Human Papillomavirus Vaccine Effectiveness Against HPV Infection: Evaluation of One, Two, and Three Doses

• Published in: The Journal of infectious diseases 2020-03, Vol.221 (6), p.910-918
• Main Authors: Markowitz, Lauri E, Naleway, Allison L, Klein, Nicola P, Lewis, Rayleen M, Crane, Brad, Querec, Troy D, Hsiao, Amber, Aukes, Laurie, Timbol, Julius, Weinmann, Sheila, Liu, Gui, Steinau, Martin, Unger, Elizabeth R
• Format: Article
• Language: English
• Subjects: Cervical cancer; Cervix; Cytology; Effectiveness; Human papillomavirus; Vaccine efficacy; Vaccines
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/jiz555

Abstract Background Highly effective human papillomavirus (HPV) vaccines are used in many national programs in 3- or 2-dose schedules. We examined HPV vaccine effectiveness against HPV prevalence by number of doses. Methods We collected residual liquid-based cytology samples from US women aged 20–29 years who were screened for cervical cancer. Women continuously enrolled from 2006 through the specimen collection date were analyzed. Specimens were tested using the Linear Array assay. We analyzed prevalence of quadrivalent HPV vaccine (4vHPV) types (HPV 6,11,16,18) and other HPV-type categories and determined prevalence ratios (PRs) and 95% confidence intervals (CIs) for 1, 2, and 3 compared with no vaccine doses. Results Among 4269 women, 1052 (24.6%) were unvaccinated, 2610 (61.1%) received 3 doses, 304 (7.1%) received 2 doses, and 303 (7.1%) received 1 dose. The 4vHPV-type prevalence was 7.4% among unvaccinated women compared with 1.7%, 1.0%, and 1.0% among 1-, 2-, and 3-dose recipients. Among women vaccinated at ≤18 years, adjusted PRs for 1, 2, and 3 doses were 0.06 (95% CI, 0.01–0.42), 0.05 (95% CI, 0.01–0.39), and 0.06 (95% CI, 0.04–0.12). Conclusions Among women who received their first dose at age ≤18, estimated HPV vaccine effectiveness was high regardless of number of doses. In this observational study of HPV vaccine effectiveness for prevention of vaccine-type prevalent infection, among women who had received their first vaccine dose at age ≤18 years, estimated vaccine effectiveness for 1, 2, and 3 doses was 92% or greater.