlight the unsuspected high burden of cervical HR-HPV infection in Chadian women, and point the potential risk of further development of HPV-associated cervical precancerous and neoplastic lesions in a large proportion of women in Chad. The high rate of preventable Gardasil-9 vaccine genotypes constitutes the rationale for introducing primary vaccine prevention against cervical cancer in young female adolescents living in Chad.

Efficacy of a Carrageenan gel Against Transmission of Cervical HPV (CATCH): interim analysis of a randomized, double-blind, placebo-controlled, phase 2B trial.

OBJECTIVES: To evaluate the efficacy of a carrageenan-based lubricant gel in reducing the risk of genital human papillomavirus (HPV) infections in women. METHODS: We conducted a planned interim analysis of a randomized, double-blind, placebo-controlled, phase 2B trial. Women aged 18 years and older were randomly assigned (1:1) to a carrageenan-based gel or a placebo gel to be self-applied every other day for the first month and before and after each intercourse during follow-up. Assessments were performed at 0.5, 1, 3, 6, 9 and 12 months. The primary outcome was incidence of a new infection by an HPV type that was not present at baseline. Intention-to-treat analyses were performed. RESULTS: Between January 2013 and June 2017, a total of 280 participants were randomly assigned to the carrageenan (n = 141) or the placebo (n = 139) arm. All participants were included in safety analyses, but three (1%) were excluded from efficacy analyses (HPV results unavailable for two participants in the carrageenan and one participant in the placebo arm). The median follow-up time was 9.2 months (interquartile range, 1.9-13.2 months). A total of 59 (42%) of 139 participants in the carrageenan arm and 78 (57%) of 138 participants in the placebo arm became infected by at least one new HPV type (hazard ratio = 0.64, 95% confidence interval = 0.45-0.89, p 0.009). A total of 62 (44%) of 141 participants in the carrageenan arm versus 43 (31%) of 139 participants in the placebo arm reported an adverse event (p 0.02), none of which was deemed related to the gels. CONCLUSIONS: Our trial's interim analysis suggests that using a carrageenan-based lubricant gel can reduce the risk of genital HPV infections in women.

Fatores associados a não realização de exame citopatológico em São Leopoldo, Rio Grande do Sul, 2015: estudo transversal de base populacional / Factores asociados a la no realización de examen citopatológico en São Leopoldo, Rio Grande do Sul, Brasil, 2015: estudio transversal de base poblacional / Factors associated with not having Pap Smears in São Leopoldo, Rio Grande do Sul, Brazil, 2015: a cross-sectional population-based study

Objetivo: estimar a prevalência de exame citopatológico não realizado nos últimos três anos e de nunca realizado em mulheres, e analisar fatores associados. Métodos: estudo transversal, com mulheres de 20 a 69 anos de idade, em São Leopoldo, RS, Brasil, em 2015; calcularam-se as razões de prevalência (RP) por regressão de Poisson. Resultados: entre 919 mulheres, a prevalência de exame atrasado foi 17,8% (intervalo de confiança de 95% [IC95%15,4;20,3), e de nunca realizado, 8,1% (IC95%6,3;9,8); na análise ajustada, o aumento na prevalência de exame atrasado mostrou-se associado à classe econômica D/E (RP=2,1 - IC95%1,3;3,5), idade de 20-29 anos (RP=3,2 - IC95%2,1;4,9) e nenhuma consulta realizada (RP=3,0 - IC95%2,1;4,1); nunca ter realizado exame associou-se com classe econômica D/E (RP=2,6 - IC95%1,4;5,0), idade de 20-29 anos (RP=24,1 - IC95%6,4;90,9) e nenhuma consulta (RP=2,9 - IC95%1,7;4,8). Conclusão: a cobertura de exame foi alta e com iniquidade.

Objetivo: estimar la prevalencia de examen en mujeres, no realizado en los últimos tres años y de nunca realizado, y analizar factores asociados. Métodos: estudio transversal con mujeres de 20 a 69 años de edad de São Leopoldo, RS, Brasil, en 2015; se calcularon las razones de prevalencia (RP) por la regresión de Poisson. Resultados: entre 919 mujeres, la prevalencia de examen retrasado fue 17,8% (intervalo de confianza del 95% [IC95%]15,4;20,3) y de nunca realizado fue del 8,1% (IC95%6,3;9,8); en el análisis ajustado, el aumento en la prevalencia de examen retrasado se asoció con clase económica D/E (RP=2,1 - IC95%1,3;3,5), a edad entre 20-29 años (RP=3,2 - IC95%2,1;4,9) y ninguna consulta (RP=3,0 - IC95%2,1;4,1); nunca haber realizado examen se asoció con clase D/E (RP=2,6 - IC95%1,4;5,0), a 20-29 años de edad (RP=24,1 - IC95%6,4;90,9) y ninguna consulta (RP=2,9 - IC95%1,7;4,8). Conclusión: la cobertura de examen fue alta y con inequidad.

Objective: to estimate the prevalence of Pap tests not performed in the last three years and never performed in women and to analyze factors. Methods: this was a cross-sectional study with women aged 20 to 69 years living in São Leopoldo, RS, Brazil, in 2015; prevalence ratios (PR) were calculated using Poisson regression. Results: among 919 women, prevalence of delayed testing was 17.8% (95% confidence interval [95%CI]15.4;20.3) and never tested prevalence was 8.1% (95%CI6.3%;9.8%); in the adjusted analysis, the increase in the prevalence of delayed testing was associated with economic class D/E (PR=2.1 - 95%CI1.3;3.5), being aged 20-29 years (PR=3.2 - 95%CI2.1;4.9) and not having had a medical appointment (PR=3.0 - 95%CI2.1;4.1); never having tested was associated with economic class D/E (PR=2.6 - 95%CI1.4;5.0), being aged 20-29 years (PR=24.1 - 95%CI6.4;90.9), and not having had a medical appointment (PR=2.9 - 95%CI1.7;4.8). Conclusion: coverage of the test was high but characterized by social inequality.

Durability of Protection Afforded by Fewer Doses of the HPV16/18 Vaccine: The CVT Trial.

Background: Previously, we demonstrated similar human papillomavirus (HPV)16/18 vaccine efficacy estimates and stable HPV16/18 antibody levels four years postvaccination in a nonrandomized analysis of women who received a varying number of doses of the bivalent HPV16/18 vaccine. Here we extend data to seven years following initial vaccination. Methods: We evaluated HPV16/18-vaccinated women who received one (n = 134), two (n 0/1 = 193, n 0/6 = 79), or three doses (n = 2043) to a median of 6.9 years postvaccination. Cervical HPV DNA was measured with the SPF10- DEIA-LiPA PCR system; HPV16/18-specific antibody levels were measured using enzyme-linked immunosorbent assays (n = 486). Infection and immunological measures were compared across vaccine dose groups. Prevalent HPV infection at year 7 was also compared with an unvaccinated control group (UCG). All statistical tests were two-sided. Results: Among women in the three-dose, two-dose 0/6 , two-dose 0/1 , and one-dose groups, cumulative incident HPV16/18 infection rates (No. of events/No. of individuals) were 4.3% (88/2036, 95% confidence interval [CI] = 3.5% to 5.3%), 3.8% (3/78, 95% CI = 1.0% to 10.1%), 3.6% (7/192, 95% CI = 1.6% to 7.1%), and 1.5% (2/133, 95% CI = 0.3% to 4.9%; P = 1.00, .85, .17 comparing the two-dose 0/6 , two-dose 0/1 , and one-dose groups to the three-dose group, respectively). The prevalence of other carcinogenic and noncarcinogenic HPV types, excluding HPV16/18/31/33/45, were high and not statistically different among all dose groups, indicating that the low incidence of HPV16/18 in the one- and two-dose groups was not due to lack of exposure. At seven years, 100% of participants in all dose groups remained HPV16 and HPV18 seropositive. A non-statistically significant decrease in the geometric mean of the HPV16 antibody levels between years 4 and 7 was observed among women in the three-dose group: -10.8% (95% CI = -25.3% to 6.6%); two-dose (0/6 months) group: -17.3% (95% CI = -39.3% to 12.8%), two-dose (0/1 month) group: -6.9% (95% CI = -22.1% to 11.2%), and one-dose group: -5.5% (95% CI = -29.7% to 27.0%); results were similar for HPV18. Conclusions: At an average of seven years of follow-up, we observed similar low rates of HPV16/18 infections and slight, if any, decreases in HPV16/18 antibody levels by dose group.

Health-related quality of life as measured by the EQ-5D in the prevention, screening and management of cervical disease: A systematic review.

PURPOSE: Cost-effectiveness analyses (CEAs) of screening can be highly sensitive to the health-related quality of life (HRQoL) effects of screen tests and subsequent treatment. Accordingly, accurate assessment of HRQoL is essential. We reviewed the literature regarding HRQoL in cervical prevention and management in order to appraise the current evidence regarding this important input to CEA. METHODS: We searched the MEDLINE, Scopus and EconLit databases for studies that estimated HRQoL in cervical cancer prevention and management published January 1995-December 2015. The primary inclusion criterion was for studies that assess HRQoL using the EQ-5D. Data were abstracted from eligible studies on setting, elicitation group, sample size, elicitation instruments, health state valuations, study design and follow-up. We assessed the quality and comparability of the studies with a particular focus on the HRQoL reported across states and groups. RESULTS: Fifteen papers met the inclusion criteria. Most used patient elicitation groups (n = 11), 2 used the general public and 2 used a mix of both. Eight studies were cross-sectional and seven were longitudinal. Six studies used both the EQ-5D-3L and the EQ-VAS together with other measures of overall HRQoL or condition-specific instruments. Extensive heterogeneity was observed across study characteristics. CONCLUSIONS: Our results reveal the challenges of sourcing reliable estimates of HRQoL for use in CEAs of cervical cancer prevention and treatment. The EQ-5D appears insufficiently sensitive for some health states. A more general problem is the paucity of HRQoL estimates for many health states and their change over time.

Alteraciones cérvico uterinas en mujeres de Santa Marta / Cervical alterations in Santa Marta women

Introducción: la citología cérvico uterina es la prueba de cribado de bajo costo que permite identificar las alteraciones cervicales en un amplio grupo de mujeres. Objetivos: determinar las alteraciones cérvico uterinas, basadas en el análisis de pruebas citológicas, en mujeres de Santa Marta. Métodos: estudio descriptivo retrospectivo de diseño documental y enfoque cuantitativo, llevado a cabo en una entidad de primer nivel de atención en salud de la ciudad de Santa Marta, Colombia. La recogida de datos se hizo sobre 2 958 registros de pruebas citológicas, correspondientes al periodo comprendido entre 2011 - 2014. Para el análisis de la información se utilizó la hoja de cálculo de Excel, el cual permitió el diseño de las tablas para el análisis de frecuencia de las alteraciones. Resultados: presentó alteraciones cérvico uterinas 7,16 por ciento; el 54,71 por ciento, Ascus; el 22,64 por ciento, neoplasia intraepitelial cervical I; 16,50 por ciento, Virus del papiloma humano; 3,77 por ciento, neoplasia intraepitelial cervical III y 1,88 por ciento, carcinoma. El 8,72 por ciento, infecciones vaginales, compatibles con vaginitis bacteriana el 62,51 por ciento y con cándida albicans 37,20 por ciento. Conclusiones: a pesar de la existencia de programas dirigidos a la prevención y detección precoz de lesiones cérvico uterinas y de las directrices de organismos internacionales y nacionales, estas alteraciones siguen representando un problema de salud pública en la región(AU)

Introduction: The cervical cytology is the low-cost screening test that allows the identification of cervical changes in a large group of women. Objectives: To determine the cervical alterations, based on the analysis of cytological tests, in Santa Marta women. Methods: Retrospective descriptive study of documentary design and quantitative approach, carried out in a first level health care institution in the city of Santa Marta, Colombia. The data collection was done from 2958 records of cytological tests, corresponding to the period between 2011 and 2014. For the analysis of the information we used an Excel processor sheet, which allowed the design of tables for the analysis of frequency of alterations. Results: 7.16 percent presented cervical alterations; 54.71 percent, ascus; 22.64 percent, cervical intraepithelial neoplasia I; 16.50 percent, human papillomavirus; 3.77 percent, cervical intraepithelial neoplasia III; and 1.88 percent, carcinoma. 8.72 percent presented vaginal infections, 62.51 percent compatible with bacterial vaginitis and 37.20 percent with candida albicans. Conclusions: Despite the existence of programs aimed at the prevention and early screening of cervical lesions, and the guidelines of international and national agencies, these alterations continue to represent a public health concern in the region(AU)

Prevalence of cervical cancer and associated mortality in Grenada, 2000-2010 / Prevalencia del cáncer cervicouterino y mortalidad asociada en Granada, 2000-2010

ABSTRACT Objective To assess cervical cancer prevalence and associated mortality in Grenada, West Indies during 2000–2010. Methods Records of visits to hospital and clinical facilities were obtained from the histopathology laboratory of the Grenada General Hospital. Records were de-identified and electronically compiled. Cervical cancer prevalence was assessed via cross-sectional analysis of this secondary data. Of a total 12 012 records, 2 527 were selected for analysis using sampling without replacement. Cases were matched to corresponding patient data from death registries, where possible, and used to calculate associated mortality rates. Results The observed prevalence of cervical cancer was 52.4 per 100 000 women (ages 15 and above). The highest rates of cervical cancer occurred in the 35–44 age group, with the second highest among 45–64-year-olds. A total of 65 deaths were attributable to cervical cancer during 2000–2010, more than 50% of which were among women > 65 years old. The observed mortality rate was 16.7 per 100 000, almost twice the rate estimated by WHO for the region. Conclusions This study demonstrates the need for a comprehensive cervical cancer-screening program in Grenada. Results should contribute to informing future studies on how to appropriately generate and execute public health policy for education, screening, prevention, and control of cervical cancer in Grenada.

RESUMEN Objetivo Evaluar la prevalencia del cáncer cervicouterino y la mortalidad asociada en Granada, Antillas Menores, entre el 2000 y el 2010. Métodos Se obtuvieron los registros de las visitas al hospital y a consultorios clínicos a partir del laboratorio de histopatología del Hospital General de Granada. Se borraron los datos personales de los registros y se los compiló electrónicamente. La prevalencia de cáncer cervicouterino se evaluó por medio del análisis transversal de estos datos secundarios. De un total de 12 012 registros, fueron seleccionados para el análisis 2 527 mediante un método de muestreo sin reemplazo. Los casos se compararon con los datos correspondientes de pacientes en los registros de defunciones, cuando fue posible, y se usaron para calcular las tasas de mortalidad asociadas. Resultados La prevalencia observada de cáncer cervicouterino fue 52,4 por 100 000 mujeres (de 15 años o más). Las tasas más elevadas de cáncer cervicouterino se observaron en el grupo de edad de 35 a 44 años, seguido por el grupo de 45 a 64 años. Del 2000 al 2010, 65 defunciones fueron atribuibles al cáncer cervicouterino, más del 50% en mujeres mayores de 65 años. La tasa de mortalidad observada fue 16,7 por 100 000, casi el doble de la calculada por la Organización Mundial de la Salud para la región. Conclusiones Este estudio indica la necesidad de establecer un programa integral de detección del cáncer cervicouterino en Granada. Los resultados deben servir como base para estudios futuros sobre cómo generar y ejecutar apropiadamente políticas de salud pública para la educación en la materia, la detección, la prevención y el control del cáncer cervicouterino en Granada.

Incidence, risk factors and treatment of cervical stenosis after radical trachelectomy: A systematic review.

PURPOSE: Cervical stenosis is a major and specific postoperative complication following radical trachelectomy. The current article presents a review of studies describing the incidence, risk factors and treatment methods of cervical stenosis after this fertility sparing procedure. METHODS: We searched PubMed, MEDLINE, Embase (January 1994 through November 2014) using the following terms: uterine cervix neoplasms, cervical cancer, radical trachelectomy, fertility sparing and fertility preservation. We included original articles and case series. Case reports, review articles, articles not in English and articles not mentioning cervical stenosis were all excluded. RESULTS: We identified 1547 patients. The incidence rates of cervical stenosis ranged from 0% to 73.3% with an average rate of 10.5%. Among patients with abdominal, vaginal, laparoscopic and robotic radical trachelectomy, the incidences of cervical stenosis were 11.0%, 8.1%, 9.3% and 0%, respectively. In patients in whom whether cerclage was placed or not, the incidence rates of cervical stenosis were 8.6% and 3.0%, respectively (P=NS). Among those in whom whether anti-stenosis tools were placed or not, the incidences of cervical stenosis were 4.6% and 12.7%, respectively (P<0.001). Cervical stenosis was a potential cause of infertility and increased the use of artificial reproductive technology. Surgical dilatation resolved stenosis in the majority of cases but had to be repeated. CONCLUSIONS: Cervical stenosis is related to the surgical approach, cerclage and anti-stenosis tools utilised. It affects not only the quality of life but also obstetrical outcomes of patients following radical trachelectomy. Greater attention should be given to the prevention and treatment of this complication.

Rationale and design of a long term follow-up study of women who did and did not receive HPV 16/18 vaccination in Guanacaste, Costa Rica.

The Costa Rica Vaccine Trial (CVT) was a randomized clinical trial conducted between 2004 and 2010, which randomized 7466 women aged 18 to 25 to receive the bivalent HPV-16/18 vaccine or control Hepatitis-A vaccine. Participants were followed for 4 years with cross-over vaccination at the study end. In 2010 the long term follow-up (LTFU) study was initiated to evaluate the 10-year impact of HPV-16/18 vaccination, determinants of the immune response, and HPV natural history in a vaccinated population. Herein, the rationale, design and methods of the LTFU study are described, which actively follows CVT participants in the HPV-arm 6 additional years at biennial intervals (3 additional study visits for 10 years of total follow-up), or more often if clinically indicated. According to the initial commitment, women in the Hepatitis-A arm were offered HPV vaccination at cross-over; they were followed 2 additional years and exited from the study. 92% of eligible CVT women accepted participation in LTFU. To provide underlying rates of HPV acquisition and cervical disease among unvaccinated women to compare with the HPV-arm during LTFU, a new unvaccinated control group (UCG) of women who are beyond the age generally recommended for routine vaccination was enrolled, and will be followed by cervical cancer screening over 6 years. To form the UCG, 5000 women were selected from a local census, of whom 2836 women (61% of eligible women) agreed to participate. Over 90% of participants complied with an interview, blood and cervical specimen collection. Evaluation of comparability between the original (Hepatitis-A arm of CVT) and new (UCG) control groups showed that women's characteristics, as well as their predicted future risk for cervical HPV acquisition, were similar, thus validating use of the UCG. LTFU is poised to comprehensively address many important questions related to long-term effects of prophylactic HPV vaccines.

Reduction in HPV 16/18-associated high grade cervical lesions following HPV vaccine introduction in the United States - 2008-2012.

BACKGROUND: Prevention of pre-invasive cervical lesions is an important benefit of HPV vaccines, but demonstrating impact on these lesions is impeded by changes in cervical cancer screening. Monitoring vaccine-types associated with lesions can help distinguish vaccine impact from screening effects. We examined trends in prevalence of HPV 16/18 types detected in cervical intraepithelial neoplasia 2, 3, and adenocarcinoma in situ (CIN2+) among women diagnosed with CIN2+ from 2008 to 2012 by vaccination status. We estimated vaccine effectiveness against HPV 16/18-attributable CIN2+ among women who received ≥1 dose by increasing time intervals between date of first vaccination and the screening test that led to detection of CIN2+ lesion. METHODS: Data are from a population-based sentinel surveillance system to monitor HPV vaccine impact on type-specific CIN2+ among adult female residents of five catchment areas in California, Connecticut, New York, Oregon, and Tennessee. Vaccination and cervical cancer screening information was retrieved. Archived diagnostic specimens were obtained from reporting laboratories for HPV DNA typing. RESULTS: From 2008 to 2012, prevalence of HPV 16/18 in CIN2+ lesions statistically significantly decreased from 53.6% to 28.4% among women who received at least one dose (Ptrend<.001) but not among unvaccinated women (57.1% vs 52.5%; Ptrend=.08) or women with unknown vaccination status (55.0% vs 50.5%; Ptrend=.71). Estimated vaccine effectiveness for prevention of HPV 16/18-attributable CIN2+ was 21% (95% CI: 1-37), 49% (95% CI: 28-64), and 72% (95% CI: 45-86) in women who initiated vaccination 25-36 months, 37-48 months, and >48 months prior to the screening test that led to CIN2+ diagnosis. CONCLUSIONS: Population-based data from the United States indicate significant reductions in CIN2+ lesions attributable to types targeted by the vaccines and increasing HPV vaccine effectiveness with increasing interval between first vaccination and earliest detection of cervical disease.

The development of a brief jail-based cervical health promotion intervention.

The primary objective of this article was to describe the development and pilot implementation of a brief jail-based cervical health promotion intervention. The intervention was guided by a preliminary study of incarcerated women's cervical health knowledge, awareness, and health literacy, as well as a social and feminist approach to intervention development. We developed and conducted a pilot implementation of the Sexual Health Empowerment Project to increase cervical health knowledge, reduce barriers related to beliefs about cervical cancer, and improve self-efficacy and confidence in navigating health systems. This article offers a framework for how empirically and theory-based interventions are developed and tailored for a jail setting. Future work should include the evaluation of the long-term effects of such a disease-specific program on health behaviors and outcomes among high-risk and vulnerable groups of women as they leave jails and enter communities.

Oral human papillomavirus (HPV) prevalence in youth and cervical HPV prevalence in women attending a youth clinic in Sweden, a follow up-study 2013-2014 after gradual introduction of public HPV vaccination.

During 2009-2011, we reported that the oral and cervical prevalence of human papillomavirus (HPV) was high by international standards at 9.3% and 74%, respectively, in youth aged 15-23 years attending a youth clinic in Stockholm. After gradual introduction of public HPV vaccination during 2007-2012, between 2013 and 2014, when 73% of the women were HPV-vaccinated, but not necessarily before their sexual debut, oral HPV prevalence had dropped to 1.4% as compared with 9.3% in 2009-2011 (p < 0.00001). Cervical HPV prevalence was high and common cervical high-risk types were HPV51, 56, 59, 73, 16, 39, 52, and 53. However, it was shown that HPV16, 31, and 70 were significantly less common among HPV-vaccinated women than among those who had not received the vaccine.

Human papillomavirus vaccination: where are we now?

The development of efficacious prophylactic human papillomavirus vaccines provided an opportunity for the primary prevention of related infections and diseases. Certain oncogenic human papillomaviruses that preferentially infect the genital epithelium cause cervical cancer and a substantial proportion of anal, penile, vaginal, vulvar and oropharyngeal cancers. Following extensive clinical trials demonstrating their efficacy and safety, two vaccines have been in global use for over 6 years. This review summarises the accumulated evidence regarding their high level of efficacy, safety in population usage, reductions in genital warts, infections and cervical disease following their adoption, and facilitators and barriers to achieving high vaccination coverage. The review also discusses practical issues and frequently asked questions regarding duration of effect, vaccination of women treated for cervical disease and alternate vaccination schedules, as well as the need to review cervical screening strategies in the post- vaccination environment.

Two-dose strategies for human papillomavirus vaccination: how well do they need to protect?

BACKGROUND: Two-dose human papillomavirus (HPV) vaccine schedules may provide short-term protection but their long-term population impact is unknown. METHODS: Two models of HPV transmission and associated cervical disease (squamous and glandular, neoplasia and cancer) were fitted to data from England and Canada on HPV epidemiology, sexual behaviour, cervical screening outcomes and cervical cancer incidence. RESULTS: Models suggest that at 40-80% coverage, if two-dose schedules protect vaccinees for 20 years, then the benefits of the third dose are small. If two doses protect for 10 years, then the third dose may prevent as many cancers as the first two. At 80% coverage, numbers needed to receive a third dose to prevent an additional cancer are 5900-110,000 (England), 3000-5100 (Canada) with 20 years two-dose protection, and 2000-5300 (England), 760-950 (Canada) with 10 years two-dose protection. CONCLUSION: Results enable decision makers to quantify risks associated with two-dose schedules despite remaining uncertainties in vaccine duration and cross-protection.

Effectiveness of quadrivalent human papillomavirus vaccine for the prevention of cervical abnormalities: case-control study nested within a population based screening programme in Australia.

OBJECTIVE: To measure the effectiveness of the quadrivalent human papillomavirus (HPV) vaccine against cervical abnormalities four years after implementation of a nationally funded vaccination programme in Queensland, Australia. DESIGN: Case-control analysis of linked administrative health datasets. SETTING: Queensland, Australia. PARTICIPANTS: Women eligible for free vaccination (aged 12-26 years in 2007) and attending for their first cervical smear test between April 2007 and March 2011. High grade cases were women with histologically confirmed high grade cervical abnormalities (n = 1062) and "other cases" were women with any other abnormality at cytology or histology (n = 10,887). Controls were women with normal cytology (n = 96,404). MAIN OUTCOME MEASURES: Exposure odds ratio (ratio of odds of antecedent vaccination (one, two, or three vaccine doses compared with no doses) among cases compared with controls), vaccine effectiveness ((1-adjusted odds ratio) × 100), and number needed to vaccinate to prevent one cervical abnormality at first screening round. We stratified by four age groups adjusted for follow-up time, year of birth, and measures of socioeconomic status and remoteness. The primary analysis concerned women whose first ever smear test defined their status as a case or a control. RESULTS: The adjusted odds ratio for exposure to three doses of HPV vaccine compared with no vaccine was 0.54 (95% confidence interval 0.43 to 0.67) for high grade cases and 0.66 (0.62 to 0.70) for other cases compared with controls with normal cytology, equating to vaccine effectiveness of 46% and 34%, respectively. The adjusted numbers needed to vaccinate were 125 (95% confidence interval 97 to 174) and 22 (19 to 25), respectively. The adjusted exposure odds ratios for two vaccine doses were 0.79 (95% confidence interval 0.64 to 0.98) for high grade cases and 0.79 (0.74 to 0.85) for other cases, equating to vaccine effectiveness of 21%. CONCLUSION: The quadrivalent HPV vaccine conferred statistically significant protection against cervical abnormalities in young women who had not started screening before the implementation of the vaccination programme in Queensland, Australia.

Incidence of genital warts in adolescents and young adults in an integrated health care delivery system in the United States before human papillomavirus vaccine recommendations.

BACKGROUND: Information on genital wart incidence in adolescents and young adults before human papillomavirus (HPV) vaccination is important for understanding the impact of the vaccine on the epidemiology of this early outcome of HPV infection. METHODS: The study population included 11- to 29-year-old enrollees of Northern California Kaiser Permanente between July 1, 2000, and July 1, 2005, before the availability of the HPV vaccine. We identified genital warts with an algorithm combining genital wart-specific International Classification of Diseases, Ninth Revision, Clinical Modification codes (078.10, 078.11, and 078.19) with physician-recorded anatomic locations. We calculated sex- and age-specific incidence rates of genital warts and described the specific anatomic location of presentation, as well as recurrences of genital warts. RESULTS: We identified 1,682 cases of genital warts among 181,264 individuals. The incidence rate was highest among women (6.3/1000 person-years) and men (2.9/1000 person-years) aged 20 to 24 years old. Among women (n = 96,792), 63.4% of the 1240 incident genital wart cases occurred on the vulva and 21.1% on the cervix. Among men (n = 84,472), 91.6% of the 442 incident genital wart cases did not have a specific anatomic location recorded. Most people with an incident genital wart diagnosis (87.2%) did not have a recurrence during the observation period. CONCLUSIONS: Our study found that the incidence of genital warts was highest among persons aged 20 to 24 years using a unique method to identify the location of the wart. Information on incidence of genital warts before vaccine use provides baseline data that can be used to measure HPV vaccine impact.