Epidemiologic Impact of HPV Vaccination

HPV 疫苗的流行病学影响

• 批准号: 9197611
• 负责人: JESSICA A KAHN
• 金额: $ 64.64万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-01-18 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9197611
• 关键词: Address; Advisory Committees; Area; Behavioral; Cervical Intraepithelial Neoplasia; Clinical Trials; Communities; Cost Effectiveness Analysis; Data; Death Rate; Disease; Effectiveness; Enrollment; Epidemiological trend; Epidemiology; Female; Future; Genotype; Health Benefit; Healthy People 2020; High-Risk Cancer; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Human Papillomavirus; Human papilloma virus infection; Immunization; Immunization Programs; Individual; Infection; Malignant Neoplasms; Malignant Vaginal Neoplasm; Malignant neoplasm of anus; Malignant neoplasm of cervix uteri; Malignant neoplasm of vulva; Methodology; Morbidity - disease rate; Outcome; Pattern; Pilot Projects; Policies; Population; Prevalence; Public Health; Research; Sampling; Sampling Studies; Science; Sexual Partners; Time; Vaccinated; Vaccination; Vaccines; Woman; clinical practice; community setting; design; innovation; men; mortality; novel; prevent; programs; prophylactic; public health relevance; racial diversity; screening; surveillance study; trend; vaccine delivery; vaccine development; vaccine effectiveness; virology; volunteer; young man; young woman

DESCRIPTION (provided by applicant): Widespread implementation of prophylactic human papillomavirus (HPV) vaccines could substantially decrease morbidity and mortality from cervical cancer and other HPV-related diseases. Information about epidemiologic trends in HPV after vaccine introduction in community settings is essential in order to assess the progress and population impact of HPV immunization programs, and to provide data for programmatic and policy decisions. Thus, we conducted pilot HPV surveillance studies among ~800 13-26 year-old young women, before (2007; none vaccinated) and three years after (2010; 59% vaccinated) widespread vaccine introduction in a community. We found: 1) a substantial decline in vaccine-type HPV prevalence among all women (58%), 2) evidence for herd protection (i.e. a decline of 49% in vaccine-type HPV among unvaccinated women), and 3) possible evidence for type-replacement (i.e. an increase of 25% in the prevalence of non- vaccine-type HPV among vaccinated women). The overall objective of this proposal is to further characterize the community-level impact of HPV vaccine introduction, in men as well as women, by determining changes in vaccine-type HPV, characterizing herd protection, and investigating possible type replacement during the first nine years after HPV vaccine introduction. We will pursue the following three specific aims: (1) Determine trends in vaccine-type HPV prevalence among young women and men to a) assess the epidemiologic impact of HPV vaccine introduction in the community, and b) explore changes in the prevalence of genetically-related HPV types; (2) Determine trends in vaccine-type HPV prevalence among unvaccinated young women and men, in order to a) characterize and b) examine mechanisms for herd protection after vaccine introduction in the community; and (3) Determine trends in non-vaccine-type HPV prevalence among vaccinated and unvaccinated young women and men, in order to a) investigate and b) examine alternative (e.g. statistical) explanations for HPV type-replacement. We plan to accomplish the overall objective using the following approach: we will enroll diverse samples of 13-26 year-old women (N=400) and men (N=400) in two additional surveillance studies (total N=1600), and examine vaccination rates and HPV prevalence at all four time points in women (2007, 2010, 2013, and 2016) and two time points in men (2013 and 2016). The proposed research is innovative because 1) it is the first study to provide empirical data concerning changes in vaccine-type HPV, herd protection, and type replacement during the first nine years after HPV vaccine introduction in both men and women; 2) the data could shift current research and clinical practice paradigms in vaccine development; and 3) the research plan utilizes novel concepts, approaches and methodologies to explore mechanisms of herd protection and type-replacement. The proposed research is significant, because it will help to characterize the community-level impact of HPV immunization programs and provide data that are essential for programmatic and policy decisions to maximize the public health impact of HPV vaccination.

描述（由申请人提供）：预防性人乳头瘤病毒（HPV）疫苗的广泛实施可以大大降低宫颈癌和其他与HPV相关疾病的发病率和死亡率。在社区环境中引入疫苗后，有关HPV流行病学趋势的信息对于评估HPV免疫计划的进度和人口影响至关重要，并为程序和政策决策提供数据。因此，我们在约800名13-26岁的年轻妇女（2007年；无疫苗接种）和三年后（2010; 59％接种疫苗）中进行了大约800名13-26岁的年轻妇女进行了试点HPV监视研究。我们发现：1）所有妇女中的疫苗型HPV患病率大幅下降（58％），2）群牛群保护的证据（即未接种妇女的疫苗型HPV下降了49％），以及3）可能的证据），3）可能用于替代类型（即，在接种疫苗的妇女中非疫苗型HPV患病率增加了25％）。该提案的总体目的是通过确定疫苗型HPV的变化，表征牛群的保护并调查前九年可能的替代品，进一步描述HPV疫苗引入，男性和女性的社区水平的影响。 HPV疫苗引入后。我们将追求以下三个具体目标：（1）确定年轻男女疫苗类型HPV患病率的趋势a）评估社区中HPV疫苗引入的流行病学影响，b）探索遗传上流行的变化。 - 相关的HPV类型； （2）确定未接种疫苗的年轻男女疫苗型HPV患病率的趋势，以便a）表征和b）检查社区疫苗引入后的畜群保护机制； （3）确定疫苗接种和未接种疫苗的年轻男性和男性中非疫苗类型HPV患病率的趋势，以a）调查和b）检查HPV类型替代品的替代方法（例如统计）解释。我们计划使用以下方法来实现总体目标：我们将在另外两项监视研究（总计n = 1600）和在女性（2007、2010、2013和2016年）中所有四个时间点的疫苗接种率和HPV患病率以及男性的两个时间点（2013年和2016年）。拟议的研究具有创新性，因为1）这是第一个提供有关在HPV疫苗引入男性和女性后的最初九年中疫苗型HPV，牛群保护和类型替代品变化的经验数据； 2）数据可能会改变当前的研究和临床实践范例在疫苗开发中； 3）研究计划利用新颖的概念，方法和方法来探索牛群保护和类型替代的机制。拟议的研究非常重要，因为它将有助于表征HPV免疫计划的社区级别影响，并提供对程序和政策决策至关重要的数据，以最大程度地提高HPV疫苗接种的公共卫生影响。