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- Title
Human Papillomavirus Genotype Replacement: Still Too Early to Tell?
- Authors
Man, Irene; Vänskä, Simopekka; Lehtinen, Matti; Bogaards, Johannes A
- Abstract
<bold>Background: </bold>Although human papillomavirus (HPV) vaccines are highly efficacious in protecting against HPV infections and related diseases, vaccination may trigger replacement by nontargeted genotypes if these compete with the vaccine-targeted types. HPV genotype replacement has been deemed unlikely, based on the lack of systematic increases in the prevalence of nonvaccine-type (NVT) infection in the first decade after vaccination, and on the presence of cross-protection for some NVTs.<bold>Methods: </bold>To investigate whether type replacement can be inferred from early postvaccination surveillance, we constructed a transmission model in which a vaccine type and an NVT compete through infection-induced cross-immunity. We simulated scenarios of different levels of cross-immunity and vaccine-induced cross-protection to the NVT. We validated whether commonly used measures correctly indicate type replacement in the long run.<bold>Results: </bold>Type replacement is a trade-off between cross-immunity and cross-protection; cross-immunity leads to type replacement unless cross-protection is strong enough. With weak cross-protection, NVT prevalence may initially decrease before rebounding into type replacement, exhibiting a honeymoon period. Importantly, vaccine effectiveness for NVTs is inadequate for indicating type replacement.<bold>Conclusions: </bold>Although postvaccination surveillance thus far is reassuring, it is still too early to preclude type replacement. Monitoring of NVTs remains pivotal in gauging population-level impacts of HPV vaccination.
- Subjects
VACCINE effectiveness; GENOTYPES; PAPILLOMAVIRUSES; HUMAN papillomavirus vaccines; VACCINATION
- Publication
Journal of Infectious Diseases, 2021, Vol 224, Issue 3, p481
- ISSN
0022-1899
- Publication type
journal article
- DOI
10.1093/infdis/jiaa032