Different Challenges in Eliminating HPV16 Compared to Other Types: A Modeling Study. (5th July 2017)

• Record Type: Journal Article
• Authors: Baussano, Iacopo; Lazzarato, Fulvio; Ronco, Guglielmo; Lehtinen, Matti; Dillner, Joakim; Franceschi, Silvia
• Is Part Of: Journal of infectious diseases. Volume 216:Number 3(2017:Aug. 01)
• Page Start: 336
• Page End: 344
• Publication Date: 2017-07-05
• Subjects: herd effect -- HPV vaccination -- cross-protection -- cervical cancer control; Communicable diseases -- Periodicals; Diseases -- Causes and theories of causation -- Periodicals; Medicine -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.9
• DOI: 10.1093/infdis/jix299
• Languages: English
• ISSNs: 0022-1899

Abstract

Summary: The level of coverage and type-specific vaccine efficacy necessary to reduce or eliminate carcinogenic human papillomavirus (HPV) is chiefly determined by their propensity to persist. Therefore, HPV-16 infection and related cancers are the most difficult to eliminate through vaccination. Abstract: Background: Human papillomavirus (HPV) vaccination is still not reaching many high-risk populations. HPV16/18 vaccines offer cross-protection against other types, for example, HPV45. Both direct vaccine efficacy and indirect herd protection contribute to vaccination effectiveness. Methods: We used a dynamic transmission model, calibrated to cervical screening data from Italy, to estimate vaccination effectiveness against HPV16 and HPV45 infection, assuming for HPV45 either 95% or lower cross-protection. Results: Basic reproductive number was smaller (2.1 vs 4.0) and hence vaccine effectiveness and herd protection stronger for HPV45 than for HPV16. The largest difference in the reduction of infection prevalence in women <35 years old was found at 70% coverage in girls-only vaccination programs (99% vs 83% for total protection for HPV45 and HPV16, respectively, mainly owing to stronger herd protection, ie, 37% vs 16%). In gender-neutral vaccination, the largest difference was at 40% coverage (herd protection, 54% vs 28% for HPV16 and HPV45, respectively). With ≥80% coverage, even 50% cross-protection would reduce HPV45 by ≥94%. Conclusions: The characteristics of individual high-risk HPV types strongly influence herd protection and determine the level of coverage and cross-protection required to reduce or eliminate the infection through HPV vaccination. HPV16 infection and related cancers are the most difficult to eliminate.