HPV Vaccine Has Significantly Reduced the Burden of HPV Infection, Cancer
Jessica Tomaszewski, MD
Primary Care Pediatrics, Nemours Children’s Health System, Wilmington, Delaware
Tomaszewski J. HPV vaccine has significantly reduced the burden of HPV infection, cancer [published online December 18, 2019]. Consultant360.
McClung NM, Lewis RM, Gargano JW, Querec T, Unger ER, Markowitz LE. Declines in vaccine-type human papillomavirus prevalence in females across racial/ethnic groups: data from a national survey. J Adolesc Health. 2019;65(6):715-722. https://doi.org/10.1016/j.jadohealth.2019.07.003.
The human papillomavirus (HPV) vaccine has been recommended since 2006 for girls and 2011 for boys. National surveys monitor HPV vaccination rates among 13- to 17-year-olds in the United States, and it has been noted that coverage among this age group has steadily increased. In 2017, coverage of 1 dose or more was 68.6% among girls and 62.6% among boys; up-to-date coverage was 53.1% among girls and 44.3% among boys. Within 4 years of vaccine introduction, a 56.0% decrease in the prevalence of quadrivalent HPV infections were observed among 14- to 19-year-old girls. Newer research notes that within 8 years of vaccine introduction, a 71.0% decrease among 14- to 19-year-olds has been seen, as well as a 61.0% decrease among 20- to 24-year-olds.
These successes are also thought to have greater implications in the reduction of racial/ethnic disparities in cancer incidence. The decrease in quadrivalent HPV types should also lead to a decrease in HPV-associated cancers. Non-Hispanic black and Hispanic women have a higher incidence of cervical cancer than non-Hispanic white women. Non-Hispanic black women also have a higher cervical cancer mortality rate, which may be due in part to differences in screening participation and/or follow-up treatment.
For their study, McClung and colleagues used National Health and Nutrition Examination Survey (NHANES) HPV prevalence data among 14- to 34-year-old women from the most recent vaccine era years (2013-2016) and compared it with the pre-vaccine era (2003-2006) overall and by race/ethnicity. NHANES is a cross-sectional survey conducted in 2-year cycles by the Centers for Disease Control and Prevention (CDC). Participants who are women aged 14 to 34 years with adequate cervico-vaginal samples were included in the analyses (n=4674). Women who self-reported race/ethnicity as non-Hispanic white, non-Hispanic black, or Mexican American were included in the race/ethnicity analyses (n=3915). Demographic data were collected via interview, sexual behavior history was collected using self-interviews, and cervico-vaginal samples were self-collected and shipped to the CDC laboratory for HPV genotyping.
In the new data collected, a significant change in the number of lifetime partners was observed among 14- to 19-year-old non-Hispanic white and non-Hispanic black girls, as well as an increase in reporting zero lifetime partners (48.5% to 58.3% among non-Hispanic white girls; 38.9% to 55.1% among non-Hispanic black girls).
Overall, vaccination coverage of 1 dose or more was 53.9% among girls aged 14 to 19 years (non-Hispanic white, 52.6%; non-Hispanic black, 58.1%; Mexican American, 59.5%) and 51.5% in women aged 20 to 24 years (non-Hispanic white, 58.8%; non-Hispanic black, 45.0%; Mexican American, 33.8%). Prevalence of quadrivalent HPV decreased overall from 11.5% to 1.8% among girls aged 14 to 19 years and from 18.5% to 5.3% among women aged 20 to 24 years. No declines were noted in older age groups.
After adjusting for lifetime sex partners, race/ethnicity, and poverty status, an 86% decline in quadrivalent HPV-type prevalence was observed. Among 20- to 24-year-olds, quadrivalent HPV-type prevalence was 18.5% in the pre-vaccine era and 5.3% in the post-vaccine era. This decrease was noted in all racial/ethnic groups among girls aged 14 to 19 years, from 11.3% to 1.5% among non-Hispanic white girls, 17.1% to 4.4% in non-Hispanic black girls, and 10.0% to 1.3% in Mexican-American girls. Among older age groups, a decline in quadrivalent HPV-type prevalence was not observed in any racial/ethnic group.
There are some limitations to this study, as many racial/ethnic groups were not included in this analysis, including further delineation of the Hispanic community beyond Mexican Americans. There is also some thought and ongoing analysis that overall changes in adolescent sexual behavior may also contribute to declining rates of HPV, but when this data was accounted for in this study, the vaccine impact appeared to be the main reason for the decline in quadrivalent HPV-type prevalence.
The declines in HPV prevalence noted within only 10 years of vaccine introduction are truly incredible, and it is noteworthy that these declines cross ethnicity groups. Such great success should be celebrated at many levels, especially our primary care providers at the forefront of this vaccination. Hopefully this data will continue to encourage the vaccine-hesitant patients and also lead to substantial reductions in HPV-associated cancers and better health care outcomes for many individuals.