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. 2017 Jun 8;7(6):e015021.
doi: 10.1136/bmjopen-2016-015021.

Timing of two versus three doses of quadrivalent HPV vaccine and associated effectiveness against condyloma in Sweden: a nationwide cohort study

F Lamb  1 , E Herweijer  1 , A Ploner  1 , I Uhnoo  2 , K Sundström  3 , P Sparén  1 , L Arnheim-Dahlström  1
Affiliations

Timing of two versus three doses of quadrivalent HPV vaccine and associated effectiveness against condyloma in Sweden: a nationwide cohort study

F Lamb et al. BMJ Open. .

Abstract

Objective: To assess incidence of condyloma after two doses of quadrivalent human papillomavirus (qHPV) vaccine, by time since first vaccine dose, in girls and women initiating vaccination before age 20 years.

Design: Register-based nationwide open cohort study.

Setting: Sweden.

Participants: Girls and women initiating qHPV vaccination before age 20 years between 2006 and 2012. The study cohort included 264 498 girls, of whom 72 042 had received two doses of qHPV vaccine and 185 456 had received all three doses.

Main outcome measure: Incidence rate ratios (IRRs) of condyloma estimated by time between first and second doses of qHPV in months (m) and age at vaccination, adjusted for attained age.

Results: For girls first vaccinated with two doses before the age of 17 years, the IRR of condyloma for 0-3 months between the first and second doses was 1.96 (95% CI 1.43 to 2.68) as compared with the standard three-dose schedule. The IRRs were 1.27 (95% CI 0.63 to 2.58) and 4.36 (95% CI 2.05 to 9.28) after receipt of two doses with 4-7 months and 8+ months between doses, respectively. For women first vaccinated after the age of 17 years, vaccination with two doses of qHPV vaccine and 0-3 months between doses was associated with an IRR of 2.12 (95% CI 1.62 to 2.77). For an interval of 4-7 months between doses, the IRR did not statistically significantly differ to the standard three-dose schedule (IRR=0.81, 95% CI 0.36 to 1.84). For women with 8+ months between dose 1 and dose 2 the IRR was 3.16 (95% CI 1.40 to 7.14).

Conclusion: A two-dose schedule for qHPV vaccine with 4-7 months between the first and second doses may be as effective against condyloma in girls and women initiating vaccination under 20 years as a three-dose schedule. Results from this nationwide study support immunogenicity data from clinical trials.

Keywords: epidemiology; infectious diseases; preventive medicine; public health.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; LAD has received research grants to her institution for other studies from MSD Sanofi Pasteur, Merck Sharp and Dohme, and GlaxoSmithKline. KS has received grants from Merck Sharp and Dohme for other studies on HPV vaccination in Sweden; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1
Details on study exclusions and the population analysed to investigate timing of two versus three doses of quadrivalent human papillomavirus (HPV) vaccine and associated effectiveness against condyloma.
See this image and copyright information in PMC

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