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Human Papillomavirus Vaccine: Another Glass Half-Empty/Full :

March 8, 2016

I alternate between being cheered and disappointed by the results of this study. Read on so you can decide for yourself.

I alternate between being cheered and disappointed by the results of this study. Read on so you can decide for yourself.

Source: Dunne EF, Naleway A, Smith N, et al. Reduction in human papillomavirus vaccine type prevalence among young women screened for cervical cancer in an integrated US healthcare delivery system in 2007 and 2012-2013. J Infect Dis. 2015;212(12):1970-1975; doi:10.1093/infdis/jiv342. See AAP Grand Rounds commentary by Dr. Rebecca Brady (subscription required).

PICO Question: Among women aged 20-29 years, how has the prevalence of vaccine-type human papillomavirus changed since human papillomavirus vaccine introduction?
Question type: Descriptive
Study design: Cross-sectional
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This study comes from a database at Kaiser Permanente Northwest, which is of course an integrated healthcare delivery system, presumably with excellent capacity to track patients longitudinally and to provide reminders to clinicians and patients about vaccination and other preventive health issues. So, I would expect their data to reflect the best we can do in implementing new vaccine recommendations.

Electron micrograph of HPV, from Fæ via Wikimedia.
Electron micrograph of HPV, from Fæ via Wikimedia.
The investigators chose an outcome that is a surrogate for perhaps the most important impact of human papillomavirus (HPV) vaccine, that of preventing cervical cancer. Of course, it takes a long time to measure that impact, but a good, and earlier, gauge of that outcome would be to look at rates of positivity for HPV types that are included in the vaccine. They compared women who had received any HPV vaccine dose to those who never received vaccine, looking at cohorts of women in 2007 (just as vaccine became available) and 2012-2013. They found an overall decrease in vaccine type HPV positivity in the vaccinated group. The prevalence of vaccine-type HPV was 7.6% in women who had never received HPV vaccine, 1.0% in women with at least 1 vaccine dose before age 19 years, and 5.8% in those with first dose at age 19 or later. That's the glass half-full part of this.

The glass half-empty part, for me anyway, is that only 31.9% of their women had received any HPV vaccination. This isn't that different from other reports we've seen, but I guess I was hoping that an integrated healthcare delivery system would have better results than that. Of course, their data analysis stopped at 2013, and there is some indication that things are a little better now. Still, it shows us a lot of work remains to realize the health benefits of HPV vaccination, now with a newer 9-valent vaccine.
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