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Epidemic Intelligence Service and Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (H.G.R.)
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Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, and Synergy America, Duluth, Georgia (R.M.L.)
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Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (J.W.G., L.E.M.)
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Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (T.D.Q., E.R.U.).
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Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (T.D.Q., E.R.U.).
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Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (J.W.G., L.E.M.)
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Human papillomavirus (HPV) vaccines were introduced in 2006 for females and in 2011 for males. This articles uses the most recent NHANES (National Health and Nutrition Examination Survey) data through 2018 to estimate the impact of the HPV vaccination program on vaccinated and unvaccinated sexually experienced females. It also estimates the effectiveness on HPV prevalence for males and females for the most recent time periods with data available.
Human papillomavirus (HPV) vaccination was introduced in 2006 for females and in 2011 for males.
To estimate vaccine impact and effectiveness against quadrivalent HPV vaccine (4vHPV)–type prevalent infection among sexually experienced U.S. females and vaccine effectiveness for sexually experienced U.S. males.
NHANES (National Health and Nutrition Examination Survey) conducted in 2003 to 2006 (prevaccine era) and in 2007 to 2010, 2011 to 2014, and 2015 to 2018 (vaccine eras).
Nationally representative U.S. surveys.
Sexually experienced participants aged 14 to 24 years.
U.S. HPV vaccination program.
Participant-collected cervicovaginal and penile specimens were tested for HPV DNA. The prevalences of 4vHPV and non-4vHPV types were estimated in each era for females and in 2013 to 2016 for males. Prevalences among the female population overall, vaccinated females, and unvaccinated females were compared in vaccine eras versus the prevaccine era (vaccine impact). Within each vaccine era, prevalence among vaccinated females was compared with that among unvaccinated females (vaccine effectiveness). Vaccine impact and effectiveness were estimated as (1 − prevalence ratio) · 100.
Among sexually experienced females aged 14 to 24 years, the impact on 4vHPV-type prevalence in 2015 to 2018 was 85% overall, 90% among vaccinated females, and 74% among unvaccinated females. No significant declines were found in non–4vHPV-type prevalence. Vaccine effectiveness ranged from 60% to 84% during vaccine eras for females and was 51% during 2013 to 2016 for males.
Self- or parent-reported vaccination history and small numbers in certain subgroups limited precision.
Nationally representative data show increasing impact of the vaccination program and herd protection. Vaccine effectiveness estimates will be increasingly affected by herd effects.
Centers for Disease Control and Prevention.
Epidemic Intelligence Service and Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (H.G.R.)
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, and Synergy America, Duluth, Georgia (R.M.L.)
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (J.W.G., L.E.M.)
Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (T.D.Q., E.R.U.).
Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.
Acknowledgment: The authors thank Carolyn Neal (National Center for Health Statistics, Research Data Center, CDC) and Juanita M. Onyekwuluje, Sonya Patel, and Krystle L. Love (Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC).
Financial Support: By the CDC.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-3798.
Reproducible Research Statement: Study protocol: Available online (wwwn.cdc.gov/nchs/nhanes/analyticguidelines.aspx). Statistical code: Not available. Data set: Publicly available data can be accessed on the NHANES website (wwwn.cdc.gov/nchs/nhanes/Default.aspx). Restricted data can be accessed through the Research Data Center via the National Center for Health Statistics (www.cdc.gov/rdc/index.htm).
Corresponding Author: Hannah G. Rosenblum, MD, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329; e-mail, [email protected]
Author Contributions: Conception and design: J.W. Gargano, R.M. Lewis, L.E. Markowitz, H.G. Rosenblum.
Analysis and interpretation of the data: J.W. Gargano, R.M. Lewis, L.E. Markowitz, H.G. Rosenblum, E.R. Unger.
Drafting of the article: J.W. Gargano, R.M. Lewis, L.E. Markowitz, H.G. Rosenblum.
Critical revision for important intellectual content: J.W. Gargano, R.M. Lewis, L.E. Markowitz, H.G. Rosenblum, T.D. Querec, E.R. Unger.
Final approval of the article: J.W. Gargano, R.M. Lewis, L.E. Markowitz, T.D. Querec, H.G. Rosenblum, E.R. Unger.
Statistical expertise: J.W. Gargano, R.M. Lewis.
Obtaining of funding: L.E. Markowitz.
Administrative, technical, or logistic support: L.E. Markowitz, E.R. Unger.
Collection and assembly of data: R.M. Lewis, T.D. Querec, E.R. Unger.
This article was published at Annals.org on 17 May 2022.
Page: 918-926
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