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Monitoring effect of HPV vaccines remains difficult
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Researchers face unique challenges, such as a lack of consistent surveillance data and deficits in knowledge about long-term outcomes, when assessing the effect of human papillomavirus vaccines on infection prevention, according to a speaker at the 44th National Immunization Conference.
“Measuring vaccine impact provides important information to policymakers and stakeholders to show the vaccine is effective, and this is even more important in a setting where there is an exclusive vaccine and a vaccine that requires more than one visit,” Eileen Dunne, MD, MPH, of the CDC, said during the presentation. “These data can also provide support for the sustainability of the vaccine program and important resources for personnel infrastructure and answer questions about implementation.”
Dunne noted that evaluating vaccine efficacy requires consistent surveillance data collected through standardized methods on long-term outcomes, but researchers confront major obstacles in acquiring this information for HPV vaccines.
“Many outcomes, such as the development of disease, precancers and cancers resulting from HPV, take a long time to develop from initial infection and may not appear until years to decades later,” Dunne said.
Dunne also said substantial monitoring systems are crucial to measuring disease outcomes.
Furthermore, many disease outcomes associated with HPV are dependent on cervical cancer screenings. The rapidly evolving technologies and methods used in this process may change over time and create potential discrepancies in data collection. Registries for screened populations also do not exist, according to Dunne.
Dunne highlighted the need for research into type-specific HPV prevalence in different outcomes and offered a brief overview of current and future research in this area.
“We’re looking at this through the National Health and Nutrition Examination Survey, and we’re also looking at this through a special study involving Pap specimens collected during cervical cancer screenings,” Dunne said. “We also have a network of STD clinics that will be able to collect information on genital warts over time, and new sentinel projects will examine cervical precancers and collect specimens for HPV typing.
“We will also be fortunate to have registries for HPV–associated cancers in the United States that will provide important information on HPV–related cancers. And on special sites, there may be HPV typing of those cancers.”
Dunne also cited existing surveillance structures, including the HPV-IMPACT monitoring project and the CDC’s Vaccine Safety Datalink, as important resources for supplying researchers with meaningful information.
Case reporting, case ascertainment and inconsistent terminology and coding are problems that need to be overcome, according to Dunne, but success with HPV vaccine programs in countries such as Australia suggests the positive potential for similar results in the United States. – by Melissa Foster
Dunne E. #23177. Presented at: 44th National Immunization Conference; April 19-22, 2010; Atlanta.