Different Challenges in Eliminating HPV16 Compared to Other Types: A Modeling Study
Different Challenges in Eliminating HPV16 Compared to Other Types: A Modeling Study
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DOI：
10.1093/infdis/jix299
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发表时间：
2017-08-01
影响因子：
6.4
通讯作者：
Franceschi, Silvia
中科院分区：
文献类型：
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作者：
Baussano, Iacopo;Lazzarato, Fulvio;Franceschi, Silvia
背景。许多高危人群仍未接种人乳头瘤病毒 (HPV) 疫苗。 HPV16/18 疫苗可针对其他类型（例如 HPV45）提供交叉保护。直接疫苗效力和间接群体保护都有助于提高疫苗接种效力。方法。我们使用动态传播模型（根据意大利的宫颈筛查数据进行校准）来估计针对 HPV16 和 HPV45 感染的疫苗接种效果，假设 HPV45 的交叉保护率为 95% 或更低。结果。 HPV45 的基本繁殖数较小（2.1 比 4.0），因此 HPV45 的疫苗有效性和群体保护作用强于 HPV16。 35 岁以下女性感染率降低的最大差异在于，仅限女孩的疫苗接种计划的覆盖率为 70%（HPV45 和 HPV16 的总保护分别为 99% 和 83%，主要是由于更强的群体保护，即 37% 和 16%）。在不分性别的疫苗接种中，最大差异在于 40% 的覆盖率（群体保护，HPV16 和 HPV45 分别为 54% 和 28%）。覆盖率 >= 80% 时，即使 50% 交叉保护也会将 HPV45 降低 >= 94%。结论。个体高危 HPV 类型的特征强烈影响群体保护，并决定通过 HPV 疫苗接种减少或消除感染所需的覆盖和交叉保护水平。 HPV16感染和相关癌症是最难消除的。
Background. Human papillomavirus (HPV) vaccination is still not reaching many high-risk populations. HPV16/18 vaccines offer cross-protection against other types, for example, HPV45. Both direct vaccine efficacy and indirect herd protection contribute to vaccination effectiveness.Methods. We used a dynamic transmission model, calibrated to cervical screening data from Italy, to estimate vaccination effectiveness against HPV16 and HPV45 infection, assuming for HPV45 either 95% or lower cross-protection.Results. Basic reproductive number was smaller (2.1 vs 4.0) and hence vaccine effectiveness and herd protection stronger for HPV45 than for HPV16. The largest difference in the reduction of infection prevalence in women < 35 years old was found at 70% coverage in girls-only vaccination programs (99% vs 83% for total protection for HPV45 and HPV16, respectively, mainly owing to stronger herd protection, ie, 37% vs 16%). In gender-neutral vaccination, the largest difference was at 40% coverage (herd protection, 54% vs 28% for HPV16 and HPV45, respectively). With >= 80% coverage, even 50% cross-protection would reduce HPV45 by >= 94%.Conclusions. The characteristics of individual high-risk HPV types strongly influence herd protection and determine the level of coverage and cross-protection required to reduce or eliminate the infection through HPV vaccination. HPV16 infection and related cancers are the most difficult to eliminate.