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Showing content from https://pubmed.ncbi.nlm.nih.gov/23664991/ below:

Modeling the impact of quadrivalent HPV vaccination on the incidence of Pap test abnormalities in the United States

. 2013 Jun 24;31(29):3019-24. doi: 10.1016/j.vaccine.2013.04.051. Epub 2013 May 10. Modeling the impact of quadrivalent HPV vaccination on the incidence of Pap test abnormalities in the United States Elaine W Flagg, Laura Koutsky, Katherine Hsu, Elizabeth R Unger, Judith C Shlay, Peter Kerndt, Khalil G Ghanem, Jonathan M Zenilman, Michael Hagensee, Hillard Weinstock, S Deblina Datta

Affiliations

Affiliation

¹ Centers for Disease Control and Prevention, Atlanta, GA, USA. hbc7@cdc.gov

PMID: 23664991
PMCID: PMC3998647
DOI: 10.1016/j.vaccine.2013.04.051

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Modeling the impact of quadrivalent HPV vaccination on the incidence of Pap test abnormalities in the United States

Harrell W Chesson et al. Vaccine. 2013.

. 2013 Jun 24;31(29):3019-24. doi: 10.1016/j.vaccine.2013.04.051. Epub 2013 May 10. Authors Harrell W Chesson¹, Elaine W Flagg, Laura Koutsky, Katherine Hsu, Elizabeth R Unger, Judith C Shlay, Peter Kerndt, Khalil G Ghanem, Jonathan M Zenilman, Michael Hagensee, Hillard Weinstock, S Deblina Datta Affiliation

¹ Centers for Disease Control and Prevention, Atlanta, GA, USA. hbc7@cdc.gov

PMID: 23664991
PMCID: PMC3998647
DOI: 10.1016/j.vaccine.2013.04.051

Item in Clipboard

Abstract

Background: We present data on Pap test results and HPV prevalence from the HPV Sentinel Surveillance project, a multiyear surveillance project enrolling women from a diverse set of 26 clinics throughout the US from 2003 to 2005. We use mathematical modeling to illustrate the potential timing and magnitude of decreases in Pap test abnormalities in sexually transmitted disease (STD), family planning, and primary care clinics in the US as a result of HPV vaccination.

Methods: The probability of an abnormal Pap result was based on three factors: (1) infection with HPV 16/18, or both; (2) infection with high-risk HPV types other than HPV 16/18; and (3) infection with HPV 6/11, or both. We estimated the relative reduction in the probability of an abnormal Pap result over the first 25 years of a female-only, quadrivalent HPV vaccination program, compared to a scenario of no HPV vaccination in which the probability of abnormal Pap results was assumed constant.

Results: The probability of an abnormal Pap result ranged from 7.0% for the lowest risk group (those without any high-risk HPV types and without HPV 6/11) to 45.2% for the highest risk group (those with HPV 16/18 and at least one other high-risk HPV type). Estimated reductions in abnormal Pap results among women in the 21- to 29-year age group were 0.8%, 10.2%, and 11.3% in years 5, 15, and 25 of the vaccine program respectively, in the lower vaccine coverage scenario, and 7.4%, 21.4%, and 22.2%, respectively, in the higher coverage scenario.

Conclusions: Our results suggest that HPV vaccination will have a discernable impact on the probability of Pap abnormalities, but the timing and magnitude of the reduction will depend substantially on vaccine coverage and the degree of cross-protection against high risk HPV types other than HPV 16/18.

Published by Elsevier Ltd.

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Figures
Fig. 1

Model summary: the population is…

Fig. 1

Model summary: the population is divided into 8 groups, based on (1) infection…

Fig. 1

Model summary: the population is divided into 8 groups, based on (1) infection with HPV types 16 or 18 or both; (2) infection with other (non 16/18) high risk HPV types; and (3) infection with HPV 6 or HPV 11 or both. The probability of an abnormal Pap result for each of the 8 groups and the distribution of the population across the 8 groups prior to onset of the vaccination program were based on data from the HPV Sentinel Surveillance (HSS) project. After onset of a quadrivalent HPV vaccination program, the distribution of the population across the 8 groups can change over time through reductions in HPV 6/11 and HPV 16/18 as described on the right of the chart. For simplicity, the potential benefits of cross-protection against high-risk HPV types other than HPV 16/18 are not illustrated.

Fig. 2

Estimated percent reduction in abnormal…

Fig. 2

Estimated percent reduction in abnormal Pap results among women aged 21-29 years over…

Fig. 2

Estimated percent reduction in abnormal Pap results among women aged 21-29 years over time after onset of a quadrivalent HPV vaccination program for three coverage scenarios (lower, intermediate, and higher) under base case assumptions, which include 96% vaccine efficacy against abnormal Pap results attributable to HPV 6, 11, 16, 18 and 15% efficacy against abnormal Pap results attributable to other high risk HPV types. Specifically, these results show the estimated percent reduction in the probability of an abnormal Pap result per Pap test conducted.

Fig. 3

Estimated percent reduction in abnormal…

Fig. 3

Estimated percent reduction in abnormal Pap results among women aged 30-39 years over…

Fig. 3

Estimated percent reduction in abnormal Pap results among women aged 30-39 years over time after onset of a quadrivalent HPV vaccination program for three coverage scenarios (lower, intermediate, and higher) under base case assumptions, which include 96% vaccine efficacy against abnormal Pap results attributable to HPV 6, 11, 16, 18 and 15% efficacy against abnormal Pap results attributable to other high risk HPV types. Specifically, these results show the estimated percent reduction in the probability of an abnormal Pap result per Pap test conducted.