Abstract
ABSTRACTBackgroundWorldwide, countries are examining whether to implement one-dose HPV vaccination. To inform policy recommendations in Canada, we used mathematical modeling to project the population-level impact and efficiency of switching from two-to one-dose gender-neutral routine HPV vaccination.MethodsWe used HPV-ADVISE, an individual-based transmission-dynamic model of HPV infections/diseases, to model 2 provinces (Quebec, Ontario), which represent higher (≈85%) and lower (≈65%) HPV vaccination coverage in Canada. We examined non-inferior and pessimistic scenarios of one-dose efficacy (VE=98%, 90%) and average duration (VD=lifelong, 30 years, 25 years) versus two doses (VE=98%, VD=lifelong). Our main outcomes were the relative reduction in HPV-16 (among females/males) and cervical cancers, and the number of doses needed to prevent one cervical cancer (NNV).ResultsOur model projects that one-dose HPV vaccination would avert a similar number of cervical cancers as two doses in Canada, under various non-inferior and pessimistic scenarios. Under the most pessimistic scenario (VD=25 years), one-dose vaccination would avert ∼3 percentage-points fewer cervical cancers than two doses over 100 years. All one-dose scenarios were projected to lead to cervical cancer elimination and were projected to be a substantially more efficient use of vaccine doses compared to two doses (NNVs one-dose vs no vaccination=800-1000; incremental NNVs two-dose vs one-dose vaccination >10,000).InterpretationIf the average duration of one-dose protection is longer than 25 years, individuals would be protected during their peak ages of sexual activity and one-dose vaccination would prevent a similar number of HPV-related cancers, while being a more efficient use of vaccine doses.
Publisher
Cold Spring Harbor Laboratory
Reference44 articles.
1. Meeting of the Strategic Advisory Group of Experts on Immunization, April 2022: conclusions and recommendations;World Health Organization (WHO;Wkly Epidemiol Rec,2022
2. Efficacy of Single-Dose Human Papillomavirus Vaccination among Young African Women;NEJM Evid,2022
3. Vaccine efficacy against persistent human papillomavirus (HPV) 16/18 infection at 10 years after one, two, and three doses of quadrivalent HPV vaccine in girls in India: a multicentre, prospective, cohort study
4. Evaluation of Durability of a Single Dose of the Bivalent HPV Vaccine: The CVT Trial;J Natl Cancer Inst,2020
5. Romero B , Herrero R , Porras C , et al. Durability of HPV-16/18 antibodies 16 years after a single dose of the bivalent vaccine: The Costa Rica HPV Vaccine Trial. 35nd International Papillomavirus Conference (IPVC); 2023 April 17-21; Washington, DC, USA; 2023.