Population-level impact of switching to 1-dose human papillomavirus vaccination in high-income countries: examining uncertainties using mathematical modeling.

Marc Brisson, Jean-François Laprise, Mélanie Drolet, Éléonore Chamberland, Élodie Bénard, Emily A Burger, Mark Jit, Jane J Kim, Lauri E Markowitz, Chantal Sauvageau, Stephen Sy
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Abstract

Background: A concern in high-income countries is that switching to 1-dose human papillomavirus (HPV) vaccination could cause a rebound in HPV infection and cervical cancer if 1-dose efficacy or duration were inferior to 2 doses. Using mathematical modeling and up-to-date trial-based data, we projected the population-level effectiveness of switching from 2-dose to 1-dose vaccination under different vaccine efficacy and duration assumptions in high-income countries.

Methods: We used HPV-ADVISE (Agent-based Dynamic model for VaccInation and Screening Evaluation), a transmission-dynamic model of HPV infection and cervical cancer, varying key model assumptions to identify those with the greatest impact on projections of HPV-16 and cervical cancer incidence over time: 1) 1-dose vaccine efficacy and vaccine duration, 2) mechanisms of vaccine efficacy and duration over time, 3) midadult (>30 years of age) sexual behavior, 4) progression to cervical cancer among midadults, and 5) vaccination coverage and programs.

Results: In high-income countries, 1-dose vaccination would cause no appreciable rebound in HPV-16 infection, except for a limited rebound under the most pessimistic assumptions of vaccine duration (average, 25 years), because 1) the switch would occur when HPV prevalence is low because of high 2-dose vaccination coverage and 2) individuals would be protected during their peak ages of sexual activity (<35 to 40 years of age). Our model projects a more limited rebound in cervical cancer because of a shift to older age at infection, resulting in fewer life-years left to potentially develop cancer. Projections were robust when varying key model assumptions.

Conclusions: High protection during peak ages of sexual activity in high-income countries would likely mitigate any potential rebounds in HPV infection and cervical cancer under the most pessimistic assumptions of 1-dose efficacy and duration.

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高收入国家改用 1 剂人类乳头瘤病毒疫苗接种对人口的影响:利用数学建模研究不确定性。
背景:高收入国家担心的一个问题是,如果接种1剂人类乳头瘤病毒(HPV)疫苗的效力或持续时间不如2剂疫苗,那么改用1剂疫苗接种可能会导致HPV感染和宫颈癌反弹。我们利用数学模型和基于试验的最新数据,预测了在不同疫苗效力和持续时间假设下,高收入国家从接种 2 剂疫苗改为接种 1 剂疫苗的人群有效性:我们使用了 HPV-ADVISE(基于代理的疫苗接种和筛查评估动态模型),这是一个关于 HPV 感染和宫颈癌的传播动态模型,我们改变了模型的主要假设,以确定那些对 HPV-16 和宫颈癌发病率的预测影响最大的假设:1) 1 剂疫苗的效力和疫苗持续时间;2) 疫苗效力和持续时间随时间变化的机制;3) 中年人(大于 30 岁)的性行为;4) 中年人患宫颈癌的进展;5) 疫苗接种覆盖率和接种计划。结果:在高收入国家,1剂疫苗接种不会导致HPV-16感染明显反弹,除了在最悲观的疫苗接种时间假设下(平均25年)会出现有限的反弹,这是因为:1)由于2剂疫苗接种覆盖率高,转换将发生在HPV流行率较低的时候;2)个人将在性活动高峰年龄段受到保护(结论:在性活动高峰年龄段受到高保护):在高收入国家,性活动高峰年龄段的高保护率很可能会减轻 HPV 感染和宫颈癌的潜在反弹,这是在最悲观的 1 剂疫苗效力和持续时间假设下得出的结论。
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