Population-level impact, herd immunity, and elimination after human papillomavirus vaccination: a systematic review and meta-analysis of predictions from transmission-dynamic models
Open accessAbstract
Background Modelling studies have been widely used to inform human papillomavirus (HPV) vaccination policy decisions; however, many models exist and it is not known whether they produce consistent predictions of population-level effectiveness and herd effects. We did a systematic review and meta-analysis of model predictions of the long-term population-level effectiveness of vaccination against HPV 16, 18, 6, and 11 infection in women and men, to examine the variability in predicted herd effects, incremental benefit of vaccinating boys, and potential for HPV-vaccine-type elimination. Methods We searched MEDLINE and Embase for transmission-dynamic modelling studies published between Jan 1, 2009, and April 28, 2015, that predicted the population-level impact of vaccination on HPV 6, 11, 16, and 18 infections in high-income countries. We contacted authors to determine whether they were willing to produce new predictions for standardised scenarios. Strategies investigated were girls-only vaccination and girls and boys vaccination at age 12 years. Base-case vaccine characteristics were 100% efficacy and lifetime protection. We did sensitivity analyses by varying vaccination coverage, vaccine efficacy, and duration of protection. For all scenarios we pooled model predictions of relative reductions in HPV prevalence (RR prev ) over time after vaccination and summarised results using the median and 10th and 90th percentiles (80% uncertainty intervals [UI]). Findings 16 of 19 eligible models from ten high-income countries provided predictions. Under base-case assumptions, 40% vaccination coverage and girls-only vaccination, the RR prev of HPV 16 among women and men was 0·53 (80% UI 0·46–0·68) and 0·36 (0·28–0·61), respectively, after 70 years. With 80% girls-only vaccination coverage, the RR prev of HPV 16 among women and men was 0·93 (0·90–1·00) and 0·83 (0·75–1·00), respectively. Vaccinating boys in addition to girls increased the RR prev of HPV 16 among women and men by 0·18 (0·13–0·32) and 0·35 (0·27–0·39) for 40% coverage, and 0·07 (0·00–0·10) and 0·16 (0·01–0·25) for 80% coverage, respectively. The RR prev were greater for HPV 6, 11, and 18 than for HPV 16 for all scenarios investigated. Finally at 80% coverage, most models predicted that girls and boys vaccination would eliminate HPV 6, 11, 16, and 18, with a median RR prev of 1·00 for women and men for all four HPV types. Variability in pooled findings was low, but increased with lower vaccination coverage and shorter vaccine protection (from lifetime to 20 years). Interpretation Although HPV models differ in structure, data used for calibration, and settings, our population-level predictions were generally concordant and suggest that strong herd effects are expected from vaccinating girls only, even with coverage as low as 20%. Elimination of HPV 16, 18, 6, and 11 is possible if 80% coverage in girls and boys is reached and if high vaccine efficacy is maintained over time. Funding Canadian Institutes of Health Research.
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HPV vaccination led to a marked reduction in the total HPV burden in the population.
“which led to a marked reduction in the total HPV burden in the population59,60.”
From A guide to vaccinology: from basic principles to new developments (2021) · cites this paper as [60]
HPV vaccination was subsequently found to also provide protection against HPV infection in heterosexual boys through herd immunity.
“it was subsequently found to also provide protection against HPV infection in heterosexual boys through herd immunity”
From A guide to vaccinology: from basic principles to new developments (2021) · cites this paper as [60]
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- Authors
- Brisson, M., Bénard, É., Drolet, M., Bogaards, J. A., Baussano, I., Vänskä, S., Jit, M., Boily, M.-C., Smith, M. A., Berkhof, J., Canfell, K., Chesson, H. W., Burger, E. A., Choi, Y. H., De Blasio, B. F., De Vlas, S. J., Guzzetta, G., Hontelez, J. A. C., Horn, J., Jepsen, M. R., Kim, J. J., Lazzarato, F., Matthijsse, S. M., Mikolajczyk, R., Pavelyev, A., Pillsbury, M., Shafer, L. A., Tully, S. P., Turner, H. C., Usher, C., & Walsh, C.
- Affiliations
- Université Laval (CA)
- Centre de recherche du CHU de Québec-Université Laval (CA)
- National Institute for Public Health and the Environment (NL)
- Centre international de recherche sur le cancer (FR)
- Finnish Institute for Health and Welfare (FI)
- Public Health England (GB)
- Cancer Council NSW (AU)
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- UNSW Sydney (AU)
- Centers for Disease Control and Prevention (US)
- Harvard University (US)
- Fondazione Bruno Kessler (IT)
- Helmholtz Centre for Infection Research (DE)
- University of Copenhagen (DK)
- Erasmus MC (NL)
- Merck & Co., Inc., Rahway, NJ, USA (United States) (US)
- University of Manitoba (CA)
- Imperial College London (GB)
- National Centre for Pharmacoeconomics (IE)
- University of Limerick (IE)
- Corresponding author
- Brisson, Marc
- ORCID
- Brisson, Marc
- Bénard, Élodie
- Drolet, Mélanie
- Bogaards, Johannes A
- Baussano, Iacopo
- Vänskä, Simopekka
- Jit, Mark
- Boily, Marie-Claude
- Smith, Megan A
- Berkhof, Johannes
- Canfell, Karen
- Chesson, Harrell W
- Burger, Emily A
- Choi, Yoon H
- Guzzetta, Giorgio
- Hontelez, Jan A C
- Horn, Johannes
- Jepsen, Martin R
- Kim, Jane J
- Lazzarato, Fulvio
- Mikolajczyk, Rafael
- Pillsbury, Matthew
- Shafer, Leigh Anne
- Turner, Hugo C
- Walsh, Cathal
- Venue
- The Lancet Public Health
- Publisher
- Elsevier BV
- Published
- 2016-11
- Volume
- 1
- Issue
- 1
- Pages
- e8-e17
- ISSN
- 2468-2667 (ISSN-L)
- PMC
- PMC6727207
- OpenAlex
- W2528304237
- Cited by
- 307
- References
- 49
- Citations by year
- 2026: 22 · 2025: 25 · 2024: 37 · 2023: 19 · 2022: 26 · 2021: 41 · 2020: 43 · 2019: 38 · 2018: 37 · 2017: 17 · 2016: 2
- FWCI
- 4.24
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Public Health (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by-nc-nd)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, cc-by-nc-nd)
- PubMed Central (acceptedVersion, cc-by-nc-nd)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- HZI (Helmholtz Centre for Infection Research) (submittedVersion, cc-by-nc-sa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion)
- Rivm Repository (Netherlands National Institute for Public Health and the Environment) (submittedVersion)
- Rivm (National Institute for Public Health and the Environment) (submittedVersion)
- The Sydney eScholarship Repository (The University of Sydney) (submittedVersion)
- Spiral (Imperial College London) (submittedVersion, other-oa)
- University of Limerick Institutional Repository (University of Limerick) (submittedVersion, cc-by-nc-sa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, cc-by-nc-nd)
- Funders
- Canadian Institutes of Health Research (number MOP-119427, number FDN-143283)
- European Community's Seventh Framework Programme (FP7-HEALTH-2013; grant number 603019)
- Bill & Melinda Gates Foundation (number OPP1053353)
- Topics
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Surgery › Genital Health and Disease
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Keywords
- HPV vaccination, herd immunity, HPV elimination, dynamic transmission model, HPV16, HPV 18, HPV 6, HPV 11, vaccination coverage, vaccine efficacy, duration of protection, high-income countries, cervical cancer prevention, anal cancer prevention, oropharyngeal cancer
- MeSH terms
- Female, Humans, Male, Models, Statistical, Papillomavirus Infections, Immunity, Herd, Papillomavirus Vaccines, Disease Eradication
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