Vaccine-Type Human Papillomavirus and Evidence of Herd Protection After Vaccine Introduction

Clinical trials have demonstrated that prophylactic human papillomavirus (HPV) vaccines are highly effective in preventing HPV infection, but the impact of vaccination on HPV prevalence rates in real-world, community settings is uncertain. WHAT THIS STUDY ADDS:This study provides evidence of a substantial decrease in the prevalence of vaccine-type HPV among young women and evidence of herd protection in a community only 4 years after the quadrivalent HPV vaccine was licensed.abstract OBJECTIVES: The aims of this study were to compare prevalence rates of human papillomavirus (HPV) in young women before and after HPV vaccine introduction to determine the following: (1) whether vaccine-type HPV infection decreased, (2) whether there was evidence of herd protection, and (3) whether there was evidence for typereplacement (increased prevalence of nonvaccine-type HPV).METHODS: Young women 13 to 26 years of age who had had sexual contact were recruited from 2 primary care clinics in 2006-2007 for a prevaccination surveillance study (N = 368, none were vaccinated) and 2009-2010 for a postvaccination surveillance study (N = 409, 59% were vaccinated).Participants completed a questionnaire and were tested for cervicovaginal HPV DNA.HPV prevalence rates were compared in the pre-versus postsurveillance studies by using x 2 tests.Propensity score weighting was used to balance differences in covariates between the 2 surveillance studies. RESULTS:The mean age was ∼19 years for both groups of participants and most were African American and non-Hispanic.After propensity score weighting, the prevalence rate for vaccine-type HPV decreased substantially (31.7%-13.4%,P , .0001).The decrease in vaccine-type HPV not only occurred among vaccinated (31.8%-9.9%,P , .0001) but also among unvaccinated (30.2%-15.4%,P , .0001)postsurveillance study participants.Nonvaccine-type HPV increased (60.7%-75.9%,P , .0001) for vaccinated postsurveillance study participants.CONCLUSIONS: Four years after licensing of the quadrivalent HPV vaccine, there was a substantial decrease in vaccine-type HPV prevalence and evidence of herd protection in this community.The increase in nonvaccine-type HPV in vaccinated participants should be interpreted with caution but warrants further study.