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Clin Infect Dis. 2018 Dec 22. doi: 10.1093/cid/ciy1081. [Epub ahead of print]

Human papillomavirus (HPV) vaccine effectiveness and potential herd immunity for reducing oncogenic oropharyngeal HPV16 prevalence in the UK; a cross-sectional study.

Author information

The Institute of Head & Neck Studies and Education, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, USA.
Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK.
Senior Epidemiologist and Statistician, Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
Clinical Research Fellow and Specialty Registrar in Otolaryngology, Head and Neck Surgery.
DDL Diagnostic Laboratory, Rijswijk, The Netherlands.
Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
Clinical and Epidemiology Research Development, GSK, Wavre, Belgium.



Oropharyngeal cancer incidence is rapidly rising due to human papillomavirus (HPV) 16 infection. The dearth of data on effectiveness of national girl-only vaccination program in preventing oral HPV infection and the potential herd immunity effect on unvaccinated boys has resulted in considerable controversy regarding the need to vaccinate boys, especially in countries with high vaccination coverage of girls.


Subjects aged 0-65 years undergoing tonsillectomy for non-malignant indications were recruited in 6 UK hospitals. Oral samples were collected in following order: oral rinse, tongue base and pharyngeal wall brushes, then tonsil tissue (tonsillectomy). Vaccination data was obtained from regional health authorities. All samples were centrally tested for HPV-DNA by PCR amplification. (NCT01330147).


Of 940 subjects, 243 girls and 69 boys were aged 12-24; median age 18.6 years. 189 (78%) girls and no boys received HPV vaccination. Overall, oropharyngeal-HPV16 prevalence in vaccinated girls was significantly lower than unvaccinated girls (0.5% vs 5.6%, p=0.04). In contrast, prevalence of any oropharyngeal-HPV type was similar in vaccinated and unvaccinated girls (19% vs 20%, p=0.76). Oropharyngeal-HPV16 prevalence in (unvaccinated) boys was similar to vaccinated girls (0% vs 0.5%, p>0.99), and lower than unvaccinated girls (0% vs 5.6%, p=0.08).


Our findings indicate that the UK girl-only national vaccination program is associated with significant reductions in oropharyngeal-HPV16 infections in children and young adults. This is also the first data to suggest potential herd immunity from girl-only vaccination against oropharyngeal HPV infection in contemporaneously-aged boys.


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