title: The efficacy and duration of vaccine protection against human papillomavirus: a systematic review and meta-analysis.
abstract: BACKGROUND
  The German Standing Committee on Vaccination (STIKO) recommends vaccination against human papillomaviruses (HPV) of the high-risk types 16 and 18. The duration of protection afforded by HPV vaccines has been reported in multiple studies to date but has not been systematically evaluated.
  
  
  METHODS
  Systematic literature review and meta-analysis on the efficacy of vaccination, with assessment of evidence by the GRADE criteria (Grading of Recommendations Assessment, Development and Evaluation).
  
  
  RESULTS
  15 studies were identified: 10 randomized controlled trials (RCTs) and 5 observational studies. The RCTs included a total of 46 436 participants. The duration of follow-up was short (median, 3 years) in 8 RCTs and long (median, 6 years) in 2 RCTs. During the period of short-term follow up, the pooled efficacy of vaccination for the study endpoint of incident HPV infection (percentage of infections prevented) was 83% (95% confidence interval [CI]: 70-90% ), while the pooled efficacy against persistent HPV infection was 90% (95% CI: 79-95% ). In this period, CIN 2+ lesions were prevented with 84% efficacy (95% CI: 50-95% ), and CIN 3+ lesions with 94% efficacy (95% CI: 83-98% ). During the period of long-term follow-up, incident infections were prevented with 94% efficacy (95% CI: 80-98% ) and persistent infections with 95% efficacy (95% CI: 84-99% ). The long-term efficacy against CIN 2+ lesions was 86% (95% CI: -166-99% ). No data are available on the long-term efficacy of vaccination against CIN 3+ lesions.
  
  
  CONCLUSIONS
  Long-term observation does not indicate any loss of antiviral protection after vaccination against HPV 16 and 18, although the evidence for long-term protection is of lesser quality than that for short-term protection.
authors.affiliation: Immunization Unit, Robert Koch Institute Berlin, Cancer Epidemiology, University Cancer Center, University Hospital Carl Gustav Carus, Dresden University of Technology, Epidemiology and Surveillance Unit, RIVM-Centre Infectious Disease Control, Bilthoven and Julius Centre Utrecht University, The Netherlands, Outpatient clinic for Pediatric and Adolescent Medicine, Ratingen, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg University Mainz.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Deleré
authors.forename: Ole
authors.initials: O
authors.lastname: Wichmann
authors.forename: Stefanie J
authors.initials: SJ
authors.lastname: Klug
authors.forename: Marianne
authors.initials: M
authors.lastname: van der Sande
authors.forename: Martin
authors.initials: M
authors.lastname: Terhardt
authors.forename: Fred
authors.initials: F
authors.lastname: Zepp
authors.forename: Thomas
authors.initials: T
authors.lastname: Harder
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D032541:Mass Vaccination / Q000706:statistics & numerical data*; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000627:therapeutic use*; D015995:Prevalence; D012307:Risk Factors; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines