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HPV vaccine effective for low-income minority females
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Recent findings published in JAMA Pediatrics indicated that the quadrivalent HPV vaccine was effective for low-income, high-risk minority females.
“This study provides crucial information about the HPV vaccine in minority populations and females engaging in high-risk sexual behaviors who arguably were underrepresented in the HPV vaccine clinical trials and post-licensure studies, yet are at increased risk for cervical cancer,” Annika M. Hofstetter, MD, PhD, in the department of pediatrics at the University of Washington, and colleagues wrote. “These real-world findings, which complement existing HPV vaccine efficacy/effectiveness data, could also have implications for the HPV vaccination recommendations with respect to timing and number of doses, including for the recently licensed nonavalent HPV vaccine.”
HPV is the most prevalent sexually transmitted infection in the United States and may disproportionately affect low-income minority females, the researchers wrote. However, only 30% of participants in three vaccine clinical trials were minorities. In addition, these trials excluded participants with prior confirmed HPV or who had more than four lifetime sexual partners.
To examine the effectiveness of the quadrivalent HPV vaccine in minority females, the researchers performed a retrospective cohort study of 4,127 females aged 11 to 20 years between 2007 and 2014 at 16 community clinics, which served a low-income minority population. To assess HPV vaccine effectiveness, the researchers looked for cervical cytology abnormalities, which they defined as atypical glandular cells, atypical squamous cells, low-grade squamous intraepithelial lesions, and high-grade squamous epithelial lesions. More than 58% of the patients were Spanish-speaking, and 92.1% were publicly insured.
The researchers found the risk for abnormal cervical cytology was 36% lower among vaccinated females than in unvaccinated females (HR = 0.64; 95% CI, 0.57-0.73), especially after the three-dose series was completed (HR = 0.48; CI, 0.41-0.56) or if the vaccine was administered when the patients were aged 11 to 14 years for at least one dose (HR = 0.36; 95% CI, 0.16-0.79) and for completion of all three doses (HR = 0.27; 95% CI, 0.12-0.63). Hofstetter and colleagues confirmed their findings after adjusting for demographics, clinic type, abnormal baseline cervical cytology result, and baseline chlamydia screening.
The risk for abnormal cytology was lowest when the vaccine was administered to patients aged 11 to 14 years, the researchers wrote.
“These findings, coupled with our understanding of health care use patterns, lend support to existing Advisory Committee on Immunization Practices recommendations targeting HPV vaccination initiation among those aged 11 through 12 years,” Hofstetter and colleagues concluded. – by Will Offit
Disclosure: Hofstetter reports receiving support for a separate investigator-initiated study from the Pfizer Medical Education Group.
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