Estimates of the timing of reductions in genital warts and high grade cervical intraepithelial neoplasia after onset of human papillomavirus (HPV) vaccination in the United States

Abstract

Background: The objective of this study was to estimate the number of years after onset of a quadrivalent HPV vaccination program before notable reductions in genital warts and cervical intraepithelial neoplasia (CIN) will occur in teenagers and young adults in the United States.

Methods: We applied a previously published model of HPV vaccination in the United States and focused on the timing of reductions in genital warts among both sexes and reductions in CIN 2/3 among females. Using different coverage scenarios, the lowest being consistent with current 3-dose coverage in the United States, we estimated the number of years before reductions of 10%, 25%, and 50% would be observed after onset of an HPV vaccination program for ages 12-26 years.

Results: The model suggested female-only HPV vaccination in the intermediate coverage scenario will result in a 10% reduction in genital warts within 2-4 years for females aged 15-19 years and a 10% reduction in CIN 2/3 among females aged 20-29 years within 7-11 years. Coverage had a major impact on when reductions would be observed. For example, in the higher coverage scenario a 25% reduction in CIN2/3 would be observed with 8 years compared with 15 years in the lower coverage scenario.

Conclusions: Our model provides estimates of the potential timing and magnitude of the impact of HPV vaccination on genital warts and CIN 2/3 at the population level in the United States. Notable, population-level impacts of HPV vaccination on genital warts and CIN 2/3 can occur within a few years after onset of vaccination, particularly among younger age groups. Our results are generally consistent with early reports of declines in genital warts among youth.

Keywords: Cervical neoplasms; Genital warts; Models; Papillomavirus; Vaccination.

Fig. 1.

The estimated decline in genital warts among females aged 15–19 years following onset of a quadrivalent HPV vaccination program under 6 vaccination scenarios. Two vaccination strategies (“Female-only vaccination” shown with solid lines and “Male and female vaccination” shown with dashed lines) for ages 12–26 years were modeled under three coverage levels (lower, intermediate, and higher) as described in Table 1.

Fig. 2.

The estimated decline in genital warts among males aged 15–19 years following onset of a quadrivalent HPV vaccination program under 6 vaccination scenarios. Two vaccination strategies (“Female-only vaccination” shown with solid lines and “Male and female vaccination” shown with dashed lines) for ages 12–26 years were modeled under three coverage levels (lower, intermediate, and higher) as described in Table 1.

Fig. 3.

The estimated decline in cervical intraepithelial neoplasia (CIN) 2/3 among females aged 20–29 years following onset of a quadrivalent HPV vaccination program under 6 vaccination scenarios. Two vaccination strategies (“Female-only vaccination” shown with solid lines and “Male and female vaccination” shown with dashed lines) for ages 12–26 years were modeled under three coverage levels (lower, intermediate, and higher) as described in Table 1.