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Int J Cancer. 2018 Jun 15;142(12):2491-2500. doi: 10.1002/ijc.31281. Epub 2018 Feb 12.

Evaluation of HPV type-replacement in unvaccinated and vaccinated adolescent females-Post-hoc analysis of a community-randomized clinical trial (II).

Author information

1
Faculty of Social Sciences, University of Tampere, Tampere, Finland.
2
Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.
3
VL Medi, Helsinki, Finland.
4
Takeda Pharmaceuticals International, Switzerland.
5
Gates Foundation, Seattle, WA.
6
Department of Vaccines, Institute for Health and Welfare, Laskut, Finland.
7
Catalan Institute of Oncology, IDIBELL, Barcelona, Spain.
8
Department of Clinical Microbiology, Skåne University Hospital, Lund, Sweden.
9
Department of Obstetrics and Gynaecology, University of Helsinki, Helsinki, Finland.

Abstract

Efficacy of human papillomavirus (HPV) vaccines promises to control HPV infections. However, HPV vaccination programs may lay bare an ecological niche for non-vaccine HPV types. We evaluated type-replacement by HPV type and vaccination strategy in a community-randomized trial executed in HPV vaccination naïve population. Thirty-three communities were randomized to gender-neutral vaccination with AS04-adjuvanted HPV16/18 vaccine (Arm A), HPV vaccination of girls and hepatitis B-virus (HBV) vaccination of boys (Arm B) and gender-neutral HBV vaccination (Arm C). Resident 1992-95 born boys (40,852) and girls (39,420) were invited. 11,662 boys and 20,513 girls were vaccinated with 20-30% and 45-48% coverage, respectively. HPV typing of 11,396 cervicovaginal samples was performed by high throughput PCR. Prevalence ratios (PR) between arms and ranked order of HPV types and odds ratio (OR) for having multiple HPV types in HPV16 or 18/45 positive individuals were calculated. The ranked order of HPV types did not significantly differ between arms or birth cohorts. For the non-HPV vaccinated 1992-1993 birth cohorts increased PR, between the gender-neutral intervention versus control arms for HPV39 (PRA 1.84, 95% CI 1.12-3.02) and HPV51 (PRA 1.56, 95% CI 1.11-2.19) were observed. In the gender-neutral arm, increased clustering between HPV39 and the vaccine-covered HPV types 16 or 18/45 (ORA16  = 5.1, ORA18/45  = 11.4) was observed in the non-HPV vaccinated 1994-1995 birth cohorts. Comparable clustering was seen between HPV51 and HPV16 or HPV18/45 (ORB16  = 4.7, ORB18/45  = 4.3), in the girls-only arm. In conclusion, definitively consistent postvaccination patterns of HPV type-replacement were not observed. Future occurrence of HPV39 and HPV51 warrant investigation.

KEYWORDS:

HPV; randomized trial; type replacement; vaccination

PMID:
29377141
DOI:
10.1002/ijc.31281

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