1. Who's Not Protected in the Herd? Factors Associated with Vaccine-Type HPV in Unvaccinated Women
- Author
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Smith, C, Ding, L, Gorbach, PM, Franco, EL, and Kahn, JA
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Clinical Trials and Supportive Activities ,Prevention ,Cancer ,Sexually Transmitted Infections ,Immunization ,HPV and/or Cervical Cancer Vaccines ,Infectious Diseases ,Clinical Research ,HIV/AIDS ,Vaccine Related ,Cervical Cancer ,Prevention of disease and conditions ,and promotion of well-being ,3.4 Vaccines ,Infection ,Good Health and Well Being ,Adolescent ,Adult ,Cross-Sectional Studies ,Female ,Humans ,Logistic Models ,Papillomavirus Infections ,Papillomavirus Vaccines ,Prevalence ,Racial Groups ,Risk Factors ,Sexual Behavior ,Sexually Transmitted Diseases ,Young Adult ,Human papillomavirus ,Herd protection ,Vaccine ,Women ,Paediatrics and Reproductive Medicine ,Obstetrics & Reproductive Medicine ,Paediatrics ,Reproductive medicine - Abstract
Study objectiveEvidence suggests that vaccine-type human papillomavirus (HPV) prevalence may decrease in unvaccinated women after HPV vaccine introduction, indicating herd protection. The aim of this study was to determine factors associated with vaccine-type HPV (i.e. absence of herd protection) after vaccine introduction.DesignWe conducted three cross-sectional studies from 2006-2014 (n = 1180): wave 1 (2006-2007), wave 2 (2009-2010), and wave 3 (2013-2014).SettingParticipants were recruited from a hospital-based teen health center and a community health department.ParticipantsWe recruited 13-26 year-old young women; those included in this analysis had not received an HPV vaccine.Interventions and main outcome measuresThe outcome measure was infection with at least one vaccine-type HPV (HPV6, 11, 16, 18).ResultsMultivariable logistic regression demonstrated that in wave 1 (before vaccine introduction), history of anal intercourse (OR = 1.8, 95% CI = 1.1-3.0), age 18-21 vs 13-17 years (OR = 2.1, CI = 1.2-3.6), and Black/multiracial vs White race (OR = 1.8, CI = 1.1-3.0) were associated with vaccine-type HPV in unvaccinated women. In wave 2, no variables were associated with HPV. In wave 3, sexually transmitted infection history (OR = 3.6, CI = 1.3-9.7) was associated with HPV.ConclusionWe did not identify a consistent set of modifiable risk factors associated with vaccine-type HPV after vaccine introduction across the three study waves, underscoring the urgency of vaccination for primary HPV prevention and the limitations of relying on herd protection.
- Published
- 2018