In a large health insurance database in Germany, incidence of anogenital warts among 15- to 19-year-old females decreased from 316/100,000 person-years in 2007 to 242 in 2008 (23% reduction, P = 0.0001). The decrease started between the first and second quarter of 2007 (human papillomavirus vaccination was introduced in March 2007).
"Emerging data from other countries further strengthen evidence of direct and indirect impact of the quadrivalent HPV vaccine. These include countries with high vaccination coverage (Denmark  and Sweden ), but also countries with lower coverage such as the United States  , Germany , and New Zealand . In the United States, an ecologic analysis of private health insurance claims data found a 38% decrease in genital warts claims in 15-to 19-year-old females, from 2.9 to 1.8 per 1,000 person-years, and a smaller decrease in females aged 21e30 years, but no change in those older than 30 years . "
[Show abstract][Hide abstract] ABSTRACT: Human papillomavirus (HPV) vaccines are available in the United States and around the world to prevent HPV-associated diseases including cervical cancer and genital warts. HPV vaccination is currently recommended for adolescents: target ages for routine and catch-up vaccinations vary by country. Because the time from vaccination to cancer development can be several decades, many studies are evaluating more immediate outcomes. In the 4 years since the vaccine was introduced, reductions in HPV vaccine type prevalence and genital warts have been reported in young females in the United States and other countries. Many questions remain about the long-term impact, but the initial studies show promising results for the relatively new HPV vaccine.
Journal of Adolescent Health 12/2013; 53(6):679-682. DOI:10.1016/j.jadohealth.2013.09.018 · 3.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Effectiveness of the quadrivalent human papillomavirus (QHPV) vaccine against cervical dysplasia has not been estimated using population-based individual level data. We assessed the vaccine effectiveness (VE) of the QHPV vaccine against cervical dysplasia using data collected routinely in Manitoba.
Females ≥ 15 years old who received the QHPV vaccine in Manitoba between September 2006 and April 2010 privately (n = 3,541) were matched on age to up to three nonvaccinated females (n = 9,594). We used Cox regression models to estimate the hazard ratios for three outcomes: atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesions (LSILs), and high-grade SILs (HSILs).
Among the 15- to 17-year-olds, the adjusted VE estimates were 35% (95% CI, -19% to 65%), 21% (-10% to 43%), and -1% (-44% to 29%) against the detection of HSILs, LSILs, and ASCUS, respectively. The corresponding estimates were higher (46% [0% to 71%], 35% [10% to 54%], and 23% [-8% to 45%]) among those who had ≥ one Pap smear after enrollment. The QHPV vaccine was associated with 23% (-17% to 48%) reduction in HSIL risk among those ≥ 18 with no history of abnormal cytology, but there was no evidence of protection among those with such a history (-8% [-59% to 27%]).
A significant percentage of vaccinated women may not be protected against HSIL and lesser dysplasia especially if they were vaccinated at older age (≥ 18) or had abnormal cytology before vaccination. These findings affirm the importance of vaccination before any significant exposure to HPV occurs and underscore the need for screening programs that cover all sexually active women, even if they were vaccinated.
[Show abstract][Hide abstract] ABSTRACT: Quadrivalent human papillomavirus (HPV) [types 6, 11, 16, 18] recombinant vaccine (Gardasil(®); Silgard(®)) is composed of virus-like particles formed by self-assembly of recombinant L1 capsid protein from each of HPV types 6, 11, 16 and 18. It is indicated for use from the age of 9 years as a two- or three-dose vaccination course over 6 months for the prevention of premalignant anogenital lesions, cervical and anal cancers, and genital warts caused by the vaccine HPV types. In placebo-controlled trials, quadrivalent HPV vaccine provided high-level protection against infection or disease caused by the vaccine HPV types over 2-4 years in females aged 15-45 years who were negative for the vaccine HPV types, and provided a degree of cross-protection against certain non-vaccine HPV types. The vaccine also provided high-level protection against persistent infection, anogenital precancerous lesions and genital warts caused by the vaccine HPV types over 3 years in susceptible males aged 16-26 years. Protection has been demonstrated for up to 8 years. In subjects who were negative for the vaccine HPV types, high seroconversion rates and high levels of anti-HPV antibodies were observed in females of all age ranges from 9 to 45 years and in males aged 9-26 years. The vaccine was generally well tolerated and was usually predicted to be cost effective in girls and young women. Therefore, quadrivalent HPV vaccine offers an effective means to substantially reduce the burden of HPV-related anogenital disease in females and males, particularly cervical cancer and genital warts.
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