Epidemiologic Impact of HPV Vaccination

HPV 疫苗的流行病学影响

• 批准号: 10227738
• 负责人: JESSICA A KAHN
• 金额: $ 61.56万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-01-18 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10227738
• 关键词: 15 year old; Address; Adherence; Age; Anogenital cancer; Area; Automobile Driving; Behavior; Behavioral Mechanisms; Biological; Cervical Cancer Screening; Clinic; Clinical; Clinical Trials; Communities; Cost Effectiveness Analysis; Counseling; Data; Data Set; Death Rate; Diagnostic; Dose; Effectiveness; Enrollment; Epidemiological trend; Epidemiology; Genotype; Goals; Healthy People 2020; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Human Papilloma Virus-Related Malignant Neoplasm; Human Papillomavirus; Human papilloma virus infection; Human papillomavirus 16; Individual; Infection; Infrastructure; Investigation; Longitudinal trends; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Marketing; Methodology; Methods; Morbidity - disease rate; Morphologic artifacts; Outcome; Policies; Population Heterogeneity; Prevalence; Public Health; Publications; Recommendation; Reporting; Research; Risk; Risk Reduction; Schedule; Screening for cancer; Seminal; Sentinel Surveillance; Signal Transduction; Time; Vaccinated; Vaccination; Vaccine Clinical Trial; Vaccines; Woman; Work; base; clinical practice; community setting; detection assay; disparity reduction; ethnic diversity; experience; health communication; high risk population; human female; inclusion criteria; innovation; male; malignant oropharynx neoplasm; men; mortality; non-compliance; novel; prevent; prophylactic; racial diversity; recruit; screening program; surveillance study; trend; vaccine effectiveness; virology; young man; young woman

Project Summary Introduction of prophylactic human papillomavirus (HPV) vaccines has the potential to dramatically decrease morbidity and mortality from anogenital and oropharyngeal cancers. However, data from vaccine clinical trials cannot predict vaccine effectiveness in “real-world” community settings, and introduction of a 9-valent (in addition to a 2- and 4-valent) vaccine in 2015 and reduced dosing schedules (from 3 to 2 doses) in 2016 could further modify vaccine effectiveness. The impact of vaccine introduction can be efficiently and accurately evaluated by HPV surveillance studies that assess vaccine effectiveness, herd protection, cross-protection (decrease in HPV types genetically related to vaccine types), and type replacement (increase in non-vaccine- type HPV due to a reduction in vaccine types). We previously conducted 4 HPV surveillance studies in women (2006-2017) and 2 in men (2013-2017). Among women, we found evidence for vaccine effectiveness (but lower effectiveness with 1 vs. 3 doses), herd protection, and cross-protection; no evidence for type- replacement; and an unexpected increase in non-vaccine-type HPV in unvaccinated women. Among men, we found preliminary evidence for vaccine effectiveness and herd protection. Continued investigation through the proposed renewal is essential to achieve the following objectives: 1) assess the effects of 9-valent vaccine introduction and reduced dosing schedules on effectiveness, 2) elucidate long-term trends in herd protection, 3) identify signals of diminished cross-protection or emerging type-replacement, and 4) determine mechanisms for increases in non-vaccine-type HPV in unvaccinated women. The specific aims are to: 1) determine long- term trends in 4-valent - and emerging trends in 9-valent - HPV prevalence among vaccinated women (2006- 2023) and men (2013-2023) to assess HPV vaccine effectiveness, and among unvaccinated women and men to assess herd protection; 2) assess the differential impact of the number of vaccine doses received on vaccine-type HPV, by age; 3) determine trends in non-vaccine-type HPV prevalence among vaccinated women and men, to examine for persistent cross-protection and emerging type replacement; and 3) explore biological and behavioral mechanisms for the increase in non-vaccine-type HPV in unvaccinated women. Our approach will be to enroll 1,600 women and men in two additional surveillance studies, to characterize the impact of vaccine introduction across a total of 6 time periods in women (2006-2023, N=2,400) and 4 in men (2013- 2023, N=1,600). The proposed research is innovative because the resulting data could shift current research and clinical practice paradigms in the areas of vaccination and virology, and the research plan utilizes novel concepts, approaches and new methodologies to explore mechanisms driving HPV trends. The proposed research is significant because the data will provide key evidence for: 1) vaccination and cervical cancer screening programs; 2) public health communications and risk-reduction counseling; and 3) cost-effectiveness analysis and policy decisions: these will help to reduce disparities and mortality due to HPV-related cancers.

项目总结