Human Papillomavirus Vaccine Impact and Effectiveness Through 12 Years After Vaccine Introduction in the United States, 2003 to 2018

Abstract

Background: Human papillomavirus (HPV) vaccination was introduced in 2006 for females and in 2011 for males.

Objective: To estimate vaccine impact and effectiveness against quadrivalent HPV vaccine (4vHPV)-type prevalent infection among sexually experienced U.S. females and vaccine effectiveness for sexually experienced U.S. males.

Design: NHANES (National Health and Nutrition Examination Survey) conducted in 2003 to 2006 (prevaccine era) and in 2007 to 2010, 2011 to 2014, and 2015 to 2018 (vaccine eras).

Setting: Nationally representative U.S. surveys.

Participants: Sexually experienced participants aged 14 to 24 years.

Intervention: U.S. HPV vaccination program.

Measurements: Participant-collected cervicovaginal and penile specimens were tested for HPV DNA. The prevalences of 4vHPV and non-4vHPV types were estimated in each era for females and in 2013 to 2016 for males. Prevalences among the female population overall, vaccinated females, and unvaccinated females were compared in vaccine eras versus the prevaccine era (vaccine impact). Within each vaccine era, prevalence among vaccinated females was compared with that among unvaccinated females (vaccine effectiveness). Vaccine impact and effectiveness were estimated as (1 - prevalence ratio) · 100.

Results: Among sexually experienced females aged 14 to 24 years, the impact on 4vHPV-type prevalence in 2015 to 2018 was 85% overall, 90% among vaccinated females, and 74% among unvaccinated females. No significant declines were found in non-4vHPV-type prevalence. Vaccine effectiveness ranged from 60% to 84% during vaccine eras for females and was 51% during 2013 to 2016 for males.

Limitation: Self- or parent-reported vaccination history and small numbers in certain subgroups limited precision.

Conclusion: Nationally representative data show increasing impact of the vaccination program and herd protection. Vaccine effectiveness estimates will be increasingly affected by herd effects.

Primary funding source: Centers for Disease Control and Prevention.

Figure 1.

Vaccine impact and vaccine effectiveness framework.

Figure 2.

HPV vaccination coverage and 4vHPV-type (top) and non–4vHPV-type (bottom) prevalence among sexually experienced 14- to 24-year-old females, by vaccination era and history. The reported receipt of ≥1 HPV vaccine dose (%) among 14- to 24-year-old female and male participants is represented by the lines. 4vHPV-type indicates quadrivalent HPV vaccine types: HPV 6, 11, 16, and 18. Non–4vHPV-type indicates 33 types detected using Linear Array that are not HPV 6, 11, 16, or 18. All estimates are weighted using NHANES (National Health and Nutrition Examination Survey) examination weights. 4vHPV = quadrivalent HPV vaccine; HPV = human papillomavirus.

Figure 3.

Vaccine impact measures and vaccine effectiveness for 4vHPV-type prevalence among sexually experienced 14- to 24-year-old females, in 3 vaccine eras. 4vHPV-type indicates quadrivalent HPV vaccine types: HPV 6, 11, 16, and 18. All estimates are weighted using NHANES (National Health and Nutrition Examination Survey) examination weights. * Impact = (1 — prevalence ratio) · 100. Bars represent 95% CIs. The following impact estimates were calculated using prevalence estimates with relative SE >30% and should be interpreted with caution: population impact 2015–2018; impact among vaccinated persons in 2007–2010, 2011–2014, and 2015–2018; impact among unvaccinated persons in 2015–2018; and vaccine effectiveness in 2007–2010, 2011–2014, and 2015–2018. † Vaccinated indicates self-/parent-reported receipt of ≥1 dose. 4vHPV = quadrivalent HPV vaccine; HPV = human papillomavirus.