How has post-implementation surveillance of high-coverage vaccination with HPV16/18-AS04 vaccine in England added to evidence about its cross-protective effects?

• Published in: Vaccine 2024-10, Vol.42 (24), p.126215, Article 126215
• Main Authors: Navarro-Torné, Adoración, Anderson, Anja, Panwar, Kavita, Ghys, Emmanuelle, Benninghoff, Bernd, Weynants, Vincent, Beddows, Simon, Checchi, Marta
• Format: Article
• Language: English
• Subjects: Chlamydia; Clinical trials; Cross-protection; Effectiveness; Efficacy; England; Estimates; Health services; HPV16/18-AS04; Human papillomavirus; Immunization; Infections; Laboratories; Medical screening; Observational studies; Public health; Sexual health; Surveillance; Vaccines; Warts; Womens health
• ISSN: 0264-410X; 1873-2518; 1873-2518
• DOI: 10.1016/j.vaccine.2024.126215

Background: Bivalent human papillomavirus HPV16/18-AS04 vaccine (Cervarix, GSK) offers direct protection against HPV16/18. Results from randomised controlled trials showed cross protective effects and suggested that declines in some closely related HPV types could be expected in a population with high vaccination coverage. Aim: To evaluate the evidence for cross-protection afforded by HPV16/18-AS04 from post-implementation surveillance in England, and how this complements clinical trial data and post-implementation observations in other countries. Methods: Evidence of cross-protection in young women offered vaccination with HPV16/18-AS04 was gathered from HPV surveillance in England. Data from clinical trials and other post-implementation studies were reviewed. Results: Surveillance using anonymised residual specimens in England found declines of 52.3%, 67.4% and 33.3% against grouped HPV-31/33/45 in 16–18, 19–21, and 22–24 year olds, respectively. Additionally, type-specific analysis found that the prevalence of HPV31 declined to below 1% across all age groups. Cross-protection has been monitored and maintained for over 10 years since the introduction of the vaccination programme. Cross-protection against HPV6/11 was not found in English surveillance outcomes. Conclusion: Surveillance of type-specific infections in vaccine-eligible populations in England has generated clear evidence of cross-protective effects from HPV16/18-AS04 vaccination against high-risk HPV 31/33/45 infections, consistent with other post-implementation observations and confirming and in some ways exceeding expectations from clinical trials. •Clinical trials suggested cross-protection could be expected from HPV16/18-AS04.•Surveillance in England showed cross-protective effects against HR-HPV 31/33/45.•The results are consistent with other post-HPV16/18-AS04 implementation observations.•Cross-protection appears to be strong and long-lasting for some HR-HPV types.•Protection offered by HPV16/18-AS04 against HPV may exceed initial expectations.