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Quadrivalent human papillomavirus vaccination and trends in genital warts in Australia: analysis of national sentinel surveillance data.
Lancet Infect Dis. 2011 Jan; 11(1):39-44
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15 Mar 2011
DOI: 10.3410/f.8980956.9542054
This paper is of exceptional interest because it demonstrates population effects of the human papillomavirus (HPV) vaccination program on the incidence of genital warts (GW), and the data demonstrate how an effective vaccination program against a difficult, treatable sexually transmitted infection (STI)...Continue reading
This paper is of exceptional interest because it demonstrates population effects of the human papillomavirus (HPV) vaccination program on the incidence of genital warts (GW), and the data demonstrate how an effective vaccination program against a difficult, treatable sexually transmitted infection (STI) can nearly halve the incidence in young women.
The effect of HPV on the incidence of GW has been effectively demonstrated in several clinical trials {1}, but this study is the first to show the effect on a population level. The authors have collected data on 112,083 new patients attending eight free public sexual health clinics widely spread around Australia. In this population, 9867 (9%) new cases of GW were found, and data were available from 2004 throughout 2009. In April 2007 a free vaccination program for 12- to 26-year-old women was initiated using the quadrivalent HPV vaccine; two of the four types targeted are HPV types 6 and 11, responsible for up to 90% of GW. There was a one-dose population coverage of 80%, hence a decline in the proportion of women in that age group with GW would be expected after the introduction of the program. Indeed the authors were able to show that, whereas 11.7% of young women were diagnosed with GW before 2007, this declined to only 4.8% after 2007 (p for trend <0.0001). No significant decline was not seen in women older than 26 years in 2007, in female non-residents who had not been offered that vaccine, or in men who have sex with men. However, among heterosexual men, there was also a significant decline from 12.3% to 8.9%, primarily driven by the drastic decline from 17.3% to 10.5% among heterosexual resident men aged 12-26 in July 2007. This is a very interesting finding, since very few men were vaccinated, no subsidy for vaccination of men was given and <5% of boys aged 15-17 years were vaccinated. This study has shown how effective preventive measures can dramatically change the reality in sexual health care services, and the authors demonstrate a powerful effect of herd immunity. GW are the first major STI to be targeted by a vaccination program, and these first experiences calls for hope for future effective preventive STI measures to be rolled out.
The effect of HPV on the incidence of GW has been effectively demonstrated in several clinical trials {1}, but this study is the first to show the effect on a population level. The authors have collected data on 112,083 new patients attending eight free public sexual health clinics widely spread around Australia. In this population, 9867 (9%) new cases of GW were found, and data were available from 2004 throughout 2009. In April 2007 a free vaccination program for 12- to 26-year-old women was initiated using the quadrivalent HPV vaccine; two of the four types targeted are HPV types 6 and 11, responsible for up to 90% of GW. There was a one-dose population coverage of 80%, hence a decline in the proportion of women in that age group with GW would be expected after the introduction of the program. Indeed the authors were able to show that, whereas 11.7% of young women were diagnosed with GW before 2007, this declined to only 4.8% after 2007 (p for trend <0.0001). No significant decline was not seen in women older than 26 years in 2007, in female non-residents who had not been offered that vaccine, or in men who have sex with men. However, among heterosexual men, there was also a significant decline from 12.3% to 8.9%, primarily driven by the drastic decline from 17.3% to 10.5% among heterosexual resident men aged 12-26 in July 2007. This is a very interesting finding, since very few men were vaccinated, no subsidy for vaccination of men was given and <5% of boys aged 15-17 years were vaccinated. This study has shown how effective preventive measures can dramatically change the reality in sexual health care services, and the authors demonstrate a powerful effect of herd immunity. GW are the first major STI to be targeted by a vaccination program, and these first experiences calls for hope for future effective preventive STI measures to be rolled out.
References
1.
Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases.
N Engl J Med 2007 May 10; 19(356):1928-43
PMID: 17494926
Disclosures
None declared
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Ostergaard L and Wejse C: F1000Prime Recommendation of [Donovan B et al., Lancet Infect Dis 2011, 11(1):39-44]. In F1000Prime, 15 Mar 2011; DOI: 10.3410/f.8980956.9542054. F1000Prime.com/8980956#eval9542054
F1000Prime Recommendations, Dissents and Comments for [Donovan B et al., Lancet Infect Dis 2011, 11(1):39-44]. In F1000Prime, 18 May 2013; F1000Prime.com/8980956
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BACKGROUND: Quadrivalent human papillomavirus (HPV) vaccine has high efficacy in clinical trials but no reports describe its effects at a population level. From July, 2007, Australia was the first country to fund a vaccination programme for all women aged 12-26 years. We established a national surveillance network in Australia and aimed to identify trends in diagnoses of genital warts in 2004-09.
METHODS: We obtained standardised data for demographic factors, frequency of genital warts, HPV vaccination status, and sexual behaviour for new patients attending eight sexual health services in Australia between January, 2004, and December, 2009. We used χ² analysis to identify significant trends in proportions of patients diagnosed with warts in periods before and after vaccination began. Our primary group of interest was female Australian residents who were eligible for free vaccination, although data were assessed for patients ineligible for free vaccination, including women older than 26 years of age, non-resident women, and men.
FINDINGS: Among 112 083 new patients attending sexual health services, we identified 9867 (9%) cases of genital warts. Before the vaccine programme started, there was no change in proportion of women or heterosexual men diagnosed with genital warts. After vaccination began, a decline in number of diagnoses of genital warts was noted for young female residents (59%, p(trend)<0·0001). No significant decline was noted in female non-residents, women older than 26 years in July, 2007, or in men who have sex with men. However, proportionally fewer heterosexual men were diagnosed with genital warts during the vaccine period (28%, p(trend)<0·0001), and this effect was more pronounced in young men. By 2009, 65·1% of female Australian residents who were eligible for free vaccine reported receipt of quadrivalent or unknown HPV vaccine.
INTERPRETATION: The decrease in frequency of genital warts in young Australian women resulting from the high coverage of HPV vaccination might provide protective effects in heterosexual men through herd immunity.
FUNDING: CSL Biotherapies.
Copyright © 2011 Elsevier Ltd. All rights reserved.
DOI: 10.1016/S1473-3099(10)70225-5
PMID: 21067976
