BACKGROUND AND PURPOSE:

• Data through 2016 demonstrates decreased HPV prevalence following introduction of the HPV vaccine
  • 2006: Introduction of the quadrivalent vaccine (4vHPV)
  • 2015: Five additional types of HPV were targeted with the nine valent vaccine (9vHPV)
• Rosenblum et al. (MMWR, 2021) provide the latest update on HPV prevalence among females through 2018

METHODS:

• Cross-sectional survey
  • National Health and Nutrition Examination Survey (NHANES)
• Population
  • Females aged 14 to 38 years
• Exposure
  • Self- or parent-reported vaccination history
• Study design
  • Data on HPV prevalence were analyzed in 4-year periods
    • Pre-vaccine: 2003-2006
    • Post-vaccine: 2007 to 2010 | 2011 to 2014 | 2015 to 2018
  • Age groups: 14 to 19 | 20 to 24 | 25 to 29 | 30 to 34 years
  • Prevalence ratios (PRs) and adjusted prevalence ratios (aPRs) were calculated to compare time periods
• Primary outcome
  • HPV prevalence, based on type
    • 4vHPV types
    • Five additional 9vHPV types
    • Non-4vHPV types
    • Non-9vHPV types

RESULTS:

Age 14 to 19 Years

• From 2003 to 2006 to 2015 to 2018, prevalence of 4vHPV-type infection decreased 88%
  • 2003 to 2006: 11.5%
  • 2015 to 2018: 1.1%
  • aPR 0.12 (95% CI, 0.06 to 0.26)
• The prevalence of five additional 9vHPV types in this age group decreased 65%
  • 2003 to 2006: 8.4%
  • 2015 to 2018: 2.3%
  • aPR 0.35 (95% CI, 0.18 to 0.65)

Age 20 to 24 years

• 4vHPV types decreased 81%
  • 2003 to 2006: 8.5%
  • 2015 to 2018: 3.3%
  • aPR 0.19 (95% CI, 0.09 to 0.40)
• However, prevalence of the 5 additional 9vHPV types did not significantly decline in this age group

Age >24 years

• Among females in older age groups, there was no statistically significant differences in the prevalence of 4vHPV or the five additional 9vHPV types between 2003 to 2006 to 2015 to 2018

Analysis Based on Vaccination

• 4vHPV-type prevalence decreased in both vaccinated and unvaccinated individuals (sexually experienced)
  • ≥1 HPV vaccine dose
    • 14 to 19 years: 97% prevalence decrease
    • 20 to 24 years: 86% prevalence decrease
  • No vaccination
    • 14 to 19 years: 87% prevalence decrease
    • 20 to 24 years:  65% prevalence decrease

CONCLUSION:

• In this 2018 update, HPV vaccine continues to impact the prevalence of 4vHPV types in the US
• Incidence of 4vHPV types has declined in unvaccinated individuals aged 14 to 19 and 20 to 24
• The authors conclude

Significant declines among unvaccinated females suggest herd effects

HPV vaccination is a critical prevention tool against HPV infection, anogenital warts, and HPV-attributable precancers and cancers

HPV vaccination is highly effective and is recommended routinely at age 11 to 12 years and through 26 years for persons not already vaccinated

Learn More – Primary Sources:

Declines in Prevalence of Human Papillomavirus Vaccine-Type Infection Among Females after Introduction of Vaccine — United States, 2003–2018

Related ObG Topics:

HPV Vaccines: Cochrane Reviews Looks at the Evidence with Multi-Year Follow-Up

HPV Vaccine and Maternal and Infant Outcomes

The HPV Vaccine Leads to a Reduction in Cervical Precancers in Young Women in the U.S.