Introduction
Methods
Results
Country (region)/References | Study design and setting | Vaccination program during the study/estimated vaccine uptake rate | Pre-/post-vaccine introduction periods [time since vaccine introduction (years)] | GW reduction in vaccine-targeted population (as defined in the study) | GW reduction in non-vaccine-targeted populations (as defined in the study) |
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Australia (Melbourne)
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Fairley [20] | Before/after study in one center (Melbourne Sexual Health Centre): all new female and male patients of any age in database | 4HPV vaccine national program: From April 2007 school-based (12–13 years), community catch-up from Jul 2007 to Dec 2009 (females aged ≤26 years)/73% with 3 doses for females 12–13 years, 70% general coverage of target population | 2004–2007/2008 (1) | Females <28 years: −25.1% (95% CI −30.5 to −19.3%) per quarter | Females ≥28 years: −4.7% (95% CI −13.9 to +5.4%) per quarter; MSW: −5.0% (95% CI −9.4 to −0.5%) per quarter |
Read [21] | As above | As above | 2004–2007/2007–2011 (4) | Females <21 years: OR (2004–2007): 1.11 (0.90–1.38); OR (2007–2011): 0.44 (0.32–0.58); OR for vaccinated females 2010–2011 vs. 2009–2010: 0.29 (0.13–0.65) | Females 22–29 years: OR (2004–2007): 1.12 (0.98–1.29); OR (2007–2011): 0.70 (0.62–0.80); MSW <21 years: OR (2004–07): 1.32 (0.92–1.90);OR (2007–11): 0.42 (0.31–0.60) |
Australia (National)
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Donovan [19] | Before/after study in national surveillance network of eight sexual health centers: all new female and male patients of any age in database | As above | 2004–2007/2007–2009 (2) | Eligible residents: 59% (95% CI 54–61%) reduction from 11.7% (2007) to 4.8% (2009) | MSW aged 12–26 years: 39.3% (95% CI 33–46%) reduction from 17.3% (2007) to 10.5% (2009); no change: non-resident eligible females, older resident females, and men, and MSMs |
Ali [18] | As above | As above | Jan 2004–Jun 2007/Jul 2007–Dec 2011 (4) | Females <21 years: 92.6% reduction from 8.8% and 11.5% (2004 and 2007) to 0.85% (2011); summary rate ratio: 0.64 (0.59–0.69) | MSW <21 years: 81.8% reduction from 7.2% and 12.1% (2004 and 2007) to 2.2% (2011); summary rate ratio: 0.72 (0.65–0.81) No significant decline in females >21 years and MSW >21 years |
Liu [23] | Before/after, country-wide telephone survey of females aged 18–39 years | As above | 2001/2011 (4) | Females 18–30 years: 41% decrease, aOR = 0.59 (95% CI 0.39–0.89) | Females 31–39 years: 64% increase, aOR = 1.64 (1.05–2.54) |
Smith [22] | Before/after analysis of national hospital database (NHMD: ICD-10 code for GW as primary or contributing diagnosis) in men and females aged 12–69 years | As above | 2006–2007/2010–2011 (4) | Females 12–17 years: 89.9% (95% CI 84.6293.4); females 18–26 years: 72.7% (95% CI 67.0–77.5); females 27–30 years: 42.1% (95% CI 26.1–54.6) | Females 31–69 years: no significant change; men 18–26 years: 38.3% reduction (95% CI 27.8–47.2); men 27–30 years: 21.2% reduction (95% CI 0.8–37.4%); men (other age groups): no significant change |
New Zealand (Auckland)
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Oliphant [24] | Before/after study at one regional sexual health service (4 centers): All new female and male patients of any age in database | 4HPV vaccine from Sep 2008 (school program: Feb 2009) for females aged 12–13 years, with initial catch-up until 2010 for those ≤20 years/School program: 51.7%; overall 38% (1990–1991 cohort); 25% (1992–1996 cohort); 20% (1997 cohort) | Jan 2007–Dec 2008/Jan 2009–Jun 2010 (1.5) | Females <20 years: 62.8% reduction from 13.7% in 2007 to 5.1% in 2010 | Men <20 years: 40.0% reduction (from 11.5 to 6.9%); male >20 years: 18.9% reduction (from 9.5 to 7.7%); females >20 years: 21.3% reduction (from 7.5 to 5.9%); (all changes from 2007 to 2010) |
Wilson [25] | National prescription database (PHARMAC) analysis for podophyllum resin-based products and imiquimod cream | As above | 2002–2007/2011–2012 (3) | Largest reduction in females <20 years: 24.5% reduction (from 15.1% of prescription in 2007/2008 to 11.4% of prescriptions in 2011/2012) | Overall population: 18% reduction in podophyllum prescriptions/year (from 2007/2008 to 2011/2012) and 22% reduction in imiquimod prescriptions/year (from 2009/2010 to 2011/2012) |
US (National)
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Flagg [27] | Before/after study using a health insurance data (ICD-9: 078.11; 078.1; 078.10; 078.19; codes for benign anogenital neoplasms, codes for GW treatment): Females and males aged 10–39 years | HPV vaccination (4HPV; 2006 and 2HPV; 2009) recommended for females aged 11–12 years with catch-up to 26 years; late 2011 boys aged 11–12 years with catch-up to 21 years/In 2011 53% of females aged 13–17 years with ≤1 dose; 35% with 3 doses; low uptake for boys | 2003–2005/2006–2010 (4) | Females aged 15–19 years: 37.9% decrease (from 2.9 in 2006 to 1.8 in 2010); females aged 20–24 years: 12.7% decrease (from 5.5 in 2007–2009 to 4.8 in 2010); females aged 25–29 years: 9.8% decrease (from 4.1 in 2009 to 3.7 in 2010); all values given in per 1,000 person-years | No reduction or small increase in other female age groups. In males (all ages grouped) incidence increased from 2003 to 2009, but did not increase in 2010; small decline in GW in men aged 20–24 years |
US (California)
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Bauer [26] | Analyses in a family planning administrative database (ICD-9: 078.10; 078.11; codes for GW treatment) for all patients | As above/in females aged 13–17 years; 56% received ≥1 dose | No comparison; study period 2007–2010 (4) | Females <21 years: 34.8% reduction (from 0.94 to 0.61%); females 21–25 years: 10% reduction (from 1.00 to 0.90%) | Men <21 years: 18.6% reduction from 2.65 to 2.16%; men 21–25 years: 11.2% reduction from 5.06 to 4.50%; stable or increase in other age groups |
US (military service members)
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Nsouli-Maktabi [28] | Analyses in the Defense Medical Surveillance System for all individuals aged ≥17 years between 2000 and 2012 using ICD-9 code 078.1 in any diagnostic position | As above | 2006/2012 (6) | Females <25 years: 40.1% reduction (from 3,575.6 to 2,143.2 per 100,000 person-years) | Females ≥25 years and all men: Stable from 2000 to 2010; increase in 2011–2012 |
Denmark (National)
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Baandrup [29] | Before/after study using data in national database; GWs (ICD-10 A63.0) in all ages and females and males | In Jan 2009 for females aged 12 years with catch-up from Oct 2008 for females up to 15-year old (1993–1995 birth cohorts)/82% and 81% for 3 doses in 1996 and 1997 birth cohorts; 85% in catch-up birth cohorts (1993, 1994, and 1995) | 2006–2008/2009–2010 (2) | Females aged 16–17 years: 45.3% average annual decrease | Smaller decreases in older age groups of females up to 26–29 years; in men: stable incidence with a trend to decrease in some age groups, e.g., aged 22–25 years, average annual % decrease = 10.9%, but none statistically significant |
Blomberg [30] | Vaccine effectiveness study in 1989–1999 female birth cohorts; GWs (ICD-10 A63.0) in vaccinated and unvaccinated females | As above/for ≥1 dose: From 14% in 1989–1990 cohort to 90% in 1995–1996 cohort | NA/Mean follow-up: 3.1 years for vaccinated and 3.5 years for unvaccinated subjects | HR for GWs (vaccinated vs. unvaccinated) 0.12, 0.22, 0.25 and 0.62 for 1995–1996, 1993–1994, 1991–1992 and 1989–1990 birth cohorts, respectively | NA |
Germany (National)
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Mikolajczyk [31] | Before/after study in a large healthcare database covering 8% of population: GWs (ICD-10 A63.0) in females and men aged 10–79 years | Mar 2007 for females aged 12–17 years (any HPV vaccine; 90% = 4HPV)/40% in 2008–2009 for females aged 16–18 years | 2005–2007/2007–2008 (1) | By end 2008 reductions of 47, 45 and 35% in females aged 16, 17, and 18 years; estimated reduction per year: 34.8, 32.8 and 24.7% for same ages | In males, no evidence of decreased incidence, except some trend to decrease in those aged 16 and 17 years; general trend over time: increased incidence in GWs |
Sweden (National)
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Leval [32] | Before/after study in national databases for those aged 10–44 years: GWs ICD-10 A63.0 (main and contributory discharge) and codes for GW treatment in prescribed drug database | May 2007 4HPV vaccination at subsidized cost for females aged 13–17 years/Aug 2011 in females aged 13–20 years: 25% ≥1 dose (>30% for females 15–18 years); highest coverage in females 18–19 years: 31.9% | 2006/2007–2010 (3) | Decreased incidence in females aged 17–21 years: RR from 0.74 for 17 years and 0.83 for 21 years; reduction of 25% in GWs incidence in females 17–18 years | In other females aged 22–25 years: RR from 0.90 for 22 years to 0.77 for 25 years; in males incidence either stable or increased |
Leval [33] | Vaccine effectiveness study in national databases in females aged 10–44 years: GWs ICD-10 A63.0 (main and contributory) and codes for GW treatment in prescribed drug database; vaccination status from databases | As above | NA (3) | Highest effectiveness in females vaccinated at 10–13 years: 93%; 80, 71, and 48% in those aged 14–18, 17–19, and 20–22 years, respectively | No significant changes in other groups studied (e.g., 21% effectiveness for females aged 23–26 years, albeit not statistically significant) |
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Heterosexual men of a similar age who could have sex with vaccinated females and therefore could be expected to benefit from herd protection;
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Older females who are less likely to be vaccinated and older heterosexual men who are less likely to benefit from herd protection;
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MSM who are unlikely to have sex with vaccinated females, and at the time of the studies, male vaccination had not been recommended.