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- Title
Prevalence of Human Papillomavirus and Estimation of Human Papillomavirus Vaccine Effectiveness in Thimphu, Bhutan, in 2011-2012 and 2018 : A Cross-sectional Study.
- Authors
Baussano, Iacopo; Tshomo, Ugyen; Tenet, Vanessa; Heideman, Daniëlle A.M.; Wangden, Tshering; Franceschi, Silvia; Clifford, Gary M.
- Abstract
<bold>Background: </bold>Bhutan implemented a national program for human papillomavirus (HPV) vaccination in 2010 involving girls aged 12 to 18 years and achieving nearly 90% coverage.<bold>Objective: </bold>To estimate HPV vaccine effectiveness in a city in Bhutan.<bold>Design: </bold>2 cross-sectional surveys, 2011-2012 and 2018.<bold>Setting: </bold>2 hospitals in Thimphu, capital of Bhutan.<bold>Participants: </bold>Sexually active women aged 17 to 29 years: 1445 participants from the baseline survey and 1595 from the repeated survey.<bold>Intervention: </bold>National HPV vaccination program.<bold>Measurements: </bold>HPV was assessed in cervical cell samples by using general primer GP5+/GP6+-mediated polymerase chain reaction. Human papillomavirus types were stratified as vaccine types (HPV6/11/16/18) and nonvaccine types. Age- and sexual behavior-adjusted overall, total, and indirect (herd immunity) vaccine effectiveness (VE) was computed as (1 - HPV prevalence ratio) for HPV among all women and among unvaccinated women.<bold>Results: </bold>Between the 2 surveys, the prevalence of HPV vaccine types decreased from 8.3% to 1.4%, whereas the prevalence of nonvaccine types increased from 25.8% to 31.4%. The overall and indirect adjusted VE against vaccine-targeted HPV types was 88% (95% CI, 80% to 92%) and 78% (CI, 61% to 88%), respectively. Among women younger than 27 years, who were targeted by the vaccination program, the overall and indirect adjusted VE was 93% (CI, 87% to 97%) and 88% (CI, 69% to 95%), respectively. No impact on nonvaccine HPV types was detectable.<bold>Limitation: </bold>Hospital-based recruitment; self-reported vaccination status.<bold>Conclusion: </bold>In Bhutan, the prevalence of vaccine-targeted HPV types has decreased sharply, providing the first evidence of the effectiveness of a high-coverage national HPV vaccination program in a lower-middle-income country.<bold>Primary Funding Source: </bold>Bill & Melinda Gates Foundation.
- Subjects
BHUTAN; RESEARCH; IMMUNIZATION; CROSS-sectional method; RESEARCH methodology; EVALUATION research; MEDICAL cooperation; TREATMENT effectiveness; MEDICAL protocols; COMPARATIVE studies; PAPILLOMAVIRUS diseases; HUMAN papillomavirus vaccines; DISEASE prevalence
- Publication
Annals of Internal Medicine, 2020, Vol 173, Issue 11, p888
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/M20-2849