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Prevalence of Human Papillomavirus and Estimation of Human Papillomavirus Vaccine Effectiveness in Thimphu, Bhutan, in 2011-2012 and 2018 : A Cross-sectional Study.

Abstract：

BACKGROUND:Bhutan implemented a national program for human papillomavirus (HPV) vaccination in 2010 involving girls aged 12 to 18 years and achieving nearly 90% coverage. OBJECTIVE:To estimate HPV vaccine effectiveness in a city in Bhutan. DESIGN:2 cross-sectional surveys, 2011-2012 and 2018. SETTING:2 hospitals in Thimphu, capital of Bhutan. PARTICIPANTS:Sexually active women aged 17 to 29 years: 1445 participants from the baseline survey and 1595 from the repeated survey. INTERVENTION:National HPV vaccination program. MEASUREMENTS:HPV was assessed in cervical cell samples by using general primer GP5+/GP6+-mediated polymerase chain reaction. Human papillomavirus types were stratified as vaccine types (HPV6/11/16/18) and nonvaccine types. Age- and sexual behavior-adjusted overall, total, and indirect (herd immunity) vaccine effectiveness (VE) was computed as (1 - HPV prevalence ratio) for HPV among all women and among unvaccinated women. RESULTS:Between the 2 surveys, the prevalence of HPV vaccine types decreased from 8.3% to 1.4%, whereas the prevalence of nonvaccine types increased from 25.8% to 31.4%. The overall and indirect adjusted VE against vaccine-targeted HPV types was 88% (95% CI, 80% to 92%) and 78% (CI, 61% to 88%), respectively. Among women younger than 27 years, who were targeted by the vaccination program, the overall and indirect adjusted VE was 93% (CI, 87% to 97%) and 88% (CI, 69% to 95%), respectively. No impact on nonvaccine HPV types was detectable. LIMITATION:Hospital-based recruitment; self-reported vaccination status. CONCLUSION:In Bhutan, the prevalence of vaccine-targeted HPV types has decreased sharply, providing the first evidence of the effectiveness of a high-coverage national HPV vaccination program in a lower-middle-income country. PRIMARY FUNDING SOURCE:Bill & Melinda Gates Foundation.

journal_name

Ann Intern Med

journal_title

Annals of internal medicine

authors

Baussano I,Tshomo U,Tenet V,Heideman DAM,Wangden T,Franceschi S,Clifford GM

doi

10.7326/M20-2849

subject

Has Abstract

pub_date

2020-12-01 00:00:00

pages

888-894

issue

eissn

0003-4819

issn

1539-3704

journal_volume

173

pub_type

杂志文章

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Prevalence of Human Papillomavirus and Estimation of Human Papillomavirus Vaccine Effectiveness in Thimphu, Bhutan, in 2011-2012 and 2018 : A Cross-sectional Study.