Background
The first HPV‐vaccine eligible cohorts in the Netherlands will enter the cervical screening program in 2023. However, a substantial number of young women already have had a cervical sample ...taken before entry into the regular screening program. This study was initiated to explore early effects of HPV vaccination on detection of cytological abnormalities in cervical samples of women younger than the screening age.
Methods
Results of cervical samples were obtained from the Dutch National Pathology Databank (PALGA) and were linked to the women's HPV vaccination status from the national vaccination registry (Praeventis) (N = 42,171). Occurrence of low‐grade and high‐grade squamous intraepithelial lesions or worse (LSIL and HSIL+) and high‐risk HPV positive tests (hrHPV) in the first cervical sample were compared between vaccinated and unvaccinated women by multivariable logistic regression analysis, corrected for age at cervical sampling and age of vaccination (12/13 years, ≥ = 14 years).
Results
For fully vaccinated women (three‐ or two‐dose schedule), statistically significant reductions were seen for all outcomes compared to unvaccinated women (hrHPV: adjusted OR, 0.70, 95% CI, 0.63–0.79; LSIL: 0.70, 0.61–0.80; HSIL+: 0.39, 0.30–0.51).
Conclusions
By linking nation‐wide registries on pathology and vaccination, we show significant beneficial early effects of HPV‐vaccination on LSIL, HSIL+, CIN3/AIS/carcinoma and hrHPV detection in young women upto 24 years of age who have a cervical sample taken before entry into the cervical cancer screening program.
By linking nation‐wide registries on pathology and vaccination, marked reductions in low‐grade (LSIL) and high‐grade (HSIL) cytological cervical abnormalities were found in young women up to 24 years of age who were fully vaccinated against HPV and did have a cervical sample taken before entry into the cervical cancer screening program.
The current study describes the long-term effectiveness of three-dose HPV16/18 vaccination among Dutch women who were eligible for vaccination during a catch-up campaign and were followed in an ...observational cohort study. Ten years post vaccination, vaccine effectiveness (VE) was estimated using generalized estimating equation models. VE against persistent infections with vaccine type infections (HPV16/18) was high at 95.8%. For cross protective type persistent infections (HPV31/33/45) this was 64.6%. There were no indications of waning of protection over time. This indicates solid long-term protection is provided by the vaccine and is promising with regard to the future clinical impact.
Abstract
Background
In the Netherlands, the bivalent human papillomavirus (HPV) vaccine has been offered to preadolescent girls via the National Immunization Program in a 2-dose schedule since 2014. ...The current study estimates vaccine effectiveness (VE) against HPV infections up to 4 years postvaccination among girls eligible for routine 2-dose immunization.
Methods
A cohort study (HAVANA2) was used in which participants annually filled out an online questionnaire and provided a vaginal self-sample for determination of HPV by the SPF10-LiPA25 assay, able to detect 25 HPV types. VE against incident type-specific infections and pooled outcomes was estimated by a Cox proportional hazards model with shared frailty between the HPV types.
Results
In total, 2027 girls were included in the study, 1098 (54.2%) of whom were vaccinated with 2 doses. Highest incidence rate was 5.0/1000 person-years (HPV-51) among vaccinated participants and 9.1/1000 person-years (HPV-74) among unvaccinated participants. Adjusted pooled VE was 84.0% (95% confidence interval CI, 27.0%–96.5%) against incident HPV-16/18 infections and 86.5% (95% CI, 39.5%–97.08%) against cross-protective types HPV-31/33/45.
Conclusions
Four years postvaccination, 2 doses of bivalent HPV vaccine were effective in the prevention of incident HPV-16/18 infections and provided cross-protection to HPV-31/33/45. Our VE estimates rival those from 3-dose schedules, indicating comparable protection by 2-dose schedules.
Approaches to estimating clearance rates, an important metric of human papillomavirus (HPV) clearance, for HPV groupings differ between studies. We aimed to identify the approaches used in the ...literature for estimating grouped HPV clearance rates. We investigated whether these approaches resulted in different estimations, using data from existing studies.
In this systematic review, we included articles that reported clearance rates of HPV groupings. We identified approaches to data in the HAVANA cohort, comprising adolescent girls, and the H2M cohort, comprising men who have sex with men. We estimated clearance rates for six HPV groupings (bivalent-, quadrivalent- and nonavalent vaccine-related, and low-risk, high-risk, and any HPV).
From 26 articles, we identified 54 theoretically possible approaches to estimating clearance rates. These approaches varied regarding definitions of clearance events and person-time, and prevalence or incidence of infections included in the analysis. Applying the nine most-used approaches to the HAVANA ( n = 1,394) and H2M ( n = 745) cohorts demonstrated strong variation in clearance rate estimates depending on the approach used. For example, for grouped high-risk HPV in the H2M cohort, clearance rates ranged from 52.4 to 120.0 clearances/1000 person-months. Clearance rates also varied in the HAVANA cohort, but differences were less pronounced, ranging from 24.1 to 57.7 clearances/1000 person-months.
Varied approaches from the literature for estimating clearance rates of HPV groupings yielded different clearance rate estimates in our data examples. Estimates also varied between study populations. We advise clear reporting of methodology and urge caution in comparing clearance rates between studies.
In the Netherlands, bivalent human papillomavirus (HPV) vaccination was included in the National Immunization Program for 12-year-old girls in 2010 (vaccination coverage, 45%-60%). We examined ...possible changes in HPV seroprevalence in the HPV-unvaccinated Dutch population aged 0-89 years, comparing prevaccination data with data of approximately 6 years after implementation of national vaccination.
Serum samples of men and women were used from two cross-sectional population-based serosurveillance studies performed before (2006-07,
= 6,384) and after (2016-17,
= 5,645) implementation of HPV vaccination in the Netherlands. Seven high-risk HPV-specific antibodies (HPV16, 18, 31, 33, 45, 52, and 58) were tested in a virus-like particle-based multiplex immunoassay.
Type-specific HPV seroprevalence increased in women between 2006-07 and 2016-17. Also, a higher seroprevalence for at least one type in women >15 years was found in 2016-17 (31.7%) compared with 2006-07 (25.2%). In men, overall HPV seroprevalence remained similar; however, a lower seroprevalence was found for HPV16 in 2016-17 (7.5%) compared with 2006-07 (10.6%).
Our results indicate an increase in high-risk HPV types in women and a rather stable exposure in men. No clear effects of the strategy of girls-only vaccination were observed in men, probably because of the short time after introduction combined with suboptimal coverage.
No herd immunity has been observed yet in a population with suboptimal HPV vaccination coverage.
Abstract
Background
Human papillomavirus (HPV) vaccination programs achieve substantial population-level impact, with effects extending beyond protection of vaccinated individuals. We assessed trends ...in HPV prevalence up to 8 years postvaccination among men and women in the Netherlands, where bivalent HPV vaccination, targeting HPV types 16/18, has been offered to (pre)adolescent girls since 2009 with moderate vaccination coverage.
Methods
We used data from the PASSYON study, a survey initiated in 2009 (prevaccination) and repeated biennially among 16- to 24-year-old visitors of sexual health centers. We studied genital HPV positivity from 2009 to 2017 among women, heterosexual men, and unvaccinated women using Poisson generalized estimating equation models, adjusted for individual- and population-level confounders. Trends were studied for 25 HPV types detected by the SPF10-LiPA25 platform.
Results
A total of 6354 women (64.7% self-reported unvaccinated) and 2414 heterosexual men were included. Percentual declines in vaccine types HPV-16/18 were observed for all women (12.6% per year 95% confidence interval {CI}, 10.6–14.5), heterosexual men (13.0% per year 95% CI, 8.3–17.5), and unvaccinated women (5.4% per year 95% CI, 2.9–7.8). We observed significant declines in HPV-31 (all women and heterosexual men), HPV-45 (all women), and in all high-risk HPV types pooled (all women and heterosexual men). Significant increases were observed for HPV-56 (all women) and HPV-52 (unvaccinated women).
Conclusions
Our results provide evidence for first-order herd effects among heterosexual men against HPV-16/18 and cross-protective types. Additionally, we show second-order herd effects against vaccine types among unvaccinated women. These results are promising regarding population-level and clinical impact of girls-only bivalent HPV vaccination in a country with moderate vaccine uptake.
This study presents trends in human papillomavirus (HPV) positivity since girls-only HPV vaccine introduction in the Netherlands, with moderate vaccine uptake. We show declining prevalences of vaccine types HPV-16/18 in heterosexual men and unvaccinated women, and of cross-protective types in heterosexual men.
In the Netherlands, the bivalent HPV vaccine (2vHPV) has been offered to preadolescent girls via the National Immunization Program (NIP) in a two-dose (2D) schedule since 2014. The current study ...estimates vaccine effectiveness (VE) against HPV infections up to four years post-vaccination among girls eligible for routine 2D immunization.
A cohort study (HAVANA2) was used in which participants annually filled out an online questionnaire and provided a vaginal self-sample for determination of HPV by the SPF10-LiPA25 assay, able to detect 25 HPV types. VE against incident type-specific infections and pooled outcomes was estimated by a Cox proportional hazards model with shared frailty between the HPV types.
In total, 2027 girls were included in the study, 1098 (54.2%) of whom were vaccinated with two doses. Highest incidence rate was 5.0/1000 person-years (HPV51) among vaccinated participants and 9.1/1000 person-years (HPV74) among unvaccinated participants. Adjusted pooled VE was 84.0% (95%CI, 27.0-96.5%) against incident HPV16/18 infections and 86.5% (95%CI, 39.5-97.08%) against cross-protective types HPV31/33/45.
Four years post-vaccination, two doses of 2vHPV vaccination were effective in the prevention of incident HPV16/18 infections and provided cross-protection to HPV31/33/45. Our VE estimates rival those from three-dose schedules, indicating comparable protection by 2D schedules.
A new generation of public programs emerges, which specifically addresses complex societal problems we witness today. Programs for these types of complex issues—in this article, we consider more ...closely the challenge of sustainable development—are characterized by emergent design, learning processes between diverse actors, and adaptive management. Managers of these kinds of programs have new demands for evaluation and evaluators. This article describes prevailing evaluation methods for sustainable development (progress assessment, goal-oriented program evaluation, and program theory evaluation) and the challenges they meet when confronted with the complexity of designing and conducting systemic intervention programs for sustainable development. The evaluation framework that we propose offers guiding principles to assist evaluators in evaluating complex programs.
This article places action learning in the context of system innovation, as it studies the potential use of action learning for system change. In order to effect such system change, collaboration ...between actors from different institutional backgrounds is essential. To gain insight into if and how action learning can be applied for system change, we study three system change projects in Dutch agriculture. We focus specifically on the approaches developed by the project leaders for collaboration between the scientists and the entrepreneurs and analyse how the interaction between these two contributed to the learning process within the project. This article concludes with guiding concepts for action learning for system change in the field of sustainable development of agriculture and beyond.
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