Evidence map›Paper›PMID 25744474›Full record

SynthesisThe Lancet. Infectious diseases2015

Population-level impact and herd effects following human papillomavirus vaccination programmes: a systematic review and meta-analysis.

Mélanie Drolet, Élodie Bénard, Marie-Claude Boily, Hammad Ali, Louise Baandrup, Heidi Bauer, Simon Beddows, Jacques Brisson, Julia M L Brotherton, Teresa Cummings and 20 more

Open access · greenAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The Lancet. Infectious diseases, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 302 papers, 16 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
302citing papers in PubMed, 16 pooled it
69.4field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

302 citing papers in PubMed, 16 syntheses or guidelines pooled it, 633 citations in OpenAlex.

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  7. Sexually Transmitted Infections Treatment Guidelines, 2021.MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports · 2021
    Guideline
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  20. Lot-to-lot consistency study of anHuman vaccines & immunotherapeutics · 2020
    Trial

242 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

30 authors at 19 institutions in 6 countries.

Mélanie DroletCentre de Recherche du CHU de Québec, Québec, QC, Canada; Département de Médecine Sociale et Préventive, Université Laval, Québec, QC, Canada.
Élodie BénardCentre de Recherche du CHU de Québec, Québec, QC, Canada; Département de Médecine Sociale et Préventive, Université Laval, Québec, QC, Canada.
Marie-Claude BoilyCentre de Recherche du CHU de Québec, Québec, QC, Canada; Département de Médecine Sociale et Préventive, Université Laval, Québec, QC, Canada; Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
Hammad AliThe Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
Louise BaandrupUnit of Virus, Lifestyle and Genes, The Danish Cancer Society Research Centre, Copenhagen, Denmark.
Heidi BauerSTD Control Branch of the California Department of Public Health, Richmond, CA, USA.
Simon BeddowsVirus Reference Department, Public Health England, London, UK.
Jacques BrissonCentre de Recherche du CHU de Québec, Québec, QC, Canada; Département de Médecine Sociale et Préventive, Université Laval, Québec, QC, Canada.
Julia M L BrothertonNational HPV Vaccination Program Register, Victorian Cytology Service, East Melbourne, Melbourne, VIC, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
Teresa CummingsDepartment of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
Basil DonovanThe Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
Christopher K FairleyMelbourne Sexual Health Centre, Melbourne, VIC, Australia; Central Clinical School, Monash University, Alfred Hospital, Melbourne, VIC, Australia.
Elaine W FlaggNational Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA, USA.
Anne M JohnsonResearch Department of Infection and Population Health, University College London, London, UK.
Jessica A KahnCincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Kimberley KavanaghDepartment of Mathematics and Statistics, University of Strathclyde, Glasgow, UK.
Susanne K KjaerUnit of Virus, Lifestyle and Genes, The Danish Cancer Society Research Centre, Copenhagen, Denmark; Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Erich V KliewerCommunity Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Cancer Control Research, British Columbia Cancer Agency, Vancouver, BC, Canada; Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada.
Philippe Lemieux-MelloukiCentre de Recherche du CHU de Québec, Québec, QC, Canada; Département de Médecine Sociale et Préventive, Université Laval, Québec, QC, Canada.
Lauri MarkowitzNational Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA, USA.
Aminata MboupCentre de Recherche du CHU de Québec, Québec, QC, Canada.
David MesherHIV and STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
Linda NiccolaiDepartment of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, CT, USA.
Jeannie OliphantAuckland Sexual Health Service, Auckland, New Zealand.
Kevin G PollockHealth Protection Scotland, Glasgow, UK.
Kate SoldanHIV and STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
Pam SonnenbergResearch Department of Infection and Population Health, University College London, London, UK.
Sepehr N TabriziDepartment of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia; Regional WHO HPV Reference Laboratory, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia; Murdoch Childrens Research Institute, Parkville, VIC, Australia.
Clare TantonResearch Department of Infection and Population Health, University College London, London, UK.
Marc BrissonCentre de Recherche du CHU de Québec, Québec, QC, Canada; Département de Médecine Sociale et Préventive, Université Laval, Québec, QC, Canada; Department of Infectious Disease Epidemiology, Imperial College London, London, UK. Electronic address: mbrisson@uresp.ulaval.ca.
Centre hospitalier universitaire de Québec · CAPublic Health England · GBUniversity College London · GBCenters for Disease Control and Prevention · USUniversité Laval · CAUNSW Sydney · AUAuckland District Health Board · NZBC Cancer Agency · CACalifornia Department of Public Health · USDanish Cancer Society · DKHealth Protection Scotland · GBIndiana University School of MedicineMelbourne Sexual Health Centre · AUMurdoch Children's Research Institute · AUUniversity of Cincinnati · USUniversity of Copenhagen · DKUniversity of Melbourne · AUUniversity of Strathclyde · GBYale University · US

Funding

Epidemiologic Impact of HPV VaccinationR01AI104709 · NIAID · CINCINNATI CHILDRENS HOSP MED CTR · PI DING, LILI, KAHN, JESSICA · 2013 to 2022
$5.6M
Behavioral and Virologic Impact of HPV ImmunizationR01AI073713 · NIAID · CINCINNATI CHILDRENS HOSP MED CTR · PI KAHN, JESSICA · 2008 to 2012
$2.7M
CIHR MOP-119427Medical Research Council G0701757NIAID NIH HHS R01 AI073713NIAID NIH HHS R01 AI104709Wellcome Trust
6 · The paper itself

Abstract

backgroundHuman papillomavirus (HPV) vaccination programmes were first implemented in several countries worldwide in 2007. We did a systematic review and meta-analysis to assess the population-level consequences and herd effects after female HPV vaccination programmes, to verify whether or not the high efficacy reported in randomised controlled clinical trials are materialising in real-world situations.

methodsWe searched the Medline and Embase databases (between Jan 1, 2007 and Feb 28, 2014) and conference abstracts for time-trend studies that analysed changes, between the pre-vaccination and post-vaccination periods, in the incidence or prevalence of at least one HPV-related endpoint: HPV infection, anogenital warts, and high-grade cervical lesions. We used random-effects models to derive pooled relative risk (RR) estimates. We stratified all analyses by age and sex. We did subgroup analyses by comparing studies according to vaccine type, vaccination coverage, and years since implementation of the vaccination programme. We assessed heterogeneity across studies using I(2) and χ(2) statistics and we did trends analysis to examine the dose-response association between HPV vaccination coverage and each study effect measure.

findingsWe identified 20 eligible studies, which were all undertaken in nine high-income countries and represent more than 140 million person-years of follow-up. In countries with female vaccination coverage of at least 50%, HPV type 16 and 18 infections decreased significantly between the pre-vaccination and post-vaccination periods by 68% (RR 0·32, 95% CI 0·19-0·52) and anogenital warts decreased significantly by 61% (0·39, 0·22-0·71) in girls 13-19 years of age. Significant reductions were also recorded in HPV types 31, 33, and 45 in this age group of girls (RR 0·72, 95% CI 0·54-0·96), which suggests cross-protection. Additionally, significant reductions in anogenital warts were also reported in boys younger than 20 years of age (0·66 [95% CI 0·47-0·91]) and in women 20-39 years of age (0·68 [95% CI 0·51-0·89]), which suggests herd effects. In countries with female vaccination coverage lower than 50%, significant reductions in HPV types 16 and 18 infection (RR 0·50, 95% CI 0·34-0·74]) and in anogenital warts (0·86 [95% CI 0·79-0·94]) occurred in girls younger than 20 years of age, with no indication of cross-protection or herd effects.

interpretationOur results are promising for the long-term population-level effects of HPV vaccination programmes. However, continued monitoring is essential to identify any signals of potential waning efficacy or type-replacement.

fundingThe Canadian Institutes of Health Research.

Indexed as

VaccinationAdolescentAdultCondylomata AcuminataCost-Benefit AnalysisCross ProtectionDeveloped CountriesFemaleHumansImmunization ProgramsMalePapillomaviridaePapillomavirus InfectionsPapillomavirus VaccinesUterine Cervical NeoplasmsPapillomavirus Vaccines

Identifiers

PMID25744474
PMCPMC5144106
OpenAlexW2103834380

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.