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Evaluation of HPV type-replacement in unvaccinated and vaccinated adolescent females—Post-hoc analysis of a community-randomized clinical trial (II)

Gray, Penelope ; Palmroth, Johanna ; Luostarinen, Tapio ; Apter, Dan ; Dubin, Gary ; Garnett, Geoff ; Eriksson, Tiina ; Natunen, Kari ; Merikukka, Marko and Pimenoff, Ville , et al. (2018) In International Journal of Cancer 142(12). p.2491-2500
Abstract

Efficacy of human papillomavirus (HPV) vaccines promises to control HPV infections. However, HPV vaccination programs may lay bare an ecological niche for non-vaccine HPV types. We evaluated type-replacement by HPV type and vaccination strategy in a community-randomized trial executed in HPV vaccination naïve population. Thirty-three communities were randomized to gender-neutral vaccination with AS04-adjuvanted HPV16/18 vaccine (Arm A), HPV vaccination of girls and hepatitis B-virus (HBV) vaccination of boys (Arm B) and gender-neutral HBV vaccination (Arm C). Resident 1992-95 born boys (40,852) and girls (39,420) were invited. 11,662 boys and 20,513 girls were vaccinated with 20–30% and 45–48% coverage, respectively. HPV typing of... (More)

Efficacy of human papillomavirus (HPV) vaccines promises to control HPV infections. However, HPV vaccination programs may lay bare an ecological niche for non-vaccine HPV types. We evaluated type-replacement by HPV type and vaccination strategy in a community-randomized trial executed in HPV vaccination naïve population. Thirty-three communities were randomized to gender-neutral vaccination with AS04-adjuvanted HPV16/18 vaccine (Arm A), HPV vaccination of girls and hepatitis B-virus (HBV) vaccination of boys (Arm B) and gender-neutral HBV vaccination (Arm C). Resident 1992-95 born boys (40,852) and girls (39,420) were invited. 11,662 boys and 20,513 girls were vaccinated with 20–30% and 45–48% coverage, respectively. HPV typing of 11,396 cervicovaginal samples was performed by high throughput PCR. Prevalence ratios (PR) between arms and ranked order of HPV types and odds ratio (OR) for having multiple HPV types in HPV16 or 18/45 positive individuals were calculated. The ranked order of HPV types did not significantly differ between arms or birth cohorts. For the non-HPV vaccinated 1992–1993 birth cohorts increased PR, between the gender-neutral intervention versus control arms for HPV39 (PRA 1.84, 95% CI 1.12–3.02) and HPV51 (PRA 1.56, 95% CI 1.11–2.19) were observed. In the gender-neutral arm, increased clustering between HPV39 and the vaccine-covered HPV types 16 or 18/45 (ORA16 = 5.1, ORA18/45 = 11.4) was observed in the non-HPV vaccinated 1994–1995 birth cohorts. Comparable clustering was seen between HPV51 and HPV16 or HPV18/45 (ORB16 = 4.7, ORB18/45 = 4.3), in the girls-only arm. In conclusion, definitively consistent postvaccination patterns of HPV type-replacement were not observed. Future occurrence of HPV39 and HPV51 warrant investigation.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
HPV, randomized trial, type replacement, vaccination
in
International Journal of Cancer
volume
142
issue
12
pages
10 pages
publisher
John Wiley and Sons Inc.
external identifiers
  • pmid:29377141
  • scopus:85041816824
ISSN
0020-7136
DOI
10.1002/ijc.31281
language
English
LU publication?
no
id
cc0fab52-8987-4134-85bd-36fbd0cfb932
date added to LUP
2018-05-22 13:42:36
date last changed
2020-10-27 01:27:33
@article{cc0fab52-8987-4134-85bd-36fbd0cfb932,
  abstract     = {<p>Efficacy of human papillomavirus (HPV) vaccines promises to control HPV infections. However, HPV vaccination programs may lay bare an ecological niche for non-vaccine HPV types. We evaluated type-replacement by HPV type and vaccination strategy in a community-randomized trial executed in HPV vaccination naïve population. Thirty-three communities were randomized to gender-neutral vaccination with AS04-adjuvanted HPV16/18 vaccine (Arm A), HPV vaccination of girls and hepatitis B-virus (HBV) vaccination of boys (Arm B) and gender-neutral HBV vaccination (Arm C). Resident 1992-95 born boys (40,852) and girls (39,420) were invited. 11,662 boys and 20,513 girls were vaccinated with 20–30% and 45–48% coverage, respectively. HPV typing of 11,396 cervicovaginal samples was performed by high throughput PCR. Prevalence ratios (PR) between arms and ranked order of HPV types and odds ratio (OR) for having multiple HPV types in HPV16 or 18/45 positive individuals were calculated. The ranked order of HPV types did not significantly differ between arms or birth cohorts. For the non-HPV vaccinated 1992–1993 birth cohorts increased PR, between the gender-neutral intervention versus control arms for HPV39 (PR<sub>A</sub> 1.84, 95% CI 1.12–3.02) and HPV51 (PR<sub>A</sub> 1.56, 95% CI 1.11–2.19) were observed. In the gender-neutral arm, increased clustering between HPV39 and the vaccine-covered HPV types 16 or 18/45 (OR<sub>A16</sub> = 5.1, OR<sub>A18/45</sub> = 11.4) was observed in the non-HPV vaccinated 1994–1995 birth cohorts. Comparable clustering was seen between HPV51 and HPV16 or HPV18/45 (OR<sub>B16</sub> = 4.7, OR<sub>B18/45</sub> = 4.3), in the girls-only arm. In conclusion, definitively consistent postvaccination patterns of HPV type-replacement were not observed. Future occurrence of HPV39 and HPV51 warrant investigation.</p>},
  author       = {Gray, Penelope and Palmroth, Johanna and Luostarinen, Tapio and Apter, Dan and Dubin, Gary and Garnett, Geoff and Eriksson, Tiina and Natunen, Kari and Merikukka, Marko and Pimenoff, Ville and Söderlund-Strand, Anna and Vänskä, Simopekka and Paavonen, Jorma and Pukkala, Eero and Dillner, Joakim and Lehtinen, Matti},
  issn         = {0020-7136},
  language     = {eng},
  month        = {06},
  number       = {12},
  pages        = {2491--2500},
  publisher    = {John Wiley and Sons Inc.},
  series       = {International Journal of Cancer},
  title        = {Evaluation of HPV type-replacement in unvaccinated and vaccinated adolescent females—Post-hoc analysis of a community-randomized clinical trial (II)},
  url          = {http://dx.doi.org/10.1002/ijc.31281},
  doi          = {10.1002/ijc.31281},
  volume       = {142},
  year         = {2018},
}