Long-term Impact of Human Papillomavirus Vaccination on Infection Rates, Cervical Abnormalities, and Cancer Incidence

被引:51
作者
Bogaards, Johannes A. [1 ,2 ]
Coupe, Veerle M. H. [1 ]
Xiridou, Maria [2 ]
Meijer, Chris J. L. M. [3 ]
Wallinga, Jacco [2 ,4 ]
Berkhof, Johannes [1 ]
机构
[1] Vrije Univ Amsterdam Med Ctr, Dept Epidemiol & Biostat, NL-1007 MB Amsterdam, Netherlands
[2] Natl Inst Publ Hlth & Environm, Ctr Infect Dis Control, NL-3720 BA Bilthoven, Netherlands
[3] Vrije Univ Amsterdam Med Ctr, Dept Pathol, NL-1007 MB Amsterdam, Netherlands
[4] Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands
关键词
COST-EFFECTIVENESS ANALYSIS; INTRAEPITHELIAL NEOPLASIA; HPV16/18; VACCINATION; NATURAL-HISTORY; HPV VACCINATION; MODEL; WOMEN; RISK; EPIDEMIOLOGY; ACQUISITION;
D O I
10.1097/EDE.0b013e31821d107b
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background: Vaccination against human papillomavirus (HPV) types 16/18 is being implemented in many countries. There may be indirect benefit of HPV vaccination to nonvaccinated women, who may experience a reduced risk of infection with vaccine-preventable types (herd immunity). We attempt to disentangle the direct and indirect effects of HPV vaccination, while accounting for 14 oncogenic HPV types in a dynamic modeling framework. Methods: On the basis of vaccine uptake among preadolescent girls in the Netherlands, we calculated how heterosexual transmission of HPV-16/18 is expected to change as a result of vaccination, and used these predictions in an individual-based simulation model of cervical carcinogenesis that considers 14 high-risk HPV types. Models were parameterized to match prevaccine data on type-specific HPV infection and cervical disease. Results: At 50% vaccine coverage, the estimated lifetime infection risk in nonvaccinated women dropped from 0.69 (95% credible interval = 0.50-0.85) to 0.49 (0.32-0.68) for HPV-16, and from 0.68 (0.46-0.79) to 0.43 (0.26-0.57) for HPV-18. For the whole population, we calculated an eventual 47% reduction in cervical cancer incidence, with 1 in 4 cases prevented among nonvaccinated women. The number of indirectly averted cancer cases was highest with vaccine coverage between 50% and 70%, approximating 70 cases per 100,000 women born from 2010 onward. Conclusions: HPV-16/18 vaccination of preadolescent girls will markedly lower infection rates among nonvaccinated women. Reduced transmission of vaccine-preventable HPV becomes a prominent aspect of cervical cancer control, especially in populations with moderate vaccine coverage.
引用
收藏
页码:505 / 515
页数:11
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