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Grand Rounds

Effects of HPV Vaccination Programs: The Latest Updated Meta-Analysis

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BACKGROUND AND PURPOSE:

  • Drolet et al. (The Lancet, 2019) have updated and quantified the impact of multiple age-cohort HPV vaccination

METHODS:

  • Updated systematic review and meta-analysis
  •  Population-level impacts of vaccination on following endpoints
    • Genital HPV infections
    • CIN2+
  • Time parameters
    • Publications on the topic between Feb 1, 2014, and Oct 11, 2018
  • Inclusion criteria
    • Pre and post vaccination frequency (prevalence or incidence) comparisons of ≥1 HPV-related endpoint
    • Same population sources and recruitment methods before and after vaccination
  • Data analysis
    • Relative risk (RR) compared the frequency of HPV-related endpoints between the pre-vaccination and post-vaccination periods
    • Analyses were stratified by: Sex | Age | Years since introduction of HPV vaccination

RESULTS:

  • 65 articles in 14 high-income countries
    • 23 for HPV infection | 29 for anogenital warts | 13 for CIN2+
    • >60 million individuals over 8 years (2007-2015)

After 5–8 years of vaccination – among females

  • HPV 16 and 18: Prevalence decreased significantly
    • 13-19 years: 83% reduction (RR 0.17, 95% CI, 0.11–0.25)
    • 20-24 years: 66% reduction (RR 0.34, 95% CI, 0.23–0.49)
  • HPV 31, 33, and 45: Prevalence decreased significantly
    • 13–19 years: 54% reduction (RR 0.46, 95% CI, 0.33–0.66)
  • Anogenital warts: Diagnoses decreased significantly
    • 15–19 years:  67% reduction (RR 0.33, 95% CI, 0.24–0.46)
    • 20–24 years: 54% reduction (RR 0.46, 95% CI, 0.36–0.60)
    • 25–29 years: 31% reduction (RR 0.69, 95% CI, 0.53–0.89)

After 5–8 years of vaccination – among males

  • Anogenital warts: Diagnoses decreased significantly
    • 15-19 years: 48% reduction (RR 0.52, 95% CI, 0.37–0.75)
    • 20-24 years: 32% reduction (RR 0.68, 95% CI, 0.47–0.98)
  • After 5–9 years of vaccination, CIN2+ decreased significantly
    • 15–19 years: 51% reduction (RR 0.49, 95% CI, 0.42–0.58)
    • 20–24 years: 31% reduction (RR 0.69, 95% CI, 0.57–0.84)
    • For the first 5 years following vaccination, significant decrease in CIN2+ was noted only in the screened girls (15-19 years)
  • Multi-cohort programs with high HPV vaccination coverage had a greater direct impact and herd effects

CONCLUSION:

  • Evidence shows considerable beneficial impact of HPV vaccination on
    • HPV infections and CIN2+ among girls and women
    • anogenital warts diagnoses among girls, women, boys, and men

Learn More – Primary Sources:

Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis

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Related ObG Topics:

HPV Vaccine Recommendations Including Guidance for Ages 27 to 45
HPV Vaccines: Cochrane Reviews Looks at the Evidence with Multi-Year Follow-Up
HPV Testing vs PAP Smear: Results of the HPV FOCAL Trial
The HPV Vaccine Leads to a Reduction in Cervical Precancers in Young Women in the U.S.

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