title: Disease burden of human papillomavirus infection in the Netherlands, 1989-2014: the gap between females and males is diminishing.
abstract: Besides cervical cancer, HPV infection is linked to a multitude of diseases in both males and females, suggesting that vaccination programmes should be re-evaluated, with a judicious assessment made of the disease burden stratified by sex, age, and genotype. Projections of burden into the near future are also needed to provide a benchmark for evaluating the impact of vaccination programmes, and to assess the need for scaling-up preventive measures.
  
  
  
  Using the disability-adjusted life-years (DALY) measure, we estimated the total HPV-associated disease burden in the Netherlands. Annual cancer registrations over the period 1989-2014 for all cancers with an aetiological link to HPV infection were retrieved, supplemented by incidence data on high-grade cervical intraepithelial neoplasia (CIN) and anogenital warts.
  
  
  
  Over the recent period 2011-2014, the average annual HPV disease burden was 10,600 DALYs (95% credible interval (CrI):10,260-10,960) in females and 3,346 DALYs (95% CrI: 2,973-3,762) in males. Burden was dominated by cervical cancer, but its share amongst women decreased from 89% in 1989 to 77% in 2014. The male share of the total disease burden increased from 9.8% in 1989 to 26% in 2014. In 2023 (before the expected clinical impact from vaccinating girls), total burden is forecasted at 1.3-fold larger than in 2014.
  
  
  
  The HPV-associated disease burden is higher than that reported for any other infectious disease in the Netherlands, with a larger burden observed in women than in men. The rapidly rising male share of the total burden underlines the prioritization of male HPV-related disease in prevention programmes.
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, The Netherlands. scott.mcdonald@rivm.nl.
authors.forename: Scott A
authors.initials: SA
authors.lastname: McDonald
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, The Netherlands.|VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: Venetia
authors.initials: V
authors.lastname: Qendri
authors.affiliation: VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: Johannes
authors.initials: J
authors.lastname: Berkhof
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, The Netherlands.
authors.forename: Hester E
authors.initials: HE
authors.lastname: de Melker
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, The Netherlands.
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Bogaards
mesh_terms: D000328:Adult; D003218:Condylomata Acuminata / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology; D017281:Cost of Illness; D005260:Female; D005833:Genital Neoplasms, Female / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology; D005834:Genital Neoplasms, Male / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D030361:Papillomavirus Infections / Q000453:epidemiology*; D053918:Papillomavirus Vaccines; D019057:Quality-Adjusted Life Years; D017678:Sex Distribution; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology; D014611:Vaccination
chemical_list: D053918:Papillomavirus Vaccines
keywords: Anogenital warts; Cancer; Disability-adjusted life-years; Disease burden; Human papillomavirus