Abstract
BackgroundThe quadrivalent human papillomavirus (HPV) vaccine has been assumed to give protection against genital warts (GW) as well as cervical cancer. Our main question was whether HPV vaccine has any effects on the prevention of GW reported in randomised controlled clinical trials (RCTs) and time-trend analyses.MethodsThis meta-analysis was performed according to the PRISMA guidelines using the PICO format. We searched in three electronic databases (PubMed, Embase, Cochrane Trials), and assessed heterogeneity using the Q-test and I-squared statistics, meta-regression was also performed. Odds ratios (OR) and their confidence intervals (CI) were calculated. The sensitivity was tested by leave-one-out method. We evaluated the presence of publication bias using the funnel plot graph and the Copas selection model. The strength of evidence was assessed using the GRADE approach.ResultsEight RCTs (per-protocol populations) and eight time-trend ecological studies were included in this meta-analysis. A significant reduction (pooled OR = 0.03, 95% CI: 0.01–0.09; I-squared = 53.6%) of GW in young women was recorded in RCTs, and in time-trend analyses both in young women (pooled OR = 0.36, CI 95% = 0.26–0.51; I-squared = 98.2%), and in young men (pooled OR = 0.69, 95% CI = 0.61–0.78; I-squared = 92.7%). In subgroup analysis, a significant reduction of the number of GW events was observed especially in women under 21 years (pooled OR = 0.33, 95% CI = 0.17–0.63). Leave-one-out analysis showed that similar results could be obtained after excluding one study, meta-regression did not show significant difference.ConclusionsProphylactic, quadrivalent HPV vaccination can prevent GW in healthy women and men, therefore, it should be included in routine immunization programme.
Highlights
The quadrivalent human papillomavirus (HPV) vaccine has been assumed to give protection against genital warts (GW) as well as cervical cancer
The results from randomised controlled trial (RCT) and time-trend analyses – representing more than 13,000 000 participants – have shown that the quadrivalent HPV vaccine is highly effective in preventing HPV 6/11 related GW both in women and men which gives an additional value to the application of this type of vaccine
Our meta-analysis provides upto-date information for the public about the effectiveness of HPV vaccination
Summary
The quadrivalent human papillomavirus (HPV) vaccine has been assumed to give protection against genital warts (GW) as well as cervical cancer. Lukács et al BMC Public Health (2020) 20:691 and consistent protection against infections and diseases related to these HPV types [2]. The World Health Organization (WHO) recognizes the importance of cervical cancer and other HPV-related diseases as global public health problems and reiterates the recommendation that HPV vaccines should be included in national immunization programmes [3]. WHO recommends vaccination for girls aged 9–13 years as this is the most cost-effective public health measure against cervical cancer [4]. By October 2019, 98 countries introduced HPV vaccines through national immunisation programmes [5]. The population-level effect of HPV vaccination programmes is expected to vary substantially between these countries, depending on the vaccine used, implementation strategies applied and vaccination coverage achieved [6]
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