Health Care

Real-world impact of cervical cancer vaccines

Real-world impact of cervical cancer vaccines”

The HPV vaccination started back in 2007, and since then, a lot of countries are using it, including Canada.

So, high coverage of this vaccination will be sufficient to eradicate this illness, says a group of scientists who worked on a major evidence based review.

To update their 2015 review which included 18 studies, the team added 47 new studies published between February 2014 and October 2018 that compared the frequency of one or more HPV endpoints (HPV infections, anogenital wart diagnoses, or histologically confirmed CIN2+) between pre and post-vaccination periods in the general population.

The researchers, whose work was published in The Lancet journal, analysed 65 studies from 14 high-income countries. It brings together data from over 60 million individuals over eight years.

Vaccination against the HPV virus, which causes most cervical cancers, began more than a decade ago and its success so far in protecting women has raised hopes the number of cancer cases should significantly fall.

Researchers also found significant decreases in precancerous cervical lesions, with a 51% reduction in 15- to 19-year-olds and a 31% reduction in 20- to 24-year-olds.

The research team also looked at the impact of the vaccination programme on levels of abnormal cells and cervical lesions, known as cervical intraepithelial neoplasia (CIN), which can be early warning signs of cervical cancer.

Anogenital wart diagnoses decreased significantly by 67% (RR=0.33; 95% CI, 0.24-0.46) among girls aged 15 to 19 years, by 54% (RR=0.46; 95% CI, 0.36-0.60) among women aged 20 to 24 years, and by 31% (RR=0.69; 95% CI, 0.53-0.89) among women aged 25 to 29 years.

Rates of both types of HPV in high-income countries, among girls aged 13 to 19, plummeted by up to 83% following five to eight years of vaccination, while a reduction of 66% was found in women aged 20 to 24.

Their research also found there were greater and faster impacts, and herd effects, in countries with both multi-cohort vaccination and high vaccination coverage. It protects against four types of HPV including the kind linked to 70 per cent of cervical cancers and the kind that cause roughly 90 per cent of genital warts.

Previously the CDC recommended that teen girls and young women who had not been adequately vaccinated receive the human papillomavirus vaccine through age 26, but the recommendation for teen boys and young men only went through age 21.

Prof Marc Brisson from Laval University, one of the authors, said: "We're working with the World Health Organization, using mathematical modelling to determine when elimination would occur".

Researchers noted there is a lack of data from low- and middle-income countries, where cervical cancer rates are much higher than in high-income countries.

The authors note some limitations, including that causality between HPV vaccination and observed changes in the three endpoints can not be concluded definitively because the analysis is based on ecological studies.

It's not clear how many cancers would be prevented in that age group or whether the cost is worth the public health benefit, experts at the meeting said.

In a separate measure, the advisory committee voted to recommend catch-up vaccinations for older adults ages 27 though 45.

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