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Lancet Public Health. 2016 Nov;1(1):e8-e17. doi: 10.1016/S2468-2667(16)30001-9. Epub 2016 Sep 27.

Population-level impact, herd immunity, and elimination after human papillomavirus vaccination: a systematic review and meta-analysis of predictions from transmission-dynamic models.

Author information

1
Centre de recherche du CHU de Québec-Université Laval, Quebec City, QC, Canada; Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada; Department of Infectious Disease Epidemiology, Imperial College, London, UK. Electronic address: marc.brisson@crchudequebec.ulaval.ca.
2
Centre de recherche du CHU de Québec-Université Laval, Quebec City, QC, Canada; Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada.
3
Centre de recherche du CHU de Québec-Université Laval, Quebec City, QC, Canada.
4
Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, Netherlands.
5
Infection and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France.
6
Vaccination Programme Unit, National Institute for Health and Welfare, Helsinki, Finland.
7
Modelling and Economics Unit, Public Health England, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
8
Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada; Department of Infectious Disease Epidemiology, Imperial College, London, UK.
9
Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia.
10
Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands.
11
Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; Lowy Cancer Research Centre, Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia.
12
Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
13
Center for Health Decision Science, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
14
National Infection Service, Public Health England, London, UK.
15
Oslo Centre for Biostatistics and Epidemiology, Division of Infectious Disease Control, Norwegian Institute of Public Health and Oslo Centre for Statistics and Epidemiology, Oslo, Norway; Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
16
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
17
Fondazione Bruno Kessler, Trento, Italy.
18
Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
19
Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research, Braunschweig, Germany.
20
Section for Geography, Department of Geosciences and Natural Resource Management, University of Copenhagen, Copenhagen, Denmark.
21
Center for Health Decision Science, Harvard T H Chan School of Public Health, Boston, MA, USA.
22
Infection and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France; Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin, Turin, Italy.
23
Merck Research Laboratories, Rahway, NJ, USA.
24
Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.
25
Department of Infectious Disease Epidemiology, Imperial College, London, UK.
26
National Centre for Pharmacoeconomics (NCPE Ireland), Dublin, Ireland.
27
Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland.

Abstract

BACKGROUND:

Modelling studies have been widely used to inform human papillomavirus (HPV) vaccination policy decisions; however, many models exist and it is not known whether they produce consistent predictions of population-level effectiveness and herd effects. We did a systematic review and meta-analysis of model predictions of the long-term population-level effectiveness of vaccination against HPV 16, 18, 6, and 11 infection in women and men, to examine the variability in predicted herd effects, incremental benefit of vaccinating boys, and potential for HPV-vaccine-type elimination.

METHODS:

We searched MEDLINE and Embase for transmission-dynamic modelling studies published between Jan 1, 2009, and April 28, 2015, that predicted the population-level impact of vaccination on HPV 6, 11, 16, and 18 infections in high-income countries. We contacted authors to determine whether they were willing to produce new predictions for standardised scenarios. Strategies investigated were girls-only vaccination and girls and boys vaccination at age 12 years. Base-case vaccine characteristics were 100% efficacy and lifetime protection. We did sensitivity analyses by varying vaccination coverage, vaccine efficacy, and duration of protection. For all scenarios we pooled model predictions of relative reductions in HPV prevalence (RRprev) over time after vaccination and summarised results using the median and 10th and 90th percentiles (80% uncertainty intervals [UI]).

FINDINGS:

16 of 19 eligible models from ten high-income countries provided predictions. Under base-case assumptions, 40% vaccination coverage and girls-only vaccination, the RRprev of HPV 16 among women and men was 0·53 (80% UI 0·46-0·68) and 0·36 (0·28-0·61), respectively, after 70 years. With 80% girls-only vaccination coverage, the RRprev of HPV 16 among women and men was 0·93 (0·90-1·00) and 0·83 (0·75-1·00), respectively. Vaccinating boys in addition to girls increased the RRprev of HPV 16 among women and men by 0·18 (0·13-0·32) and 0·35 (0·27-0·39) for 40% coverage, and 0·07 (0·00-0·10) and 0·16 (0·01-0·25) for 80% coverage, respectively. The RRprev were greater for HPV 6, 11, and 18 than for HPV 16 for all scenarios investigated. Finally at 80% coverage, most models predicted that girls and boys vaccination would eliminate HPV 6, 11, 16, and 18, with a median RRprev of 1·00 for women and men for all four HPV types. Variability in pooled findings was low, but increased with lower vaccination coverage and shorter vaccine protection (from lifetime to 20 years).

INTERPRETATION:

Although HPV models differ in structure, data used for calibration, and settings, our population-level predictions were generally concordant and suggest that strong herd effects are expected from vaccinating girls only, even with coverage as low as 20%. Elimination of HPV 16, 18, 6, and 11 is possible if 80% coverage in girls and boys is reached and if high vaccine efficacy is maintained over time.

FUNDING:

Canadian Institutes of Health Research.

Comment in

PMID:
29253379
DOI:
10.1016/S2468-2667(16)30001-9
[Indexed for MEDLINE]
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