Population-level health impact of hypothetical waning 1-dose human papillomavirus vaccination and 2-dose mitigation strategies in a high cervical cancer burden setting.

Emily A Burger, Jean-François Laprise, Allison Portnoy, Jennifer C Spencer, Stephen Sy, Mary Caroline Regan, Élodie Bénard, Mélanie Drolet, Marc Brisson, Jane J Kim
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Abstract

Background: We simulated the impact of hypothetical waning scenarios of a 1-dose human papillomavirus (HPV) vaccination paired with switching to 2-dose mitigation strategies guided by empirical vaccine trial reporting timelines.

Methods: Using 2 independent mathematical models fitted to a high-burden setting, we projected the cumulative cervical cancer cases averted over 85 years for alternative HPV vaccination scenarios under 2 program adoption timelines: 1) de novo introduction of a 1-dose HPV vaccination and 2) a switch from an existing 2-dose HPV vaccination program to a 1-dose vaccination. We assumed 80% vaccination coverage with the bivalent vaccine and an average duration of a 1-dose HPV vaccine protection of either 30 or 25 years with 100% efficacy. We varied the eligible age group(s) at program introduction and the 2-dose mitigation (single-age cohort or multi-age cohort). If needed for mitigation, reintroduction of 2-dose vaccination was assumed to occur in 2036 (ie, 30 years after initiation of the Costa Rica Vaccine Trial).

Results: Under both vaccine adoption timelines, the models projected that countries could achieve the same level of health benefits by switching to 2 doses in 2036 using a multi-age cohort approach as with initiating a 2-dose or 1-dose vaccination program with no waning. With only a single-age cohort 2-dose mitigation approach, 98%-99% of cases would be prevented compared with the health benefits of 2 doses or a noninferior, durable 1 dose.

Conclusions: Countries hesitant to adopt a 1-dose HPV vaccination program may have opportunities to leverage the benefits and efficiency of a 1-dose schedule while awaiting longer-term reporting from 1-dose durability studies, including Costa Rica Vaccine Trial.

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在宫颈癌负担较重的环境中,假设性减弱 1 剂人类乳头瘤病毒疫苗接种和 2 剂缓解策略对人群健康的影响。
背景:我们模拟了1剂人乳头瘤病毒(HPV)疫苗接种的假设减弱情景,以及在经验疫苗试验报告时间表的指导下转向2剂缓解策略的影响:我们使用两个独立的数学模型来模拟高负担环境,预测了在两种计划采用时间表下,HPV 疫苗接种方案在 85 年内可避免的宫颈癌累计病例数:1)重新引入 1 剂 HPV 疫苗接种;2)从现有的 2 剂 HPV 疫苗接种计划转为 1 剂疫苗接种。我们假设二价疫苗的接种覆盖率为 80%,1 剂 HPV 疫苗的平均保护期为 30 年或 25 年,有效率为 100%。我们改变了计划引入时的合格年龄组和 2 剂缓解(单年龄组群或多年龄组群)。如果需要缓解,则假定在 2036 年(即哥斯达黎加疫苗试验启动 30 年后)重新引入 2 剂疫苗接种:结果:在采用两种疫苗的时间表下,根据模型预测,采用多年龄队列方法在2036年改用2剂疫苗接种,各国可获得的健康益处与启动2剂或1剂疫苗接种计划所获得的健康益处水平相同,且不会减弱。与2剂或非劣效、持久的1剂疫苗的健康益处相比,仅采用单年龄队列2剂缓解方法可预防98%-99%的病例:结论:对采用1剂HPV疫苗接种计划犹豫不决的国家可能有机会利用1剂接种计划的益处和效率,同时等待包括哥斯达黎加疫苗试验在内的1剂耐久性研究的长期报告。
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