Abstract
Study Objective
Evidence suggests that vaccine-type human papillomavirus (HPV) prevalence may decrease
in unvaccinated women after HPV vaccine introduction, indicating herd protection.
The aim of this study was to determine factors associated with vaccine-type HPV (i.e.
absence of herd protection) after vaccine introduction.
Design
We conducted three cross-sectional studies from 2006-2014 (n = 1180): wave 1 (2006-2007),
wave 2 (2009-2010), and wave 3 (2013-2014).
Setting
Participants were recruited from a hospital-based teen health center and a community
health department.
Participants
We recruited 13-26 year-old young women; those included in this analysis had not received
an HPV vaccine.
Interventions and Main Outcome Measures
The outcome measure was infection with at least one vaccine-type HPV (HPV6, 11, 16,
18).
Results
Multivariable logistic regression demonstrated that in wave 1 (before vaccine introduction),
history of anal intercourse (OR = 1.8, 95% CI = 1.1-3.0), age 18-21 vs 13-17 years
(OR = 2.1, CI = 1.2-3.6), and Black/multiracial vs White race (OR = 1.8, CI = 1.1-3.0)
were associated with vaccine-type HPV in unvaccinated women. In wave 2, no variables
were associated with HPV. In wave 3, sexually transmitted infection history (OR = 3.6,
CI = 1.3-9.7) was associated with HPV.
Conclusion
We did not identify a consistent set of modifiable risk factors associated with vaccine-type
HPV after vaccine introduction across the three study waves, underscoring the urgency
of vaccination for primary HPV prevention and the limitations of relying on herd protection.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric and Adolescent GynecologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Global burden of human papillomavirus and related diseases.Vaccine. 2012; 30: F12
- Prophylactic HPV vaccination: past, present, and future.Epidemiol Infect. 2016; 144: 449
- Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study.Lancet Oncol. 2010; 11: 1048
- Population-level impact and herd effects following human papillomavirus vaccination programmes: a systematic review and meta-analysis.Lancet Infect Dis. 2015; 15: 565
- Substantial decline in vaccine-type human papillomavirus (HPV) among vaccinated young women during the first 8 years after HPV vaccine introduction in a community.Clin Infect Dis. 2016; 63: 1281
- Human papillomavirus (HPV) in young women in Britain: population-based evidence of the effectiveness of the bivalent immunisation programme and burden of quadrivalent and 9-valent vaccine types.Papillomavirus Res. 2017; 3: 36
- Early effects of human papillomavirus vaccination in Belgium.Eur J Cancer Prev. 2015; 24: 340
- Surveillance of effects of HPV vaccination in Belgium.Cancer Epidemiol. 2016; 41: 152
- Assessment of herd immunity and cross-protection after a human papillomavirus vaccination programme in Australia: a repeat cross-sectional study.Lancet Infect Dis. 2014; 14: 958
- Human papillomavirus prevalence and herd immunity after introduction of vaccination program, Scotland, 2009-2013.Emerg Infect Dis. 2016; 22: 56
- Quadrivalent vaccine-targeted human papillomavirus genotypes in heterosexual men after the Australian female human papillomavirus vaccination programme: a retrospective observational study.Lancet Infect Dis. 2017; 17: 68
- Standaert B: Dissecting the indirect effects caused by vaccines into the basic elements.Hum Vaccin Immunother. 2015; 11: 2142
- Prevalence of HPV after introduction of the vaccination program in the United States.Pediatrics. 2016; 137: 1
- Patterns of sexual mixing with respect to social, health and sexual characteristics among heterosexual couples in England: analyses of probability sample survey data.Epidemiol Infect. 2015; 143: 1500
- Vaccine-type human papillomavirus and evidence of herd protection after vaccine introduction.Pediatrics. 2012; 130: e249
- Improved amplification of genital human papillomaviruses.J Clin Microbiol. 2000; 38: 357
- Epidemiologic profile of type-specific human papillomavirus infection and cervical neoplasia in Guanacaste, Costa Rica.J Infect Dis. 2005; 191: 1796
- Prevalence of HPV infection among females in the United States.JAMA. 2007; 297: 813
- Epidemiology and risk factors for human papillomavirus infection in a diverse sample of low-income young women.J Clin Virol. 2009; 46: 107
- Prevalence of genital human papillomavirus among females in the United States, the National Health and Nutrition Examination Survey, 2003-2006.J Infect Dis. 2011; 204: 566
- Racial and ethnic differences in human papillomavirus positivity and risk factors among low-income women in Federally Qualified Health Centers in the United States.Prev Med. 2015; 81: 258
- Cervical, anal and oral HPV in an adolescent inner-city health clinic providing free vaccinations.PLoS One. 2012; 7: e37419
Article info
Publication history
Published online: September 21, 2017
Footnotes
Dr Kahn has cochaired 2 National Institutes of Health-funded human papillomavirus (HPV) vaccine clinical trials in HIV-infected individuals, for which Merck & Co, Inc, provided vaccine and immunogenicity titers. Dr Franco has served as occasional advisor to companies involved with HPV vaccination (Merck, GlaxoSmithKline) and HPV and cervical cancer diagnostics (Roche, Becton Dickinson, Qiagen). His institution has received unconditional funding from Merck for investigator-initiated studies carried out in his unit. The remaining authors indicate no conflicts of interest.
Ms Smith is now at North Carolina State University.
Identification
Copyright
© 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.
