Human Papillomavirus Vaccination and Screening in the Elimination of HPV-Associated Cancers: Evidence-Based Randomized Trials

Vaccination and Human Papillomavirus Typereplacement

Author(s): Matti Lehtinen *

Pp: 39-47 (9)

DOI: 10.2174/9789815305487124010006

* (Excluding Mailing and Handling)

Abstract

We anticipated that moderate human papillomavirus (HPV) vaccination in the Finnish community-randomized trial will demonstrate changes in ecological niche of the circulating HPVs such as the niche occupation by non-vaccine-covered HPV types. In this study we exploited a re-randomized cervical screening trial that had been launched in 2014 among 14,686 HPV-vaccinees starting from 22-year-old omen, born in 1992 (refer to Chapter V). Approximately half of the HPV-vaccinees, 6,958 women participated the trial and provided serial cervical samples for HPV typing at ages 22, 25 and 28 years. With the trial follow-up we could verify the more (gender-neutral vaccination arm) or less (girls-only vaccination arm) efficient vacation of ecological niche initially occupied by the vaccine-covered HPV types 16/18/31/45 up to eight years post-vaccination. However, no consistent changes were observed neither in the gender-neutral arm nor in the girls-only arm in epidemiological analyses for the nonvaccine-covered HPV39/51/52/56/58/59/66/68/73 determined by PCR of cervical samples or by serology. In contrast, our analyses at the community level revealed rising ecological diversity of the more or less non-vaccine-covered HPV types 33/35/51/52/56/58/59 in gender-neutral vaccination communities with a stronger herd immunity compared with girls-only vaccination communities from four to eight years post vaccination. This is probably the first recorded sign of niche occupation by the non-vaccine-targeted HPV types post-population level vaccination.


Keywords: Alpha-diversity, beta-diversity, ecology, human papillomavirus, prevalence, seroprevalence, Shannon-index, type-distribution.

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