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Cited by 1,384Cervical Cancer and HPV ResearchGenital Health and DiseaseWomen's cancer prevention and management

Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis

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Drolet, Mélanie, Bénard, Élodie, Pérez, Norma, Brisson, Marc, Ali, Hammad, Boily, Marie-Claude, Baldo, Vincenzo, Brassard, Paul +43 more·2019·The Lancet
DOI 10.1016/s0140-6736(19)30298-3PMC PMC7316527
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Abstract

Background More than 10 years have elapsed since human papillomavirus (HPV) vaccination was implemented. We did a systematic review and meta-analysis of the population-level impact of vaccinating girls and women against human papillomavirus on HPV infections, anogenital wart diagnoses, and cervical intraepithelial neoplasia grade 2+ (CIN2+) to summarise the most recent evidence about the effectiveness of HPV vaccines in real-world settings and to quantify the impact of multiple age-cohort vaccination. Methods In this updated systematic review and meta-analysis, we used the same search strategy as in our previous paper. We searched MEDLINE and Embase for studies published between Feb 1, 2014, and Oct 11, 2018. Studies were eligible if they compared the frequency (prevalence or incidence) of at least one HPV-related endpoint (genital HPV infections, anogenital wart diagnoses, or histologically confirmed CIN2+) between pre-vaccination and post-vaccination periods among the general population and if they used the same population sources and recruitment methods before and after vaccination. Our primary assessment was the relative risk (RR) comparing the frequency (prevalence or incidence) of HPV-related endpoints between the pre-vaccination and post-vaccination periods. We stratified all analyses by sex, age, and years since introduction of HPV vaccination. We used random-effects models to estimate pooled relative risks. Findings We identified 1702 potentially eligible articles for this systematic review and meta-analysis, and included 65 articles in 14 high-income countries: 23 for HPV infection, 29 for anogenital warts, and 13 for CIN2+. After 5-8 years of vaccination, the prevalence of HPV 16 and 18 decreased significantly by 83% (RR 0·17, 95% CI 0·11-0·25) among girls aged 13-19 years, and decreased significantly by 66% (RR 0·34, 95% CI 0·23-0·49) among women aged 20-24 years. The prevalence of HPV 31, 33, and 45 decreased significantly by 54% (RR 0·46, 95% CI 0·33-0·66) among girls aged 13-19 years. Anogenital wart diagnoses decreased significantly by 67% (RR 0·33, 95% CI 0·24-0·46) among girls aged 15-19 years, decreased significantly by 54% (RR 0·46, 95% CI 0.36-0.60) among women aged 20-24 years, and decreased significantly by 31% (RR 0·69, 95% CI 0·53-0·89) among women aged 25-29 years. Among boys aged 15-19 years anogenital wart diagnoses decreased significantly by 48% (RR 0·52, 95% CI 0·37-0·75) and among men aged 20-24 years they decreased significantly by 32% (RR 0·68, 95% CI 0·47-0·98). After 5-9 years of vaccination, CIN2+ decreased significantly by 51% (RR 0·49, 95% CI 0·42-0·58) among screened girls aged 15-19 years and decreased significantly by 31% (RR 0·69, 95% CI 0·57-0·84) among women aged 20-24 years. Interpretation This updated systematic review and meta-analysis includes data from 60 million individuals and up to 8 years of post-vaccination follow-up. Our results show compelling evidence of the substantial impact of HPV vaccination programmes on HPV infections and CIN2+ among girls and women, and on anogenital warts diagnoses among girls, women, boys, and men. Additionally, programmes with multi-cohort vaccination and high vaccination coverage had a greater direct impact and herd effects. Funding WHO, Canadian Institutes of Health Research, Fonds de recherche du Québec - Santé.

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Authors
Drolet, M., Bénard, É., Pérez, N., Brisson, M., Ali, H., Boily, M.-C., Baldo, V., Brassard, P., Brotherton, J. M. L., Callander, D., Checchi, M., Chow, E. P. F., Cocchio, S., Dalianis, T., Deeks, S. L., Dehlendorff, C., Donovan, B., Fairley, C. K., Flagg, E. W., Gargano, J. W., Garland, S. M., Grün, N., Hansen, B. T., Harrison, C., Herweijer, E., Imburgia, T. M., Johnson, A. M., Kahn, J. A., Kavanagh, K., Kjaer, S. K., Kliewer, E. V., Liu, B., Machalek, D. A., Markowitz, L., Mesher, D., Munk, C., Niccolai, L., Nygård, M., Ogilvie, G., Oliphant, J., Pollock, K. G., Purriños-Hermida, M. J., Smith, M. A., Steben, M., Söderlund-Strand, A., Sonnenberg, P., Sparen, P., Tanton, C., Wheeler, C. M., Woestenberg, P. J., & Yu, B. N.
Affiliations
  • Centre de recherche du CHU de Québec-Université Laval (CA)
  • Université Laval (CA)
  • Canadian Institutes of Health Research (CA)
Corresponding author
Brisson, Marc
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2019-08
Volume
394
Issue
10197
Pages
497-509
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(19)30298-3
PMC
PMC7316527
OpenAlex
W2955245499
Cited by
1,384
References
4
Citations by year
2026: 192 · 2025: 169 · 2024: 163 · 2023: 151 · 2022: 149 · 2021: 161 · 2020: 362 · 2019: 37
FWCI
25.86
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • ResearchOnline (Glasgow Caledonian University) (acceptedVersion, cc-by-nc-nd)
  • Strathprints: The University of Strathclyde institutional repository (University of Strathclyde) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • ResearchOnline (acceptedVersion, cc-by-nc-nd)
  • UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
  • UCL Discovery (University College London) (submittedVersion)
  • Rivm Repository (Netherlands National Institute for Public Health and the Environment) (submittedVersion)
  • Spiral (Imperial College London) (submittedVersion, cc-by-nc-nd)
  • Padua Research Archive (University of Padova) (submittedVersion)
  • Rivm (National Institute for Public Health and the Environment) (submittedVersion)
Funders
  • Canadian Institutes of Health Research (FDN-143283)
  • Fonds de Recherche du Québec - Santé
  • World Health Organization
Topics
  • Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
  • Health Sciences › Medicine › Surgery › Genital Health and Disease
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
Keywords
HPV vaccination, herd effect, population effects, HPV infection, genital warts, cervical intraepithelial neoplasia, HPV 16/18, HPV prevalence, HPV incidence, women aged 20-24
MeSH terms
Adolescent, Adult, Uterine Cervical Dysplasia, Uterine Cervical Neoplasms, Condylomata Acuminata, Female, Humans, Male, Incidence, Prevalence, Age Distribution, Endpoint Determination, Papillomaviridae, Papillomavirus Infections, Mass Vaccination, Papillomavirus Vaccines, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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