Validating the predicted impact of HPV vaccination on HPV prevalence, cervical lesions, and cervical cancer: A systematic review of population level data and modelling studies
Daniël de Bondt , Emi Naslazi , Erik Jansen , Rachel Kupets , Bronwen McCurdy , Christine Stogios , Inge de Kok , Jan Hontelez
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Abstract
Background
We compared model predictions with independently published primary data from population-based studies on the impact of HPV vaccination on HPV prevalence, cervical cancer and its precursors.
Methods
We searched Cochrane Library, EMBASE, MEDLINE, Web of Science for studies concerning high-income countries published between 2005 to June 2, 2023. Relative risk (RR) for HPV-related outcomes comparing the pre-vaccination and post-vaccination periods were collected from observational and modelling studies. The relationship between vaccination coverage and observed relative reductions was determined using meta-regressions, and we compared model prediction to observations.
Findings
We identified a total of 5649 potential articles, of which one systematic review, 14 observational studies and 32 modelling studies met our inclusion criteria. A clear relation was found between the RR of HPV diseases related outcomes in the pre- versus post-vaccination era and the vaccination coverage, with 23 out of 28 data points and 19 out of 20 data points showing significant reductions in HPV prevalence and CIN2+ prevalence respectively. Around 67 % (n/N = 12/18) of model predictions were more optimistic on HPV prevalence reductions compared to the 95 % CI of the meta-regression derived from observational studies. For CIN2+ lesions, 48 % (n/N = 31/64) of model predictions for CIN2+ outcomes fell within the 95 % CI.
Interpretation
Model predictions and observational data agree that HPV vaccination can have a substantial impact on HPV related outcomes on a population level. Despite large heterogeneity in observational data and modelling studies, it is particularly encouraging that model predictions on the impact of HPV vaccination on CIN2+ model lesions align with observational studies.
Funding
Ontario Health (formerly known as Cancer Care Ontario).
我们将模型预测与独立发表的基于人群的HPV疫苗接种对HPV患病率、宫颈癌及其前体的影响的原始数据进行了比较。方法检索Cochrane Library、EMBASE、MEDLINE、Web of Science，检索2005年至2023年6月2日发表的有关高收入国家的研究。比较接种前和接种后hpv相关结果的相对风险（RR）来自观察性和模型研究。疫苗接种覆盖率与观察到的相对减少之间的关系使用元回归确定，并将模型预测与观察结果进行比较。结果：我们共确定了5649篇潜在的文章，其中1篇系统综述、14项观察性研究和32项模型研究符合我们的纳入标准。疫苗接种前后HPV疾病相关结果的RR与疫苗接种覆盖率之间存在明确的关系，28个数据点中的23个数据点和20个数据点中的19个数据点分别显示HPV患病率和CIN2+患病率显着降低。约67% （n/ n = 12/18）的模型预测对HPV患病率降低更为乐观，而来自观察性研究的meta回归的CI为95%。对于CIN2+病变，48% （n/ n = 31/64）的CIN2+预后模型预测在95% CI范围内。模型预测和观察数据一致认为，HPV疫苗接种可以在人群水平上对HPV相关结果产生实质性影响。尽管观察性数据和模型研究存在很大的异质性，但特别令人鼓舞的是，关于HPV疫苗接种对CIN2+模型病变影响的模型预测与观察性研究一致。资助安大略健康（以前称为安大略癌症护理）。
期刊介绍：
Gynecologic Oncology, an international journal, is devoted to the publication of clinical and investigative articles that concern tumors of the female reproductive tract. Investigations relating to the etiology, diagnosis, and treatment of female cancers, as well as research from any of the disciplines related to this field of interest, are published.
Research Areas Include:
• Cell and molecular biology
• Chemotherapy
• Cytology
• Endocrinology
• Epidemiology
• Genetics
• Gynecologic surgery
• Immunology
• Pathology
• Radiotherapy
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