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Open Access 01-12-2021 | Human Papillomavirus | Research article

Significant decline of HPV 6 infection and genital warts despite low HPV vaccination coverage in young women in Germany: a long-term prospective, cohort data analysis

Authors: Agnieszka Denecke, Thomas Iftner, Angelika Iftner, Sebastian Riedle, Marion Ocak, Alexander Luyten, Isak Üye, Kübra Tunc, Karl Ulrich Petry

Published in: BMC Infectious Diseases | Issue 1/2021

Abstract

Background

The introduction of human papillomavirus (HPV) vaccination has resulted in a remarkable decline of genital warts in women and men, but in Germany historical rates of vaccination are relatively low. We report long-term surveillance data on changes in HPV 6 and HPV 11 infection and the prevalence of genital warts in young women in the Wolfsburg HPV epidemiological study (WOLVES).

Methods

Women born in 1983/84, 1988/89, and 1993/94 participated in four cohorts between 2009/10 and 2014/15. Quadrivalent vaccination coverage and prevalence of HPV 6/11 infection and genital warts are reported for participants aged 19–22 years and 24–27 years at the time of sample collection. Statistical analyses were done to compare similarly aged participants using 2 × 2 contingency tables (Röhmel-Mansmann unconditional exact test; two-side alpha of 0.05).

Results

A total of 2456 women were recruited. Between 2010 and 2015, there was a statistically significant decrease in the prevalence of HPV 6 infection among women aged 24–27 years (2.1% versus 0.0%; P < 0.0001) and women aged 19–22 years (2.0% versus 0.0%; P = 0.0056). There was no significant decline in HPV 11 infection. In total, 52 of 2341 participants were diagnosed with genital warts. There was a statistically significant drop in the risk of developing genital warts in women aged 24–27 years between 2010 and 2015 (4.7% versus 1.7%, respectively; P = 0.0018). The overall risk of developing genital warts in women aged 19–27 years decreased from 3.1% in 2010 to 1.2% in 2015 (P = 0.0022).

Conclusions

An increase in vaccination coverage was associated with a decreased prevalence of genital warts in young women. A protective effect greater than herd immunity alone was seen despite low vaccination rates. Quadrivalent vaccine had a protective effect on genital HPV 6 infection and an almost fully protective effect on the development of genital warts in the youngest population.

Patel H, Wagner M, Singhal P, Kothari S. Systematic review of the incidence and prevalence of genital warts. BMC Infect Dis. 2013;13(1):39. https://doi.org/10.1186/1471-2334-13-39.CrossRefPubMedPubMedCentral

Petry KU, Luyten A, Justus A, Iftner A, Strehlke S, Schulze-Rath R, et al. Prevalence of low-risk HPV types and genital warts in women born 1988/89 or 1983/84 -results of WOLVES, a population-based epidemiological study in Wolfsburg, Germany. BMC Infect Dis. 2012;12(1):367. https://doi.org/10.1186/1471-2334-12-367.CrossRefPubMedPubMedCentral

Gross G, Hagedorn M, Ikenberg H, Rufli T, Dahlet C, Grosshans E, et al. Bowenoid papulosis. Presence of human papillomavirus (HPV) structural antigens and of HPV 16-related DNA sequences. Arch Dermatol. 1985;121(7):858–63. https://doi.org/10.1001/archderm.1985.01660070048013.CrossRefPubMed

Garland SM, Steben M, Sings HL, James M, Lu S, Railkar R, et al. Natural history of genital warts: analysis of the placebo arm of 2 randomized phase III trials of a quadrivalent human papillomavirus (types 6, 11, 16, and 18) vaccine. J Infect Dis. 2009;199(6):805–14. https://doi.org/10.1086/597071.CrossRefPubMed

Lacey CJ, Lowndes CM, Shah KV. Chapter 4: burden and management of non-cancerous HPV-related conditions: HPV-6/11 disease. Vaccine. 2006;24(Suppl 3):S3/35–41.

Navarro-Illana E, Lopez-Lacort M, Navarro-Illana P, Vilata JJ, Diez-Domingo J. Effectiveness of HPV vaccines against genital warts in women from Valencia. Spain Vaccine. 2017;35(25):3342–6. https://doi.org/10.1016/j.vaccine.2017.04.080.CrossRefPubMed

Ali H, McManus H, O'Connor CC, Callander D, Kong M, Graham S, et al. Human papillomavirus vaccination and genital warts in young indigenous Australians: national sentinel surveillance data. Med J Aust. 2017;206(5):204–9. https://doi.org/10.5694/mja16.00597.CrossRefPubMed

Tabrizi SN, Brotherton JM, Kaldor JM, Skinner SR, Liu B, Bateson D, et al. Assessment of herd immunity and cross-protection after a human papillomavirus vaccination programme in Australia: a repeat cross-sectional study. Lancet Infect Dis. 2014;14(10):958–66. https://doi.org/10.1016/S1473-3099(14)70841-2.CrossRefPubMed

Schneede P. One decade of HPV vaccination in Germany. Urologe A. 2017;56(6):728–33. https://doi.org/10.1007/s00120-017-0394-4.CrossRefPubMed

10.

Hillemanns P, Breugelmans JG, Gieseking F, Benard S, Lamure E, Littlewood KJ, et al. Estimation of the incidence of genital warts and the cost of illness in Germany: a cross-sectional study. BMC Infect Dis. 2008;8(1):76. https://doi.org/10.1186/1471-2334-8-76.CrossRefPubMedPubMedCentral

11.

von Krogh G, Lacey CJ, Gross G, Barrasso R, Schneider A. European course on HPV associated pathology: guidelines for primary care physicians for the diagnosis and management of anogenital warts. Sex Transm Infect. 2000;76(3):162–8. https://doi.org/10.1136/sti.76.3.162.CrossRef

12.

Klug SJ, Molijn A, Schopp B, Holz B, Iftner A, Quint W, et al. Comparison of the performance of different HPV genotyping methods for detecting genital HPV types. J Med Virol. 2008;80(7):1264–74. https://doi.org/10.1002/jmv.21191.CrossRefPubMed

13.

Iftner A, Klug SJ, Garbe C, Blum A, Stancu A, Wilczynski SP, et al. The prevalence of human papillomavirus genotypes in nonmelanoma skin cancers of nonimmunosuppressed individuals identifies high-risk genital types as possible risk factors. Cancer Res. 2003;63(21):7515–9.PubMed

14.

Dehlendorff C, Sparen P, Baldur-Felskov B, Herweijer E, Arnheim-Dahlstrom L, Ploner A, et al. Effectiveness of varying number of doses and timing between doses of quadrivalent HPV vaccine against severe cervical lesions. Vaccine. 2018;36(43):6373–8. https://doi.org/10.1016/j.vaccine.2018.09.011.CrossRefPubMed

15.

Kreimer AR, Herrero R, Sampson JN, Porras C, Lowy DR, Schiller JT, et al. Evidence for single-dose protection by the bivalent HPV vaccine-review of the Costa Rica HPV vaccine trial and future research studies. Vaccine. 2018;36(32):4774–82. https://doi.org/10.1016/j.vaccine.2017.12.078.CrossRefPubMedPubMedCentral

16.

Garland SM, Kjaer SK, Munoz N, Block SL, Brown DR, DiNubile MJ, et al. Impact and effectiveness of the quadrivalent human papillomavirus vaccine: a systematic review of 10 years of real-world experience. Clin Infect Dis. 2016;63(4):519–27. https://doi.org/10.1093/cid/ciw354.CrossRefPubMedPubMedCentral

17.

Drolet M, Benard E, Perez N, Brisson M, Group HPVVIS. Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. Lancet. 2019;394(10197):497–509. https://doi.org/10.1016/S0140-6736(19)30298-3.CrossRefPubMedPubMedCentral

18.

Patel C, Brotherton JM, Pillsbury A, Jayasinghe S, Donovan B, Macartney K, et al. The impact of 10 years of human papillomavirus (HPV) vaccination in Australia: what additional disease burden will a nonavalent vaccine prevent? Euro Surveill. 2018;23(41). https://doi.org/10.2807/1560-7917.ES.2018.23.41.170073.

19.

Smith LM, Strumpf EC, Kaufman JS, Lofters A, Schwandt M, Levesque LE. The early benefits of human papillomavirus vaccination on cervical dysplasia and anogenital warts. Pediatrics. 2015;135(5):e1131–40. https://doi.org/10.1542/peds.2014-2961.CrossRefPubMed

20.

Ali H, Guy RJ, Wand H, Read TR, Regan DG, Grulich AE, et al. Decline in in-patient treatments of genital warts among young Australians following the national HPV vaccination program. BMC Infect Dis. 2013;13(1):140. https://doi.org/10.1186/1471-2334-13-140.CrossRefPubMedPubMedCentral

21.

Brisson M, Benard E, Drolet M, Bogaards JA, Baussano I, Vanska S, et al. Population-level impact, herd immunity, and elimination after human papillomavirus vaccination: a systematic review and meta-analysis of predictions from transmission-dynamic models. Lancet Public Health. 2016;1(1):e8–e17. https://doi.org/10.1016/S2468-2667(16)30001-9.CrossRefPubMedPubMedCentral

22.

Mikolajczyk RT, Kraut AA, Horn J, Schulze-Rath R, Garbe E. Changes in incidence of anogenital warts diagnoses after the introduction of human papillomavirus vaccination in Germany-an ecologic study. Sex Transm Dis. 2013;40(1):28–31. https://doi.org/10.1097/OLQ.0b013e3182756efd.CrossRefPubMed

23.

Thone K, Horn J, Mikolajczyk R. Evaluation of vaccination herd immunity effects for anogenital warts in a low coverage setting with human papillomavirus vaccine-an interrupted time series analysis from 2005 to 2010 using health insurance data. BMC Infect Dis. 2017;17(1):564. https://doi.org/10.1186/s12879-017-2663-7.CrossRefPubMedPubMedCentral

24.

Kahn JA, Brown DR, Ding L, Widdice LE, Shew ML, Glynn S, et al. Vaccine-type human papillomavirus and evidence of herd protection after vaccine introduction. Pediatrics. 2012;130(2):e249–56. https://doi.org/10.1542/peds.2011-3587.CrossRefPubMedPubMedCentral

Title: Significant decline of HPV 6 infection and genital warts despite low HPV vaccination coverage in young women in Germany: a long-term prospective, cohort data analysis
Authors: Agnieszka Denecke
Thomas Iftner
Angelika Iftner
Sebastian Riedle
Marion Ocak
Alexander Luyten
Isak Üye
Kübra Tunc
Karl Ulrich Petry
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Human Papillomavirus
Vaccination
Wart
Published in: BMC Infectious Diseases / Issue 1/2021
Electronic ISSN: 1471-2334
DOI: https://doi.org/10.1186/s12879-021-06139-y

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