1. A modelled analysis of the impact of COVID-19-related disruptions to HPV vaccination.
- Author
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Velentzis LS, Smith MA, Killen J, Brotherton JML, Guy R, and Canfell K
- Subjects
- Male, Female, Adolescent, Humans, Early Detection of Cancer, Vaccination, Human Papillomavirus Viruses, Cost-Benefit Analysis, Uterine Cervical Neoplasms epidemiology, Uterine Cervical Neoplasms prevention & control, Papillomavirus Infections complications, Papillomavirus Infections epidemiology, Papillomavirus Infections prevention & control, COVID-19 epidemiology, COVID-19 prevention & control, Papillomavirus Vaccines
- Abstract
COVID-19 disrupted school attendance in many countries, delaying routine adolescent vaccination against human papillomavirus (HPV) in some settings. We used Policy1-Cervix , a dynamic model simulating HPV transmission, natural history, vaccination, cervical screening, and diagnosis of HPV-related cancers, to estimate the impact on HPV-related cancers from disruptions to HPV vaccination in a high-income setting. A baseline scenario of no disruption to HPV vaccination was modelled, which assumed uptake of the nonavalent vaccine at the age of 12 by 82.4% of females and 75.5% of males, as is the coverage in Australia. Additional lifetime HPV-related cancer cases were calculated for three disruption scenarios affecting one birth cohort (2008; aged 12 in 2020) compared to the baseline scenario: (1) 1-year delay (no doses missed); (2) 1- to 7-year delay (slow catch-up); (3) no catch-up (herd effects only). A fourth scenario assumed no catch-up HPV vaccination for two birth cohorts, that is all individuals born in 2008 and in 2009 missed vaccination (worst-case scenario). Compared to 1532 HPV-related cancer cases estimated for the baseline no disruption scenario, we found a 1-year delay could result in ≤0.3% more HPV-related cancers ( n = 4) but the increase would be greater if catch-up was slower (5%; n = 70), and especially if there was no catch-up (49%; n = 750). Additional cancers for a single missed cohort were most commonly cervical (23% of the additional cases) and anal cancers (16%) in females and oropharyngeal cancers in males (20%). In the worst-case scenario of two birth cohorts missing vaccination, ≤62% more HPV-related cancers would be diagnosed ( n = 1892). In conclusion, providing catch-up of missed HPV vaccines is conducted, short-term delays in vaccinating adolescents are unlikely to have substantial long-term effects on cancer., Competing Interests: LV, JK, RG No competing interests declared, MS receives salary support via fellowship grants from the National Health and Medical Research Council (NHMRC) of Australia and Cancer Institute NSW and contracts paid to her institution (the Daffodil Centre) with the Commonwealth Department of Health (Australia) and National Screening Unit (New Zealand), JB former employer ACPCC has received donated HPV tests and related items for validation and research purposes from Roche, Seegene, Abbott, Becton Dickinson, Cepheid and Copan, KC Co-PI of an investigator-initiated trial of cervical screening, “Compass”, run by the Australian Centre for Prevention of Cervical Cancer (ACPCC), which is a government-funded not-for-profit charity. Compass receives infrastructure support from the Australian government and the ACPCC has received equipment and a funding contribution from Roche Molecular Diagnostics, USA. Co-PI on a major implementation program Elimination of Cervical Cancer in the Western Pacific which has received support from the Minderoo Foundation and the Frazer Family Foundation and equipment donations from Cepheid Inc. Receives contract funding from Commonwealth Department of Health, Australia to her institution for work to monitor the safety of the National Cervical Screening Program. Also receives support for a range of other Australian and international government projects including support from philanthropic organizations, WHO, and government agencies related to cervical cancer control, (© 2023, Velentzis, Smith et al.)
- Published
- 2023
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