Population-level impact, herd immunity, and elimination after human papillomavirus vaccination: a systematic review and meta-analysis of predictions from transmission-dynamic models.
Population-level impact, herd immunity, and elimination after human papillomavirus vaccination: a systematic review and meta-analysis of predictions from transmission-dynamic models.
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DOI：
10.1016/s2468-2667(16)30001-9
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发表时间：
2016-11
期刊：
影响因子：
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通讯作者：
Walsh C
中科院分区：
文献类型：
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作者：
Brisson M;Bénard É;Drolet M;Bogaards JA;Baussano I;Vänskä S;Jit M;Boily MC;Smith MA;Berkhof J;Canfell K;Chesson HW;Burger EA;Choi YH;De Blasio BF;De Vlas SJ;Guzzetta G;Hontelez JAC;Horn J;Jepsen MR;Kim JJ;Lazzarato F;Matthijsse SM;Mikolajczyk R;Pavelyev A;Pillsbury M;Shafer LA;Tully SP;Turner HC;Usher C;Walsh C
模型研究已被广泛用于为人类乳头瘤病毒（HPV）疫苗接种政策决策提供信息;然而，存在许多模型，目前尚不清楚它们是否能对人群水平的有效性和群体效应产生一致的预测。我们对女性和男性接种HPV 16，18，6和11感染疫苗的长期人群水平有效性的模型预测进行了系统回顾和荟萃分析，以检查预测的群体效应的变异性，接种男孩的增量效益以及HPV疫苗类型消除的潜力。我们在MEDLINE和Embase中检索了2009年1月1日至2015年4月28日期间发表的传播动态建模研究，这些研究预测了高收入国家接种疫苗对HPV 6，11，16和18感染的人群水平影响。我们联系了作者，以确定他们是否愿意为标准化情景做出新的预测。调查的策略是仅女孩接种疫苗和12岁的女孩和男孩接种疫苗。基础病例疫苗特征为100%有效性和终身保护。我们通过不同的疫苗接种覆盖率、疫苗效力和保护期进行了敏感性分析。对于所有情况，我们汇总了疫苗接种后HPV患病率（RRprev）随时间推移相对降低的模型预测，并使用中位数和第10和第90位数（80%不确定区间[UI]）总结了结果。来自10个高收入国家的19个合格模型中有16个提供了预测。在基础病例假设下，40%的疫苗接种覆盖率和仅女孩接种，70年后女性和男性HPV 16的RRprev分别为0.53（80%UI 0.46 - 0.68）和0.36（0.28 - 0.61）。在仅女孩接种率为80%的情况下，女性和男性HPV 16的RRprev分别为0.93（0.90 - 1.00）和0.83（0.75 - 1.00）。在40%的覆盖率下，接种男孩和女孩的HPV 16的RRprev分别增加了0.18（0.13 - 0.32）和0.35（0.27 - 0.39），在80%的覆盖率下，分别增加了0.07（0.00 - 0.10）和0.16（0.01 - 0.25）。在所有研究的情况下，HPV 6、11和18的RRprev均大于HPV 16。最后，在80%的覆盖率下，大多数模型预测女孩和男孩接种疫苗将消除HPV 6，11，16和18，所有四种HPV类型的女性和男性的中位RRprev为1.00。汇总结果的变异性较低，但随着疫苗接种覆盖率降低和疫苗保护期缩短（从终生到20年）而增加。尽管HPV模型在结构、用于校准的数据和设置方面有所不同，但我们的人群水平预测通常是一致的，并表明仅接种女孩疫苗会产生强烈的群体效应，即使覆盖率低至20%。消除HPV 16，18，6和11是可能的，如果在女孩和男孩中达到80%的覆盖率，如果随着时间的推移保持高疫苗效力。加拿大卫生研究院。
Modelling studies have been widely used to inform human papillomavirus (HPV) vaccination policy decisions; however, many models exist and it is not known whether they produce consistent predictions of population-level effectiveness and herd effects. We did a systematic review and meta-analysis of model predictions of the long-term population-level effectiveness of vaccination against HPV 16, 18, 6, and 11 infection in women and men, to examine the variability in predicted herd effects, incremental benefit of vaccinating boys, and potential for HPV-vaccine-type elimination. We searched MEDLINE and Embase for transmission-dynamic modelling studies published between Jan 1, 2009, and April 28, 2015, that predicted the population-level impact of vaccination on HPV 6, 11, 16, and 18 infections in high-income countries. We contacted authors to determine whether they were willing to produce new predictions for standardised scenarios. Strategies investigated were girls-only vaccination and girls and boys vaccination at age 12 years. Base-case vaccine characteristics were 100% efficacy and lifetime protection. We did sensitivity analyses by varying vaccination coverage, vaccine efficacy, and duration of protection. For all scenarios we pooled model predictions of relative reductions in HPV prevalence (RRprev) over time after vaccination and summarised results using the median and 10th and 90th percentiles (80% uncertainty intervals [UI]). 16 of 19 eligible models from ten high-income countries provided predictions. Under base-case assumptions, 40% vaccination coverage and girls-only vaccination, the RRprev of HPV 16 among women and men was 0·53 (80% UI 0·46–0·68) and 0·36 (0·28–0·61), respectively, after 70 years. With 80% girls-only vaccination coverage, the RRprev of HPV 16 among women and men was 0·93 (0·90–1·00) and 0·83 (0·75–1·00), respectively. Vaccinating boys in addition to girls increased the RRprev of HPV 16 among women and men by 0·18 (0·13–0·32) and 0·35 (0·27–0·39) for 40% coverage, and 0·07 (0·00–0·10) and 0·16 (0·01–0·25) for 80% coverage, respectively. The RRprev were greater for HPV 6, 11, and 18 than for HPV 16 for all scenarios investigated. Finally at 80% coverage, most models predicted that girls and boys vaccination would eliminate HPV 6, 11, 16, and 18, with a median RRprev of 1·00 for women and men for all four HPV types. Variability in pooled findings was low, but increased with lower vaccination coverage and shorter vaccine protection (from lifetime to 20 years). Although HPV models differ in structure, data used for calibration, and settings, our population-level predictions were generally concordant and suggest that strong herd effects are expected from vaccinating girls only, even with coverage as low as 20%. Elimination of HPV 16, 18, 6, and 11 is possible if 80% coverage in girls and boys is reached and if high vaccine efficacy is maintained over time. Canadian Institutes of Health Research.