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Vaccination program leads to decline in high-risk HPV in England
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Eight years after a national HPV vaccination program was introduced in the United Kingdom, researchers documented substantial declines in the prevalence of some high-risk types of HPV in England, including the two that cause most cervical cancers, according to study results published in the Journal of Infectious Diseases.
The national program introduced in 2008 offered routine HPV vaccination to adolescents aged 12 to 13 years and catch-up vaccination to girls up to age 18 years, David Mesher, MSc, senior scientist at Public Health England, and colleagues noted.
“The U.K. national program initially used the bivalent HPV vaccine (Cervarix, GlaxoSmithKline) with high efficacy against high-risk types HPV16 and HPV18, which have been shown to be responsible for around 70% of cervical cancers worldwide and around 80% of cancers in the U.K.,” they wrote. “In 2012, the U.K. program changed to use the quadrivalent vaccine (Gardasil, Merck), which additionally offers high efficacy against low-risk types HPV6 and HPV11, which cause the majority of genital warts.”
For their study, the researchers collected residual vulva-vaginal swab specimens from women aged 16 to 24 years who were screened for chlamydia at general practices, community and sexual health services or youth clinics between 2010 and 2016. The samples were tested for HPV DNA.
Mesher and colleagues calculated HPV prevalence for three age groups (16-18 years, 19-21 years and 22-24 years), and prevalence ratios comparing HPV prevalence in vaccinated compared with unvaccinated women.
The analysis included 15,459 specimens. There was a decrease in prevalence of HPV types 16 and 18 from 8.2% to 1.6% in females aged 16 to 18 years and from 14% to 1.6% in women aged 19 to 21 years between 2010-2011 and 2016. There also was a decline in HPV types 31, 33 and 45 from 6.5% to 0.6% for females aged 16 to 18 years and from 8.6% to 2.6% for those aged 19 to 21 years.
The vaccine was 82% effective for HPV types 16 and 18 (95% CI, 60.6%-91.8%) and 48.7% effective for HPV types 31, 33 and 45 (95% CI, 20.8%-66.8%).
Mesher and colleagues also were encouraged by evidence showing “substantial” herd protection from the vaccination campaign. In unvaccinated women aged 16 to 21 years, there was a reduction in the prevalence of HPV types 16 or 18 from 15.9% in 2010-2011 to 6.9% in 2014-2016 (P = .013).
“Among ages offered HPV vaccination, we have demonstrated clear reductions in infections with the HPV vaccine types since the introduction of the HPV vaccination program in England, with greater reductions in younger women (with higher vaccination coverage and vaccinated at a younger age),” the researchers wrote. – by Bruce Thiel
Disclosures: Mesher reports financial support to his institution from GlaxoSmithKline for reports on HPV surveillance. Please see the study for all other authors’ relevant financial disclosures.
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