Dataset Information

Vaccinating Girls and Boys with Different Human Papillomavirus Vaccines: Can It Optimise Population-Level Effectiveness?

ABSTRACT:

Background

Decision-makers may consider vaccinating girls and boys with different HPV vaccines to benefit from their respective strengths; the quadrivalent (HPV4) prevents anogenital warts (AGW) whilst the bivalent (HPV2) may confer greater cross-protection. We compared, to a girls-only vaccination program with HPV4, the impact of vaccinating: 1) both genders with HPV4, and 2) boys with HPV4 and girls with HPV2.

Methods

We used an individual-based transmission-dynamic model of heterosexual HPV infection and diseases. Our base-case scenario assumed lifelong efficacy of 100% against vaccine types, and 46,29,8,18,6% and 77,43,79,8,0% efficacy against HPV-31,-33,-45,-52,-58 for HPV4 and HPV2, respectively.

Results

Assuming 70% vaccination coverage and lifelong cross-protection, vaccinating boys has little additional benefit on AGW prevention, irrespective of the vaccine used for girls. Furthermore, using HPV4 for boys and HPV2 for girls produces greater incremental reductions in SCC incidence than using HPV4 for both genders (12 vs 7 percentage points). At 50% vaccination coverage, vaccinating boys produces incremental reductions in AGW of 17 percentage points if both genders are vaccinated with HPV4, but increases female incidence by 16 percentage points if girls are switched to HPV2 (heterosexual male incidence is incrementally reduced by 24 percentage points in both scenarios). Higher incremental reductions in SCC incidence are predicted when vaccinating boys with HPV4 and girls with HPV2 versus vaccinating both genders with HPV4 (16 vs 12 percentage points). Results are sensitive to vaccination coverage and the relative duration of protection of the vaccines.

Conclusion

Vaccinating girls with HPV2 and boys with HPV4 can optimize SCC prevention if HPV2 has higher/longer cross-protection, but can increase AGW incidence if vaccination coverage is low among boys.

SUBMITTER: Drolet M

PROVIDER: S-EPMC3694081 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Vaccinating Girls and Boys with Different Human Papillomavirus Vaccines: Can It Optimise Population-Level Effectiveness?

Drolet Mélanie M Boily Marie-Claude MC Van de Velde Nicolas N Franco Eduardo L EL Brisson Marc M

PloS one 20130626 6

<h4>Background</h4>Decision-makers may consider vaccinating girls and boys with different HPV vaccines to benefit from their respective strengths; the quadrivalent (HPV4) prevents anogenital warts (AGW) whilst the bivalent (HPV2) may confer greater cross-protection. We compared, to a girls-only vaccination program with HPV4, the impact of vaccinating: 1) both genders with HPV4, and 2) boys with HPV4 and girls with HPV2.<h4>Methods</h4>We used an individual-based transmission-dynamic model of het ...[more]

PMID: 23840589

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Project description:ObjectiveTo assess the reduction in the vaccine preventable burden of cancer in men if boys are vaccinated along with girls against oncogenic human papillomavirus (HPV).DesignBayesian evidence synthesis approach used to evaluate the impact of vaccination against HPV types 16 and 18 on the burden of anal, penile, and oropharyngeal carcinomas among heterosexual men and men who have sex with men. The reduced transmission of vaccine-type HPV from vaccination of girls was assumed to lower the risk of HPV associated cancer in all men but not to affect the excess risk of HPV associated cancers among men who have sex with men.SettingGeneral population in the Netherlands.InterventionInclusion of boys aged 12 into HPV vaccination programmes.Main outcome measuresQuality adjusted life years (QALYs) and numbers needed to vaccinate.ResultsBefore HPV vaccination, 14.9 (95% credible interval 12.2 to 18.1) QALYs per thousand men were lost to vaccine preventable cancers associated with HPV in the Netherlands. This burden would be reduced by 37% (28% to 48%) if the vaccine uptake among girls remains at the current level of 60%. To prevent one additional case of cancer among men, 795 boys (660 to 987) would need to be vaccinated; with tumour specific numbers for anal, penile, and oropharyngeal cancer of 2162, 3486, and 1975, respectively. The burden of HPV related cancer in men would be reduced by 66% (53% to 805) if vaccine uptake among girls increases to 90%. In that case, 1735 boys (1240 to 2900) would need to be vaccinated to prevent an additional case; with tumour specific numbers for anal, penile, and oropharyngeal cancer of 2593, 29107, and 6484, respectively.ConclusionsMen will benefit indirectly from vaccination of girls but remain at risk of cancers associated with HPV. The incremental benefit of vaccinating boys when vaccine uptake among girls is high is driven by the prevention of anal carcinomas, which underscores the relevance of HPV prevention efforts for men who have sex with men.

Project description:Human Papillomavirus (HPV) vaccination is of paramount importance to reduce HPV-associated cancers in both genders. In South Korea, the prophylactic vaccine is recognized as prevention of cervical cancer with little attention given to male HPV vaccination. The purpose of this study was to explore perceptions of male HPV vaccination and underlying factors for vaccine hesitancy among mothers of unvaccinated boys in Seoul, Korea using a qualitative method. We used a purposive sampling strategy to recruit mothers of unvaccinated middle school-aged boys living in one of the 25 districts in Seoul, supplemented by a snowball sampling approach. We conducted one-on-one telephone interviews with ten mothers using a semi-structured interview guide. Questions probed mothers' views on vaccinating boys against HPV and the reasons for not vaccinating their sons. We found that mothers were hesitant to vaccinate their sons against HPV due to high out-of-pocket costs, fear of side effects concerning the young age of their sons, and low awareness of HPV and HPV vaccine, all of which stemmed from the exclusion of male HPV vaccination in the national immunization program. Sociocultural factors, including vaccination norms, lack of HPV education, and values associated with sexually transmitted infections were also likely to negatively impact mothers' vaccination decision-making. Despite the barriers, mothers were willing to accept HPV vaccination when it was framed as cancer prevention for not only the sons but also their future spouses. In conclusion, reasons for Korean mothers' hesitancy for their sons' HPV vaccine uptake were multifaceted. Healthcare providers' role in emphasizing and conveying the importance of gender-neutral HPV vaccination will be essential to alleviate negative sentiments around the vaccine for boys and reduce their risk of compromised sexual health. As an effective public health strategy, tailored cancer prevention messages should be delivered heightening significant benefits of the HPV vaccine beyond the prevention of cervical cancer.

Project description:Puberty is marked by substantial increases and emerging sex differences in psychological disorders and risky behaviors. However, few studies have examined these effects beyond adolescence, and the previous literature has been dominated by samples of White girls. The current study examines the broadest known set of health sequelae related to traditional pubertal markers and peer-relative pubertal timing in a representative sample of 14,545 U.S. youth from the National Longitudinal Study of Adolescent to Adult Health. Maturational timing was assessed by age at menarche for girls and physical development for boys (e.g., facial hair, voice change), and then categorized as early (1 SD below mean), on-time, or late (1 SD above mean) within-sex. Early and late peer-relative timing was assessed by a self-report of looking "much older" or "much younger" than one's peers. We examined psychological (depressive symptoms, antisocial behavior), behavioral (number of sex partners, drug use, physical activity, screen time, sleep hours), and physical health (self-reported health, BMI) outcomes during adolescence and young adulthood in a series of sex-stratified regression analyses using survey weights and a comprehensive set of sociodemographic covariates. Results indicated that, overall, earlier pubertal timing (i.e., maturational timing and peer-relative timing) put both girls and boys at risk during adolescence, while later timing was protective. However, longitudinal models revealed mixed results. For instance, early maturational timing was associated with higher young adult BMI (girls: β = 0.139, p < .01; boys: β = 0.107, p < .01), but later timing for boys was associated with both risky (e.g., more screen time; β = 0.125, p < .05) and health promoting (e.g., more sleep; β = .296, p < .01) behaviors. Analysis of this holistic set of outcomes with sex differences in mind allows for more careful evidence-based recommendations for adolescent health promotion.

Project description:BACKGROUND:Postural stability is one of the determinants of proper body posture and a condition for developing motor abilities in every human being. The measurement of the centre of pressure (COP) location and displacement is the most common technique of postural stability assessment. OBJECTIVE:The aim of this study was to assess differences in postural stability depending on sex of 5-year-old children with different body heights. METHODS:A study included 435 healthy children (200 girls and 235 boys) born in 2010 whose parents gave a written consent to their participation in the project. Postural stability was assessed with the use of the dynamographic platform (Zebris FDM 1.8). The assessment of postural stability was based on COP shift parameters (sway path length of COP and average velocity of COP) and COP surface area parameters (area of the ellipse, length of ellipse in the anterior-posterior direction and length of the ellipse in the medial-lateral direction). Body height was measured with Holtein anthropometer and the obtained values were compared with percentile ranks determined by the WHO. RESULTS:The analysis of the parameters describing postural stability in the examined children revealed dimorphism. For the COP shift parameters and COP surface area parameters, the level of statistical significance was recorded for girls and boys. Girls achieved lower results of these parameters than boys regardless of their body height. In the groups of normal- and tall-statured children, differences between the genders were statistically significant. CONCLUSIONS:The present study characterised sex differences in postural stability of 5-year-old children. Sex-related differences were found during a natural stance for all COP parameters. Girls maintained a two-legged standing position with lower sway velocity and a smaller range of sway than their male counterparts. Normal- and tall-statured girls demonstrated better postural stability significantly more often than boys.

Project description:BackgroundReaching and maintaining high global human papillomavirus (HPV) vaccine uptake has been challenging. The impact of publicly funded HPV immunization programs and the interplay of sociodemographic, psychosocial and policy factors in maximizing vaccination is poorly understood. This observational study examined the impact of introducing publicly funded school-based HPV vaccination programs for boys directly on uptake in boys and indirectly on uptake in girls, while concurrently examining other important sociodemographic and psychosocial factors.MethodsData were collected from a national, longitudinal sample of Canadian parents of children aged 9-16 years during August-September 2016 (T1) and June-July 2017 (T2). Participants completed an online questionnaire measuring sociodemographic characteristics, vaccine knowledge and attitudes, health care provider recommendation, and HPV vaccine uptake. Analyses were conducted separately for parents of boys and girls using logistic regression analyses at T1 and T2. Jurisdictions with HPV vaccine funding for boys at both time-points were compared to those with funding at neither time-points and those that introduced funding between time-points.FindingsThe sample included parents of boys (n = 716) and girls (n = 843). In multivariable analyses, jurisdictions with funding for boys at both time-points had higher odds of vaccination (adjusted odds ratio, T1 = 10.18, T2 = 11.42; 95% confidence interval, T1 = 3.08-33.58, T2 = 5.61-23.23) than jurisdictions without funding at both time-points; however, funded jurisdictions did not have higher odds of vaccination compared to jurisdictions that newly introduced funding for boys. Vaccination was associated with consistent determinants in boys and girls including child's age, health care provider recommendation, perceived vaccine harms, and perceived vaccine affordability.InterpretationThis gender-sensitive analysis highlights the interplay of sociodemographic, psychosocial, and policy factors that can improve HPV vaccination. Publicly funded school-based programs are an impactful strategy to increase vaccine uptake.FundingThis work was supported by the Canadian Cancer Society Research Institute (#704,036). GKS was supported by the Vanier Canada Graduate Scholarship and Queen Elizabeth II Diamond Jubilee Scholarship programs. The funders of this work had no role in the data collection, analysis, or interpretation, or any aspect pertinent to the study.

Project description:BackgroundHuman papillomavirus (HPV) is the most widespread sexually transmitted infection worldwide. It causes several health consequences, in particular accounting for the majority of cervical cancer cases in women. In the United Kingdom, a vaccination campaign targeting 12-year-old girls started in 2008; this campaign has been successful, with high uptake and reduced HPV prevalence observed in vaccinated cohorts. Recently, attention has focused on vaccinating both sexes, due to HPV-related diseases in males (particularly for high-risk men who have sex with men) and an equity argument over equalising levels of protection.MethodsWe constructed an epidemiological model for HPV transmission in the UK, accounting for nine of the most common HPV strains. We complemented this with an economic model to determine the likely health outcomes (healthcare costs and quality-adjusted life years) for individuals from the epidemiological model. We then tested vaccination with the three HPV vaccines currently available, vaccinating either girls alone or both sexes. For each strategy we calculated the threshold price per vaccine dose, i.e. the maximum amount paid for the added health benefits of vaccination to be worth the cost of each vaccine dose. We calculated results at 3.5% discounting, and also 1.5%, to consider the long-term health effects of HPV infection.ResultsAt 3.5% discounting, continuing to vaccinate girls remains highly cost-effective compared to halting vaccination, with threshold dose prices of £56-£108. Vaccination of girls and boys is less cost-effective (£25-£53). Compared to vaccinating girls only, adding boys to the programme is not cost-effective, with negative threshold prices (-£6 to -£3) due to the costs of administration. All threshold prices increase when using 1.5% discounting, and adding boys becomes cost-effective (£36-£47). These results are contingent on the UK's high vaccine uptake; for lower uptake rates, adding boys (at the same uptake rate) becomes more cost effective.ConclusionsVaccinating girls is extremely cost-effective compared with no vaccination, vaccinating both sexes is less so. Adding boys to an already successful girls-only programme has a low cost-effectiveness, as males have high protection through herd immunity. If future health effects are weighted more heavily, threshold prices increase and vaccination becomes cost-effective.

Project description:BackgroundThe nine-valent human papillomavirus (9vHPV) vaccine protects against infection and disease related to HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58. The pivotal 36-month Phase III immunogenicity study of 9vHPV vaccine in 9- to 15-year-old girls and boys was extended to assess long-term immunogenicity and effectiveness through approximately 10 years after vaccination. We describe results of an interim analysis based on approximately 8 years of follow-up after vaccination.MethodsParticipants aged 9-15 years who received three doses of 9vHPV vaccine (at day 1, month 2, and month 6) in the base study and consented to follow-up were enrolled in the long-term follow-up study extension (N = 1272 [females, n = 971; males, n = 301]). Serum was collected at months 66 and 90 to assess antibody responses. For effectiveness analysis, genital swabs were collected (to assess HPV DNA by polymerase chain reaction [PCR]) and external genital examination was conducted (to detect external genital lesions) every 6 months starting when the participant reached 16 years of age. Cervical cytology tests were conducted annually when female participants reached 21 years of age; participants with cytological abnormalities were triaged to colposcopy based on a protocol-specified algorithm. External genital and cervical biopsies of abnormal lesions were performed, and histological diagnoses were adjudicated by a pathology panel. Specimens were tested by PCR to detect HPV DNA.ResultsGeometric mean titers for each 9vHPV vaccine HPV type peaked around month 7 and gradually decreased through month 90. Seropositivity rates remained >90% through month 90 for each of the 9vHPV vaccine types by HPV immunoglobulin Luminex Immunoassay. No cases of HPV6/11/16/18/31/33/45/52/58-related high-grade intraepithelial neoplasia or genital warts were observed in the per-protocol population (n = 1107) based on a maximum follow-up of 8.2 years (median 7.6 years) post-Dose 3. Incidence rates of HPV6/11/16/18/31/33/45/52/58-related 6-month persistent infection in females and males were 49.2 and 37.3 per 10,000 person-years, respectively, which were within ranges expected in vaccinated cohorts. There were no vaccine-related SAEs or deaths during the period covered by this interim analysis.ConclusionsThe 9vHPV vaccine provided sustained immunogenicity and durable effectiveness through approximately 7 and 8 years, respectively, following vaccination of girls and boys aged 9-15 years.

Dataset Information

Vaccinating Girls and Boys with Different Human Papillomavirus Vaccines: Can It Optimise Population-Level Effectiveness?

Background

Methods

Results

Conclusion

Publications

Vaccinating Girls and Boys with Different Human Papillomavirus Vaccines: Can It Optimise Population-Level Effectiveness?

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