human papillomavirus

Vulvar cancer is an underrecognized gynecologic malignant disease. The incidence of vulvar cancer is 2.3 per 100 000 people in Canada, and is increasing with the rising prevalence of human papillomavirus (HPV). More than 90% of vulvar cancers are squamous cell carcinomas (SCC), mostly diagnosed after age 65 years. Vulvar SCC mimics nonspecific inflammation, which often delays diagnosis. Risk factors include advanced age, HPV infection, lichen sclerosis, smoking, immunodeficiency, and pelvic radiation

Author/s:

Jennifer Davis, Jacob McGee, Anjali Kulkarni

Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis

John Bayhi — Fri, 09 Aug 2019 19:52:40 +0000

Date Added:

August 9, 2019

Journal/Publication:

Lancet

Publisher:

Elsevier Ltd

Publication Date:

June 26, 2019

Issue:

10197

Volume:

394

Pages:

497-509

URL:

Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/S0140-6736(19)30298-3

Keywords

human papillomavirus

hpv vaccine

vaccination

PMID (1):

31255301

MeSH

Papillomavirus Vaccines

Papillomavirus Infections

HPV vaccination works. Just do it! James W. Mold, MD, MPH

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BACKGROUND:

More than 10 years have elapsed since human papillomavirus (HPV) vaccination was implemented. We did a systematic review and meta-analysis of the population-level impact of vaccinating girls and women against human papillomavirus on HPV infections, anogenital wart diagnoses, and cervical intraepithelial neoplasia grade 2+ (CIN2+) to summarise the most recent evidence about the effectiveness of HPV vaccines in real-world settings and to quantify the impact of multiple age-cohort vaccination.

METHODS:

In this updated systematic review and meta-analysis, we used the same search strategy as in our previous paper. We searched MEDLINE and Embase for studies published between Feb 1, 2014, and Oct 11, 2018. Studies were eligible if they compared the frequency (prevalence or incidence) of at least one HPV-related endpoint (genital HPV infections, anogenital wart diagnoses, or histologically confirmed CIN2+) between pre-vaccination and post-vaccination periods among the general population and if they used the same population sources and recruitment methods before and after vaccination. Our primary assessment was the relative risk (RR) comparing the frequency (prevalence or incidence) of HPV-related endpoints between the pre-vaccination and post-vaccination periods. We stratified all analyses by sex, age, and years since introduction of HPV vaccination. We used random-effects models to estimate pooled relative risks.

FINDINGS:

We identified 1702 potentially eligible articles for this systematic review and meta-analysis, and included 65 articles in 14 high-income countries: 23 for HPV infection, 29 for anogenital warts, and 13 for CIN2+. After 5-8 years of vaccination, the prevalence of HPV 16 and 18 decreased significantly by 83% (RR 0·17, 95% CI 0·11-0·25) among girls aged 13-19 years, and decreased significantly by 66% (RR 0·34, 95% CI 0·23-0·49) among women aged 20-24 years. The prevalence of HPV 31, 33, and 45 decreased significantly by 54% (RR 0·46, 95% CI 0·33-0·66) among girls aged 13-19 years. Anogenital wart diagnoses decreased significantly by 67% (RR 0·33, 95% CI 0·24-0·46) among girls aged 15-19 years, decreased significantly by 54% (RR 0·46, 95% CI 0.36-0.60) among women aged 20-24 years, and decreased significantly by 31% (RR 0·69, 95% CI 0·53-0·89) among women aged 25-29 years. Among boys aged 15-19 years anogenital wart diagnoses decreased significantly by 48% (RR 0·52, 95% CI 0·37-0·75) and among men aged 20-24 years they decreased significantly by 32% (RR 0·68, 95% CI 0·47-0·98). After 5-9 years of vaccination, CIN2+ decreased significantly by 51% (RR 0·49, 95% CI 0·42-0·58) among screened girls aged 15-19 years and decreased significantly by 31% (RR 0·69, 95% CI 0·57-0·84) among women aged 20-24 years.

INTERPRETATION:

This updated systematic review and meta-analysis includes data from 60 million individuals and up to 8 years of post-vaccination follow-up. Our results show compelling evidence of the substantial impact of HPV vaccination programmes on HPV infections and CIN2+ among girls and women, and on anogenital warts diagnoses among girls, women, boys, and men. Additionally, programmes with multi-cohort vaccination and high vaccination coverage had a greater direct impact and herd effects.

FUNDING:

WHO, Canadian Institutes of Health Research, Fonds de recherche du Québec - Santé.

Author/s:

HPV Vaccination Impact Study Group, Benard, M, Perez, E, Brisson, N

Sexually Transmitted Infections

Tracy Ashby — Thu, 11 Apr 2019 05:00:00 +0000

Date Added:

April 11, 2019

Journal/Publication:

American Family Physician

Publisher:

American Academy of Family Physicians

URL:

Sexually Transmitted Infections

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Web Page

Keywords

sexually transmitted infections

human papillomavirus

MeSH

sexually transmitted diseases

acquired immunodeficiency syndrome

hepatitis A

hepatitis

This is a set of links to all recent American Family Physician/AAFP articles about sexually transmitted disease. James W. Mold, MD, MPH

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This collection features the best content from AFP, as identified by the AFP editors, on sexually transmitted disease and related issues, including chlamydia, genital herpes, gonorrhea, human papillomavirus, and syphilis. New research may affect the interpretation and application of this material. Clinical judgment is advised. Note that AFP content published within the past 12 months is accessible to AAFP members and paid subscribers only.
Note: This topic collection does not include human immunodeficiency virus (see separate topic collection on HIV/AIDS) or hepatitis (see separate topic collection on Hepatitis and Other Liver Diseases).