Abstract
Rates of human papillomavirus (HPV) infection have decreased since the introduction of HPV vaccines in populations with high vaccine uptake. Data are limited for adolescent and young adult populations in US metropolitan centers. To determine HPV infection rates in adolescent girls and young women aged 13 to 21 years in New York City following HPV vaccination. This cohort study of type-specific cervical HPV detection was conducted at a large adolescent-specific integrated health center in New York City between October 2007 and September 2019. Participants included an open cohort of adolescent girls and young adult women who received the HPV vaccine (Gardasil; Merck & Co) over a 12-year period following HPV vaccination introduction. Data analysis was concluded September 2019. Calendar date and time since receipt of first vaccine dose. Temporal associations in age-adjusted postvaccine HPV rates. A total of 1453 participants, with a mean (SD) age at baseline of 18.2 (1.4) years, were included in the cohort (African American with no Hispanic ethnicity, 515 [35.4%] participants; African American with Hispanic ethnicity, 218 [15.0%] participants; Hispanic with no reported race, 637 [43.8%] participants). Approximately half (694 [47.8%] participants) were vaccinated prior to coitarche. Age-adjusted detection rates for quadrivalent vaccine types (HPV-6, HPV-11, HPV-16, and HPV-18) and related types (HPV-31, and HPV-45) decreased year over year, with the largest effect sizes observed among individuals who had been vaccinated before coitarche (adjusted odds ratio [aOR], 0.81; 95% CI, 0.67-0.98). By contrast, detection was higher year over year for nonvaccine high-risk cervical HPV types (aOR, 1.08; 95% CI, 1.04-1.13) and anal HPV types (aOR, 1.11; 95% CI, 1.05-1.17). The largest effect sizes were observed with nonvaccine types HPV-56 and HPV-68. Whereas lower detection rates of vaccine-related HPV types were observed since introduction of vaccines in female youth in New York City, rates of some nonvaccine high-risk HPV types were higher. Continued monitoring of high-risk HPV prevalence is warranted.
Highlights
Age-adjusted detection rates for quadrivalent vaccine types (HPV-6, human papillomavirus (HPV)-11, HPV-16, and HPV-18) and related types (HPV-31, and HPV-45) decreased year over year, with the largest effect sizes observed among individuals who had been vaccinated before coitarche
Detection was higher year over year for nonvaccine high-risk cervical HPV types and anal HPV types
Whereas lower detection rates of vaccine-related HPV types were observed since introduction of vaccines in female youth in New York City, rates of some nonvaccine high-risk HPV types were higher
Summary
Human papillomavirus (HPV) infections remain the most common sexually transmitted infection in female adolescents and young adults, and are responsible for the development of anogenital warts, cervix cancer, and the majority of anal and oropharyngeal cancers.[1,2] The quadrivalent vaccine has been shown to be highly effective at reducing the incidence of cervical and anogenital HPV infections and related diseases caused by vaccine types (HPV-6, HPV-11, HPV-16, and HPV-18),[3,4,5,6] along with 2 phylogenetically related high-risk HPV types (HPV-31 and HPV-45) that benefitted from crossprotection by the quadrivalent vaccine.[7,8,9,10,11,12] With the introduction of the 9-valent HPV vaccine in 2017, protection was extended to 5 additional high-risk HPV types (HPV-31, HPV-45, HPV-33, HPV-52, and HPV-58).Based on the prevaccine era population estimates,[13] eliminating the above 9 HPV types would prevent over 90% of cervical and anal neoplasia[8,14,15,16] and anogenital warts.[17]. While nonvaccine high-risk HPV types (ie, HPV-35, HPV-39, HPV-51, HPV-56, HPV-59, and HPV-68) collectively account for less than 10% of all cervical and anal cancers in women,[28 1] or more of these types are detected in a majority (56.1%) of sexually active 20- to 24-year-old US women,[12] and the prevalence of some nonvaccine types (like HPV-35 and HPV-59) have been found to be higher among racial/ethnic minority groups.[14,29,30,31]
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