EXECUTIVE SUMMARY

The Advisory Committee on Immunization Practices (ACIP) recently approved use of the 9-valent HPV vaccine for persons ages 27-45 years. The recommendation to expand use of the vaccine comes as findings from a large meta-analysis indicate that the HPV vaccine has substantially reduced infections and precancerous lesions.

  • ACIP’s recommendation is for men and women in the noted age range who have not previously received an HPV vaccine series and who are at risk of acquiring HPV. The shot is most effective when given during the recommended ages of 11-12 years.
  • The FDA approved the use of the 9-valent HPV vaccine in women and men ages 27-45 years in October 2018. However, ACIP’s recent recommendation is an important move, since insurance reimbursement often is based on the committee’s guidance.

The Advisory Committee on Immunization Practices (ACIP) recently approved use of the 9-valent HPV vaccine for persons ages 27-45 years. The recommendation to expand use of the vaccine comes as findings from a large meta-analysis indicate that the HPV vaccine has substantially reduced infections and precancerous lesions.1

ACIP’s recommendation is for men and women in the noted age range who have not previously received an HPV vaccine series and who are at risk for acquisition of HPV. The shot is most effective when administered during the recommended ages of 11-12 years.

Providers are encouraged to discuss the potential benefits of HPV vaccination with patients in the mid-age category, addressing the reduced efficacy compared to vaccination within the younger target age range, as well as the reduced risk of high-grade disease and cervical cancer, notes Christopher Zahn, MD, vice president of practice activities at the American College of Obstetricians and Gynecologists.

“Women’s decisions will also likely consider their individual circumstances, preferences, and concerns, and the role of the obstetrician-gynecologist is to provide unbiased information in a balanced, thorough way in order to aid that decision-making,” Zahn said in a statement. (The statement can be found at: https://bit.ly/2Z4me7f.)

The FDA approved the use of the 9-valent HPV vaccine in women and men ages 27-45 years in October 2018. However, ACIP’s recent recommendation is an important move, since insurance reimbursement often is based on the committee’s guidance.

Data are growing in support of the effectiveness of the HPV vaccine. The authors of a 2015 study noted that the prevalence of HPV 16/18 in lesions decreased from 53.6% to 28.4% among women who received at least one dose of the HPV vaccine, with no significant statistical difference among unvaccinated women or those with unknown vaccination status.2

In a recent study, researchers examined health data on 1,580 women ages 13-26 years from hospital-based or community health clinics. Data were collected in four waves between 2006 and 2017. The analysis shows HPV vaccination rates rose from 0% to 84.3%, with almost all vaccinated women receiving the earlier quadrivalent vaccine. Data indicate that among vaccinated women, 4-valent type HPV infections decreased 81% from 35% to 6.7%. Compared to the first 2006-2007 wave, vaccine effectiveness was 90% in the 2013-2014 third wave, and 80% in the 2016-2017 fourth wave.3

The effect of the HPV vaccine is further magnified with results from the new meta-analysis, which included 60 million individuals in 14 countries. The report authors note significant decreases in HPV infections, anogenital wart diagnoses, and precancerous cervical lesions (cervical squamous intraepithelial neoplasia 2, or CIN2+) over eight to nine years after administering girls-only HPV vaccination.1

The study authors reviewed 65 studies in 14 countries that established HPV vaccine programs in the last 10 years. Investigators examined the frequency of HPV infections, anogenital warts, and precancerous cervical lesions before and after such programs were initiated.

Findings indicate that infections dropped by 83% among girls ages 13-19 years, and 66% among women ages 20-24 years. In the case of anogenital warts, numbers fell 67% among teen females ages 15-19 years, 54% in women ages 20-24 years, and 31% for those ages 25-29 years. Levels of precancerous cervical lesions also decreased 51% among teens ages 15-19 years, and 31% among women ages 20-24 years.

Vaccination of young women also is producing herd protection for young men, according to the report. Anogenital warts among males have decreased 48% for those in the ages 15 to 19 years bracket, and 32% for those ages 20-24 years.1

While HPV vaccination still is too recent to directly measure its effects on cervical cancer, the recent analysis indicates that vaccination is producing substantial reductions in the infections that cause cervical cancer and precancerous lesions, says co-author Mélanie Drolet, PhD, an epidemiologist and senior research associate in epidemiology at Université Laval in Québec City. The decreases are a first sign that vaccination could eventually lead to the elimination of cervical cancer as a public health problem, she states.

“We are now trying to determine when elimination could be achieved and which vaccination and screening programs could help us achieve it faster,” Drolet said in a statement. (The statement can be found online at: https://bit.ly/2Z4oag1.)

REFERENCES

  1. Drolet M, Bénard É, Pérez N. HPV Vaccination Impact Study Group. Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: Updated systematic review and meta-analysis. Lancet 2019; doi:10.1016/S0140-673630298-3.
  2. Hariri S, Bennett NM, Niccolai LM, et al; HPV-IMPACT Working Group. Reduction in HPV 16/18-associated high grade cervical lesions following HPV vaccine introduction in the United States — 2008-2012. Vaccine 2015;33:1,608-1,613.
  3. Spinner C, Ding L, Bernstein DI, et al. Human papillomavirus vaccine effectiveness and herd protection in young women. Pediatrics 2019; doi:10.1542/peds.2018-1902.