Prevalence of Human Papillomavirus Among Females After Vaccine Introduction-National Health and Nutrition Examination Survey, United States, 2003-2014

Abstract

Background: Human papillomavirus (HPV) vaccine was recommended in 2006 for routine vaccination of US females aged 11-12 years. Most vaccine used through 2014 was quadrivalent vaccine (4vHPV), which prevents HPV-6, -11, -16, and -18 infection. To evaluate vaccine impact, we measured HPV prevalence in the National Health and Nutrition Examination Survey (NHANES).

Methods: We analyzed HPV DNA types detected in self-collected cervicovaginal specimens and demographic, sexual behavior, and self-reported vaccination data from females 14-34 years old. We estimated HPV prevalence in the prevaccine (2003-2006) and vaccine eras (2007-2010 and 2011-2014).

Results: Among 14- to 19-year-olds, 4vHPV-type prevalence decreased from 11.5% (95% confidence interval [CI], 9.1%-14.4%) in 2003-2006 to 3.3% (95% CI, 1.9%-5.8%) in 2011-2014, when ≥1-dose coverage was 55%. Among 20- to 24-year-olds, prevalence decreased from 18.5% (95% CI, 14.9%-22.8%) in 2003-2006 to 7.2% (95% CI, 4.7%-11.1%) in 2011-2014, when ≥1-dose coverage was 43%. Compared to 2003-2006, 4vHPV prevalence in sexually active 14- to 24-year-olds in 2011-2014 decreased 89% among those vaccinated and 34% among those unvaccinated. Vaccine effectiveness was 83%.

Conclusions: Within 8 years of vaccine introduction, 4vHPV-type prevalence decreased 71% among 14- to 19-year-olds and 61% among 20- to 24-year-olds. Estimated vaccine effectiveness was high. The decrease in 4vHPV-type prevalence among unvaccinated females suggests herd protection.

Keywords: HPV vaccine; human papillomavirus; prevalence; vaccine effectiveness; vaccine impact.

Figure 1

Participation and sample collection among females—National Health and Nutrition Examination Survey, 2003–2014. ^aThe response rate during 2003–2004 and 2005–2006 among females was 79.7% and 80.9% for the interview portion and 76.0% and 77.8% for the examination portion, respectively. ^bThe response rate during 2007–2008 and 2009–2010 among females was 78.6% and 79.7% for the interview portion and 75.5% and 77.4% for the examination portion, respectively. ^cThe response rate during 2011–2012 and 2013–2014 among females was 72.6% and 71.4% for the interview portion and 69.4% and 68.8% for the examination portion, respectively.

Figure 2

Prevalence of individual human papillomavirus (HPV) types among females aged 14–19 years (A) and 20–24 years (B), National Health and Nutrition Examination Survey, 2003–2006 and 2011–2014. *P < .05 based on Wald χ² test, comparing 2011–2014 to 2003–2006. HPV types ordered from highest to lowest prevalence among 14- to 19-year-old females in 2003–2006 within each HPV type category. Estimates with a relative standard error (RSE) of >30% to 50% are as follows: 14- to 19-year-old females: 2003–2006: HPV-11, -26, -33, -64, -71, -82; 2011–2014: HPV-6, -18, -31, -45, -53, -54, -55, -56, -61, -62, -68, -70, -73, -81, -82, -83. 20- to 24-year-old females: 2003–2006: HPV-31, -33, -35, -45, -55, -56, -67, -68, -73, -81, -82, -83; 2011–2014: HPV-18, -31, -40, -45, -58, -67, -70, -81, -82. Estimates with an RSE of >50% are as follows: 14- to 19-year-old females: 2003–2006: HPV-69, -72, -IS39; 2011–2014: HPV-11, -16, -26, -33, -35, -40, -71, -72, -IS39. 20- to 24-year-old females: 2003–2006: HPV-11, -26, -40, -69, -71, -72, -IS39; 2011–2014: HPV-6, -11, -26, -33, -69, -71, -72, -IS39.