Epidemiologic Impact of HPV Vaccination

HPV 疫苗的流行病学影响

• 批准号: 9197611
• 负责人: JESSICA A KAHN
• 金额: $ 64.64万
• 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 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9197611
• 关键词: Address; Advisory Committees; Area; Behavioral; Cervical Intraepithelial Neoplasia; Clinical Trials; Communities; Cost Effectiveness Analysis; Data; Death Rate; Disease; Effectiveness; Enrollment; Epidemiological trend; Epidemiology; Female; Future; Genotype; Health Benefit; Healthy People 2020; High-Risk Cancer; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Human Papillomavirus; Human papilloma virus infection; Immunization; Immunization Programs; Individual; Infection; Malignant Neoplasms; Malignant Vaginal Neoplasm; Malignant neoplasm of anus; Malignant neoplasm of cervix uteri; Malignant neoplasm of vulva; Methodology; Morbidity - disease rate; Outcome; Pattern; Pilot Projects; Policies; Population; Prevalence; Public Health; Research; Sampling; Sampling Studies; Science; Sexual Partners; Time; Vaccinated; Vaccination; Vaccines; Woman; clinical practice; community setting; design; innovation; men; mortality; novel; prevent; programs; prophylactic; public health relevance; racial diversity; screening; surveillance study; trend; vaccine delivery; vaccine development; vaccine effectiveness; virology; volunteer; young man; young woman

DESCRIPTION (provided by applicant): Widespread implementation of prophylactic human papillomavirus (HPV) vaccines could substantially decrease morbidity and mortality from cervical cancer and other HPV-related diseases. Information about epidemiologic trends in HPV after vaccine introduction in community settings is essential in order to assess the progress and population impact of HPV immunization programs, and to provide data for programmatic and policy decisions. Thus, we conducted pilot HPV surveillance studies among ~800 13-26 year-old young women, before (2007; none vaccinated) and three years after (2010; 59% vaccinated) widespread vaccine introduction in a community. We found: 1) a substantial decline in vaccine-type HPV prevalence among all women (58%), 2) evidence for herd protection (i.e. a decline of 49% in vaccine-type HPV among unvaccinated women), and 3) possible evidence for type-replacement (i.e. an increase of 25% in the prevalence of non- vaccine-type HPV among vaccinated women). The overall objective of this proposal is to further characterize the community-level impact of HPV vaccine introduction, in men as well as women, by determining changes in vaccine-type HPV, characterizing herd protection, and investigating possible type replacement during the first nine years after HPV vaccine introduction. We will pursue the following three specific aims: (1) Determine trends in vaccine-type HPV prevalence among young women and men to a) assess the epidemiologic impact of HPV vaccine introduction in the community, and b) explore changes in the prevalence of genetically-related HPV types; (2) Determine trends in vaccine-type HPV prevalence among unvaccinated young women and men, in order to a) characterize and b) examine mechanisms for herd protection after vaccine introduction in the community; and (3) Determine trends in non-vaccine-type HPV prevalence among vaccinated and unvaccinated young women and men, in order to a) investigate and b) examine alternative (e.g. statistical) explanations for HPV type-replacement. We plan to accomplish the overall objective using the following approach: we will enroll diverse samples of 13-26 year-old women (N=400) and men (N=400) in two additional surveillance studies (total N=1600), and examine vaccination rates and HPV prevalence at all four time points in women (2007, 2010, 2013, and 2016) and two time points in men (2013 and 2016). The proposed research is innovative because 1) it is the first study to provide empirical data concerning changes in vaccine-type HPV, herd protection, and type replacement during the first nine years after HPV vaccine introduction in both men and women; 2) the data could shift current research and clinical practice paradigms in vaccine development; and 3) the research plan utilizes novel concepts, approaches and methodologies to explore mechanisms of herd protection and type-replacement. The proposed research is significant, because it will help to characterize the community-level impact of HPV immunization programs and provide data that are essential for programmatic and policy decisions to maximize the public health impact of HPV vaccination.

描述（由申请人提供）：广泛实施预防性人乳头瘤病毒（HPV）疫苗可以大大降低宫颈癌和其他HPV相关疾病的发病率和死亡率。为了评估HPV免疫规划的进展和对人群的影响，并为规划和政策决策提供数据，在社区环境中引入疫苗后，有关HPV流行病学趋势的信息至关重要。因此，我们在约800名13-26岁的年轻女性中进行了HPV监测试点研究，在2007年（没有接种疫苗）和2010年（59%接种疫苗）在社区广泛引入疫苗之前和之后三年（59%接种疫苗）。我们发现：1)所有女性中疫苗型HPV患病率大幅下降（58%），2)群体保护的证据（即未接种疫苗的女性中疫苗型HPV患病率下降49%），以及3)类型替代的可能证据（即接种疫苗的女性中非疫苗型HPV患病率增加25%）。本建议的总体目标是通过确定HPV疫苗类型的变化，确定群体保护的特征，并调查HPV疫苗引入后的前9年可能的类型替代，进一步确定HPV疫苗引入对男性和女性的社区一级影响。我们将追求以下三个具体目标：(1)确定疫苗型HPV在年轻女性和男性中的流行趋势，a)评估HPV疫苗在社区引入的流行病学影响，以及b)探索遗传相关HPV类型流行的变化；(2)确定未接种疫苗的年轻男女中疫苗型HPV流行趋势，以便a)确定特征，b)检查社区引入疫苗后群体保护机制；(3)确定接种疫苗和未接种疫苗的年轻男女中非疫苗型HPV流行趋势，以便a)调查和b)检查HPV型替代的其他解释（例如统计）。我们计划采用以下方法实现总体目标：我们将在另外两项监测研究（总N=1600）中招募13-26岁女性（N=400）和男性（N=400）的不同样本，并在女性（2007年、2010年、2013年和2016年）和男性（2013年和2016年）的所有四个时间点检查疫苗接种率和HPV患病率。拟议的研究是创新的，因为1)它是第一个提供关于HPV疫苗在男性和女性引入HPV疫苗后的前9年期间疫苗型HPV，群体保护和类型替代变化的经验数据的研究；2)这些数据可以改变目前疫苗开发的研究和临床实践范式；3)运用新颖的概念、方法和方法来探索群体保护和类型替代的机制。拟议的研究意义重大，因为它将有助于描述HPV免疫规划在社区层面的影响，并为规划和政策决策提供必要的数据，以最大限度地提高HPV疫苗接种对公共卫生的影响。