Potential impact of a nonavalent HPV vaccine on the occurrence of HPV-related diseases in France.
BACKGROUND
Human Papillomavirus (HPV) infection is known to be associated with a number of conditions including cervical, vaginal, vulvar, penile, anal neoplasias and cancers, oropharynx cancers and genitals warts (GW). Two prophylactic vaccines are currently available: a bivalent vaccine designed to prevent HPV type 16 and 18 infection and a quadrivalent vaccine targeting HPV 6, 11, 16, and 18. In France, HPV vaccination is recommended in 11-14 year-old girls with a catch-up for girls aged 15-19. The objective of this study was to assess the potential impact of an HPV 6/11/16/18/31/33/45/52/58 nonavalent vaccine on anogenital and oropharyngeal HPV-related diseases in France.


METHODS
HPV genotype distributions from 6 multicentric retrospective studies (EDiTH I to VI) were analyzed including 516 cases of invasive cervical cancers (ICC), 493 high-grade cervical neoplasias (CIN2/3), 397 low-grade squamous intraepithelial lesions (LSIL), 423 GW, 366 anal cancer and 314 oropharyngeal carcinomas. Low and high estimates of HPV vaccine impact were calculated as follows: low estimate: prevalence of HPV 6/11/16/18/31/33/45/52/58 genotypes alone or in association but excluding presence of another HPV type; high estimate: prevalence of HPV 6/11/16/18/31/33/45/52/58 genotypes alone or in association, possibly in presence of another HPV type.


RESULTS
Estimates of potential impact varied from 85% (low estimate) to 92% (high estimate) for ICC, 77% to 90% for CIN2/3, 26% to 56% for LSIL, 69% to 90% for GW, 81% to 93% for anal cancer, and 41% to 44% for oropharyngeal carcinomas. Compared to the quadrivalent vaccine, the proportion of additional cases potentially prevented by the nonavalent vaccine was 9.9%-15.3% for ICC, 24.7%-33.3% for CIN2/3, 12.3%-22.7% for LSIL, 2.1%-5.4% for GW, 8.5%-10.4% for anal cancer, and 0.0%-1.6% for oropharyngeal carcinoma.


CONCLUSIONS
The nonavalent HPV vaccine showed significant increased potential impact compared to the HPV 6/11/16/18 quadrivalent vaccine for ICC, CIN2/3 and LSIL. Considering a 100% vaccine efficacy and high vaccine coverage, about 90% of ICC, CIN2/3, GW or anal cancer cases could be prevented by a nonavalent HPV vaccine in France.
Service de gynécologie obstétrique, CHU Saint Jacques, Besançon, France. didier.riethmuller@univ-fcomte.fr.
Didier
D
Riethmuller
Sanofi Pasteur MSD, 12 rue Jonas Salk, 69367, Lyon, Cedex 07, France. acjacquard@spmsd.com.
Anne-Carole
AC
Jacquard
Service d'Oto-rhino-laryngologie et chirurgie cervico-faciale, Hôpital Tenon, Université de Paris 6 et Faculté de Pierre et Marie Curie, Assistance Publique-Hôpitaux de Paris, Paris, France. jean.lacau@tnn.aphp.fr.
Jean
J
Lacau St Guily
Service de dermatologie, Centre Hospitalier Universitaire Saint-Jacques, Besançon, France. faubin@chu-besancon.fr.
François
F
Aubin
Department of Obstetrics and Gynaecology, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille (APHM), Aix-Marseille Université (AMU), CNRS, IRD, Avignon Université, IMBE UMR 7263, 13397, Marseille, France. xcarco@free.fr.
Xavier
X
Carcopino
Department of Hepatology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France. pierre.pradat@univ-lyon1.fr.
Pierre
P
Pradat
Sanofi Pasteur MSD, 12 rue Jonas Salk, 69367, Lyon, Cedex 07, France. ADahlab@spmsd.com.
André
A
Dahlab
Université Franche-Comte, F-25000, Besançon, France. jean_luc.pretet@univ-fcomte.fr.|EA 3181, FED4234, LabEx LipSTIC ANR-11-LABX-0021, CIC-BT 506, F-25000, Besancon, France. jean_luc.pretet@univ-fcomte.fr.|CHRU Besançon, F-25000, Besançon, France. jean_luc.pretet@univ-fcomte.fr.
Jean-Luc
JL
Prétet
D052685:Alphapapillomavirus / Q000235:genetics; D001005:Anus Neoplasms / Q000517:prevention & control* / Q000821:virology; D005260:Female; D005602:France / Q000453:epidemiology; D005838:Genotype; D006801:Humans; D008297:Male; D009959:Oropharyngeal Neoplasms / Q000517:prevention & control* / Q000821:virology; D030361:Papillomavirus Infections / Q000517:prevention & control* / Q000821:virology; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D015995:Prevalence; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000821:virology
D053918:Papillomavirus Vaccines