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Open Access 01-12-2020 | Human Papillomavirus | Research article

Measuring vaccine effectiveness against persistent HPV infections: a comparison of different statistical approaches

Authors: R. Donken, J. Hoes, M. J. Knol, G. S. Ogilvie, S. Dobson, A. J. King, J. Singer, P. J. Woestenberg, J. A. Bogaards, C. J. L. M. Meijer, H. E. de Melker

Published in: BMC Infectious Diseases | Issue 1/2020

Abstract

Background

Persistent high-risk human papillomavirus (HPV) infection is endorsed by the World Health Organization as an intermediate endpoint for evaluating HPV vaccine effectiveness/efficacy. There are different approaches to estimate the vaccine effectiveness/efficacy against persistent HPV infections.

Methods

We performed a systematic literature search in Pubmed to identify statistical approaches that have been used to estimate the vaccine effectiveness/efficacy against persistent HPV infections. We applied these methods to data of a longitudinal observational study to assess their performance and compare the obtained vaccine effectiveness (VE) estimates.

Results

Our literature search identified four approaches: the conditional exact test for comparing two independent Poisson rates using a binomial distribution, Generalized Estimating Equations for Poisson regression, Prentice Williams and Peterson total time (PWP-TT) and Cox proportional hazards regression. These approaches differ regarding underlying assumptions and provide different effect measures. However, they provided similar effectiveness estimates against HPV16/18 and HPV31/33/45 persistent infections in a cohort of young women eligible for routine HPV vaccination (range VE 93.7–95.1% and 60.4–67.7%, respectively) and seemed robust to violations of underlying assumptions.

Conclusions

As the rate of subsequent infections increased in our observational cohort, we recommend PWP-TT as the optimal approach to estimate the vaccine effectiveness against persistent HPV infections in young women. Confirmation of our findings should be undertaken by applying these methods after longer follow-up in our study, as well as in different populations.

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Title: Measuring vaccine effectiveness against persistent HPV infections: a comparison of different statistical approaches
Authors: R. Donken
J. Hoes
M. J. Knol
G. S. Ogilvie
S. Dobson
A. J. King
J. Singer
P. J. Woestenberg
J. A. Bogaards
C. J. L. M. Meijer
H. E. de Melker
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Human Papillomavirus
Vaccination
Published in: BMC Infectious Diseases / Issue 1/2020
Electronic ISSN: 1471-2334
DOI: https://doi.org/10.1186/s12879-020-05083-7

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