Genital wart cases drop after program launched

Five years after Australia launched a national human papillomavirus (HPV) vaccination program in young women, data indicates that genital wart cases have dropped not only among women, but heterosexual men as well.1

Australia implemented its initial quadrivalent vaccine national immunization program in 2007, first targeting girls ages 12-13, with catch-up programs launched from 2007-2009 for girls 13-18 and young women ages 18-26. In 2010 the vaccination coverage rates in the school-based program were reported to be 83% for the first dose, 80% for the second dose, and 73% for the third dose in those age 12-13, with coverage rates decreasing with increasing age.

To perform the current study, investigators from the University of New South Wales in Sydney and Melbourne Sexual Health Centre analyzed the ongoing population effect of the vaccination program five years after it was established. Data were taken from eight sexual health clinics; Australian-born patients who attended any of the clinics for the first time between January 2004 and December 2011 were included in the analysis.

The study period was divided into the pre-vaccination period (2004-2007) and the vaccination period (2007-2011). Researchers looked at three age groups: those under 21, those age 21-30, and those 30 and older.

Between 2004 and 2011, 85,770 patients were seen for the first time. Of these, 7,686 (9%) were diagnosed with genital warts. Overall, data indicate the proportion of women diagnosed with genital warts increased during the pre-vaccination period from 9% in 2004 to 10% in 2007, then decreased in the vaccination period to 3%. In men, the proportion remained relatively stable in the pre-vaccination period from 13% in 2004 to 12% in 2007, and then decreased during the vaccination period to 7%.

In women under age 21, results showed that 9% were diagnosed with genital warts in 2004 and 11% in 2007. During the vaccination period, the proportion declined dramatically to 0.85% (13 cases). In 2011, none of the vaccinated women under age 21 were diagnosed with genital warts. In the same year, 7% of unvaccinated women under age 21 (out of 161) were diagnosed with genital warts. Significant declines in genital warts also were seen in women ages 21-30, and heterosexual men under age 21 and ages 21-30, during the vaccination period.1

Shot makes mark

What are some of the reasons the HPV vaccine has been so well-received in Australia?

Acceptance of the HPV vaccine stems from its universally offered school-based program and its marketing as a cancer vaccine, says the study’s lead author, Basil Donovan, MD, professor and head of the Sexual Health Program at The Kirby Institute at the University of New South Wales, Sydney, Australia,.

“The influence of religious extremists is minimal in Australia, as is the influence of the general anti-vaccination lobby,” says Donovan. “As a background issue, the virus-like-particle that forms the basis of the vaccine was an Australian invention, and the inventor, Professor Ian Fraser, is a national hero. Perhaps this gives Australians some sense of ownership.”

Australia’s success with HPV vaccine uptake has made an impact on other European countries. According to Colm O’Mahony, MD a consultant in genito-urinary medicine at the Countess of Chester Hospital in Chester, England, and co-author of an accompanying editorial to the current research, vaccine uptake in the United Kingdom has been “very good — around 80%.”

What about young males?

How about immunization in young males? In 2013, the Australian government began a publicly funded HPV vaccination program for boys ages 12-13, with a catch-up for boys ages 14-15. No national program has yet been implemented in the United Kingdom, says O’Mahony.

“The Joint Committee on Vaccination and Immunization is aware of the benefit of vaccinating boys, but no decision has been made yet,” he notes. “In the current financial meltdown of the National Health Service, we are not hopeful of getting a male vaccination program.”

Where is the United States in HPV vaccine uptake? According to a 2013 report, 32% (95% confidence interval [CI] = 30.3% to 33.6%) of girls ages 13-17 in 2010 had received three doses of the HPV vaccine.2 Coverage was statistically significantly lower among the uninsured (14.1%, 95% CI = 9.4% to 20.6%) and in some Southern states, such as in Alabama (20.0% [95% CI = 13.9% to 27.9%]) and Mississippi [95% CI = 13.8% to 28.2%]), where cervical cancer rates were highest and recent Pap testing prevalence was the lowest.2

HPV vaccines are given as three shots to protect against HPV infection and HPV-related diseases. There are two approved vaccines. Cervarix is a bivalent vaccine that protects against HPV types 16 and 18. Gardasil, a quadrivalent vaccine, guards against HPV types 16 and 18, which are associated with most HPV-related cancers, as well as HPV types 6 and 11, which are associated with the occurrence of anal and genital warts. Both vaccines have been approved to protect against cervical cancers in women; Gardasil also is approved to guard against genital warts, as well as cancers of the anus, vagina, and vulva. Both vaccines are available for females; Gardasil is available for males.

Current recommendations by the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices call for preteen girls and boys to receive the vaccine at ages 11 or 12. The HPV vaccines are recommended for all teen girls and women up to age 26 who did not get all three doses of the vaccine when they were younger, and for all teen boys and men through age 21 who did not get all three doses of the vaccine when they were younger. It is also recommended for gay and bisexual men or any men who have sex with men, as well as men with compromised immune systems, including HIV infection, through age 26.3

References

1. Ali H, Donovan B, Wand H, et al. Genital warts in young Australians five years into national human papillomavirus vaccination programme: national surveillance data. BMJ 2013; doi: http://dx.doi.org/10.1136/bmj.f2032.

2. Barton S, O’Mahony C. HPV vaccination — reaping the rewards of the appliance of science. BMJ 2013; doi: 10.1136/bmj.f2184.

3. Simard E. Status of HPV-Related Cancers and Vaccination Trends. Podcast Feb. 21, 2013. Accessed at http://bit.ly/Yqe0Tg.