title: Efficacy of vaccination against HPV infections to prevent cervical cancer in France: present assessment and pathways to improve vaccination policies.
abstract: BACKGROUND
  Seventy percent of sexually active individuals will be infected with Human Papillomavirus (HPV) during their lifetime. These infections are incriminated for almost all cervical cancers. In France, 3,068 new cases of cervical cancer and 1,067 deaths from cervical cancer occurred in 2005. Two vaccines against HPV infections are currently available and vaccination policies aim to decrease the incidence of HPV infections and of cervical cancers. In France, vaccine coverage has been reported to be low.
  
  
  METHODS
  We developed a dynamic model for the heterosexual transmission of Human Papillomavirus types 16 and 18, which are covered by available vaccines. A deterministic model was used with stratification on gender, age and sexual behavior. Immunity obtained from vaccination was taken into account. The model was calibrated using French data of cervical cancer incidence.
  
  
  RESULTS
  In view of current vaccine coverage and screening, we expected a 32% and 83% reduction in the incidence of cervical cancers due to HPV 16/18, after 20 years and 50 years of vaccine introduction respectively. Vaccine coverage and screening rates were assumed to be constant. However, increasing vaccine coverage in women or vaccinating girls before 14 showed a better impact on cervical cancer incidence. On the other hand, performing vaccination in men improves the effect on cervical cancer incidence only moderately, compared to strategies in females only.
  
  
  CONCLUSIONS
  While current vaccination policies may significantly decrease cervical cancer incidence, other supplementary strategies in females could be considered in order to improve vaccination efficacy.
authors.affiliation: Laboratoire Mathématiques Appliquées à Paris 5, Centre National de la Recherche Scientifique Unité Mixte de Recherche n°8145, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. laureen.majed@parisdescartes.fr
authors.forename: Laureen
authors.initials: L
authors.lastname: Ribassin-Majed
authors.forename: Rachid
authors.initials: R
authors.lastname: Lounes
authors.forename: Stephan
authors.initials: S
authors.lastname: Clémençon
mesh_terms: D000367:Age Factors; D003198:Computer Simulation; D005260:Female; D005602:France / Q000453:epidemiology; D052162:Human papillomavirus 16 / Q000276:immunology*; D052161:Human papillomavirus 18 / Q000276:immunology*; D006801:Humans; D015994:Incidence; D008297:Male; D008954:Models, Biological; D030361:Papillomavirus Infections / Q000150:complications / Q000517:prevention & control* / Q000635:transmission*; D053918:Papillomavirus Vaccines / Q000276:immunology*; D015995:Prevalence; D012737:Sex Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*
chemical_list: D053918:Papillomavirus Vaccines