scholarly journals HPV vaccination and allocative efficiency: regional analysis of the costs and benefits with the bivalent AS04-adjuvanted vaccine, from the perspective of public health, for the prevention of cervical cancer and its pre-cancerous lesions

2012 ◽  
Vol 13 (2S) ◽  
pp. 3-15
Author(s):  
Paolo Bonanni ◽  
Donatella Panatto ◽  
Bruna Dirodi ◽  
Sara Boccalini ◽  
Roberto Gasparini
Keyword(s):  
Public Health ◽  
Cervical Cancer ◽  
Vaccine Efficacy ◽  
Hpv Vaccination ◽  
Vaccination Strategy ◽  
Cross Protection ◽  
Costs And Benefits ◽  
Cancerous Lesions ◽  
The Impact ◽  
Single Cohort

Introduction: by means of the decisions on whether to introduce the HPV vaccination, Public Health has already established the importance of associating the vaccination strategy to the policy of secondary prevention. The screening + vaccination strategy is more effective than the two methods taken individually. In support of this combined strategy and in order to make available per each region concrete elements for their regional planning, an assessment has been made, which also takes into account the effect of cross-protection regarding high-risk strains not contained in both vaccines, bivalent and quadrivalent, and more frequently responsible for pre-cancerous lesions and cervical cancer (CCU). This analysis evaluates the costs and benefits of screening + vaccination strategy in a 12-year-old female cohort. Furthermore, the paper provides results that may be useful to assess the opportunity to extend the vaccination to a second cohort of 24-25-year-old women. The analysis is preceded by a brief summary of CCU epidemiology available data, public health policies that give precise guidelines for vaccination strategies and analytical tools suitable to support public policy makers to efficiently allocate resources. Methods: two different models were used for two regional analyses.The vaccines may have different sustained- and cross-protection levels against non-vaccine oncogenic HPV-types. In the first analysis, a prevalence-based model estimated the potential net difference in HPV-related lesions (abnormal pap smear, cervical intraepithelial neoplasia (CIN), cervical cancer (CC) and genital warts (GW)) and associated costs generated by the two vaccines. Vaccine efficacy rates were based on published data for each vaccine. Lifetime vaccine efficacy was assumed. Results are reported over one year after reaching a steady state. Incidence and treatment costs were obtained from Italian and European sources. We also performed a cost-effectiveness analysis with a Markov model for each Italian region, previously described and successfully adapted to the national scenario. The analysis compares the HPV vaccination of a single cohort (12-year-old females) with a multiple cohort (12- + 25-year-old girls). Resource use was based on a standard therapeutic path applied to all regions. However we quantified the impact of the so-called “decentralization progress” by collecting regional data on: pap test coverage, tariffs for treatments, and cost of the vaccination course. Results: the results are set out in 21 regional reports. Conclusions: in the Italian scenario, characterized by decentralization and local autonomy, a further level of detail is essential in order to describe the specific local settings and implications of a new health intervention. The results show that the vaccination on a multiple cohort is more effective than a single cohort. Indeed, a major number of pre-cancerous lesions, cases of cancer, and related deaths are avoided. In a period of sharp decline in the health budget, investment in prevention seems to be the most reasonable choice in view of avoiding in the medium term pre-cancerous and cancerous lesions generating a significant expense. Our analysis places the extent of HPV vaccination among the measures that the regional decision-makers should put in place to maximize the efficiency of scarce resource.

scholarly journals Impact of HPV-16/18 AS04-adjuvanted vaccine on preventing subsequent infection and disease after excision treatment: Post-hoc analysis from a randomized controlled trial

2020 ◽  
Author(s):  
Shuang Zhao ◽  
Shangying Hu ◽  
Xiaoqian Xu ◽  
Xun Zhang ◽  
Qinjing Pan ◽  
...  
Keyword(s):  
Vaccine Efficacy ◽  
Hpv Vaccination ◽  
Hpv Infection ◽  
Occurrence Rate ◽  
Subsequent Infection ◽  
Hpv 16 ◽  
Post Hoc Analysis ◽  
Adjuvanted Vaccine ◽  
Post Hoc ◽  
The Impact

Abstract Background: It is widely acknowledged that HPV prophylactic vaccine could prevent new infections and their associated lesions among women who were predominantly HPV-naive at vaccination. Yet there still remains uncertainty about whether HPV vaccination could benefit to individuals who had undergone surgery for cervical disease. Methods: This post-hoc analysis intends to focus on intent-to-treat participants who underwent excision treatment at baseline and the follow-up period in a phase II/III, double-blind, randomized trial (ClinicalTrials.gov, number NCT00779766) conducted in Jiangsu province, China. We evaluate the impact of HPV vaccination on preventing women from subsequent infection and cervical lesions (LSIL+ and CIN2+) after excision treatment. Results: 168 (vaccine, n=87; placebo, n=81) performed excisional treatment in this clinical trial. We observed a significant effect of vaccination on acquiring 14 high-risk HPV (HR-HPV) infection after treatment (vaccine efficacy: 27.0%; 95% CI 4.9%, 44.0%). The vaccine efficacy against new infections after treatment for 14 HR-HPV infection was estimated as 32.0% (95%CI 1.8%, 52.8%), and was 41.2% (95%CI -162.7%, 86.8%) for HPV16/18 infection. The accumulative clearance rates of the vaccine group and placebo group were 88.9% and 81.6% for HPV16/18 infection (P=0.345), 63.4%, 48.7% for 14 HR-HPV infection (P=0.062), respectively. No significant difference was observed on the persistent rate of HPV16/18, 14 HR-HPV infection and occurrence rate of LSIL+ between the two groups. Conclusions: No significant evidence from this study showed that HPV-16/18 AS04-adjuvanted vaccine could lead to viral faster clearance or have any effect on the rates of persistent infection among women who had excision treatment. However, the vaccine may still benefit post-treatment women with “primary prophylactic” effect. Further research is required in clarifying the effect of using the prophylactic HPV vaccine as therapeutic agents. ClinicalTrials.gov Identifier: NCT00779766Date and status of trial registration: October 24, 2008 Completed; Has Results

scholarly journals Increasing HPV vaccination uptake among adolescents: A Systematic Review

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
A Acampora ◽  
A Grossi ◽  
A Barbara ◽  
V Colamesta ◽  
F A Causio ◽  
...  
Keyword(s):  
Systematic Review ◽  
Vaccination Coverage ◽  
Positive Impact ◽  
Hpv Vaccination ◽  
Vaccination Strategy ◽  
The United States ◽  
Medical Visit ◽  
Specific Context ◽  
Vaccination Uptake ◽  
The Impact

Abstract Background Human Papillomavirus (HPV) is responsible for the development of several pathologies besides the cervical cancer and HPV vaccination is a key strategy for primary prevention. The aim of this research was to identify strategies adopted to increase HPV vaccination coverage among the adolescents. Methods A systematic review was carried-out by searching electronic databases (Pubmed, Scopus, and Web of Science) using selected keywords as “papillomavirus vaccine”, “vaccination strategy” and “efficacy”. Articles conducted in high-income countries and evaluating the impact of one or more strategies on vaccination coverage (initiation e/o completion) in adolescents were included. Results Out of 3571 single citations screened, 42 papers (2011-2018) were included. Study size ranged from 50 to 325229 individuals. The major part of the studies was from the United States (n = 35; 83,3%) and conducted with an experimental design (n = 17; 40,5%). The evaluated outcomes included first dose uptake, schedule completion, vaccination timeliness and the number of administered doses. Identified strategies included reminds (9), education activities (9), multicomponent strategies (22) and others (2) and were focused on adolescents/parents and/or healthcare providers. Significant positive results were reported in seven studies (77,8%) evaluating the impact of reminds, four studies (44,4%) on education strategies, and in 12 studies (54,5%) on multicomponent strategies. Offering vaccination in “bundle” or during any medical visit was also reported as significantly effective. Conclusions Increasing the vaccination coverage is essential to achieve HPV-related diseases control. Several types of strategies are available and showed a positive impact on vaccination uptake, in particular those relied on reminds. Nonetheless, the heterogeneity of interventions suggests the importance to adapt such initiatives to the specific context in order to maximize the improvement in vaccination uptake. Key messages Several types of strategies to increase vaccination uptake are available at international level and showed a positive impact among adolescents. These interventions are heterogeneous suggesting the importance of their adaptation to the specific context in order to gain the maximum improvement in vaccination uptake.

scholarly journals The role of connectivity on COVID-19 preventive approaches

2021 ◽  
Author(s):  
V. Miró Pina ◽  
J. Nava-Trejo ◽  
A. Tóbiás ◽  
E. Nzabarushimana ◽  
A. Gonzalez-Casanova ◽  
...  
Keyword(s):  
Public Health ◽  
Contact Structure ◽  
Vaccination Strategy ◽  
Demographic Characteristics ◽  
Health Interventions ◽  
Public Health Interventions ◽  
The Impact ◽  
Modelling Approaches

AbstractPreventive and modelling approaches to address the COVID-19 pandemic have been primarily based on the age or occupation, and often disregard the importance of the population contact structure and individual connectivity. To address this gap, we developed models that first incorporate the role of heterogeneity and connectivity and then can be expanded to make assumptions about demographic characteristics. Results demonstrate that variations in the number of connections of individuals within a population modify the impact of public health interventions such vaccination approaches. We conclude that the most effective vaccination strategy will vary depending on the underlying contact structure of individuals within a population and on timing of the interventions.

scholarly journals Human Papilloma Virus Vaccine for Cervical Cancer Prevention

2021 ◽  
Vol 39 (2) ◽  
pp. 123-131
Author(s):  
Chowdhury Shamima Sultana
Keyword(s):  
Public Health ◽  
Cervical Cancer ◽  
Screening Program ◽  
Hpv Vaccination ◽  
Invasive Cervical Cancer ◽  
Public Health Problem ◽  
Developed Countries ◽  
Hpv Infection ◽  
Human Papilloma Virus Vaccine ◽  
Major Public Health Problem

HPV infection is estimated to be responsible for about 5% of human cancers worldwide. Among all HPV-associated malignancies, cervical cancer is the most important cause of morbidity and mortality worldwide. Cervical cancer is the fourth most common cancer in women worldwide and leading cause of cancer death among females in less developed countries. Persistent HPV infection is a necessary cause of invasive cervical cancer with a prevalence of 99.7% in cervical cancer worldwide.At least 70% of cervical cancers are caused by HPV 16 and HPV 18. HPV vaccination in combination with regular screening offers the most effective way for women to be protected against cervical cancer.The global burden of cervical cancer falls heaviest on the developing countries which haven’t introduced the HPV vaccine as part of their national public health strategy to prevent and control cervical cancer. Different studies showed a drop in the prevalence of HPV associated diseases in vaccinated populations. Sustained efficacy, immunogenicity, and safety of the bHPV vaccine were observed in the final analysis of a follow-up study up to 9.4 years postvaccination. Cervical cancer is a major public health problem in Bangladesh. There has been little success with screening program against cervical cancer in Bangladesh. Therefore, a National HPV Vaccination Program seems to be the window of opportunity to reduce the mortality and morbidity of cervical cancer in Bangladesh. J Bangladesh Coll Phys Surg 2021; 39(2): 123-131

scholarly journals 973Eliminating Cervical Cancer in the Asia Pacific- From Research to Policy and Practice

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Sharon Hanley
Keyword(s):  
Public Health ◽  
Cervical Cancer ◽  
Cervical Screening ◽  
Hpv Vaccination ◽  
Scale Up ◽  
Public Health Problem ◽  
Associate Professor ◽  
Asia Pacific ◽  
Vaccine Hesitancy ◽  
Research Fellow

Abstract Focus and outcomes for participants Rationale for the symposium, including for its inclusion in the Congress Cervical cancer, caused by persistent infection with oncogenic human papillomavirus (HPV), is one of the most preventable and treatable forms of cancer, yet more than 300,000 women die from the disease annually and over 500,000 cases are diagnosed. Modelling has shown that effective integration of HPV immunization programmes, HPV-based screening, and access to high-quality cancer treatment and palliative care services has the potential to eliminate cervical cancer in most countries in the world over the next century. In 2018, the Director-General of WHO made a global call to action for the elimination of cervical cancer as a public health problem. As a result, WHO has developed a global strategy towards eliminating cervical cancer as a public health problem due for endorsement at the World Health Assembly in May 2020, which proposes an elimination threshold of four cases per 100 000 women and includes 2030 triple-intervention coverage targets for scale-up of HPV vaccination of 90%, twice-lifetime cervical screening of 70%, and treatment of pre-invasive lesions and invasive cancer of 90%. As the first country to establish a national HPV immunization programme and one of the first countries to move to an HPV based screening programme, Australia has played a leading role in the global battle against cervical cancer and is on course to eliminate the disease within the next decade. However, while the burden of disease and the highest mortality from cervical cancer occur in lower income countries, factors such as the inequitable cervical cancer burden in Indigenous populations and vaccine hesitancy mean that significant barriers to the elimination of cervical cancer also exists within high-income countries. This session will have seven experts working in four countries within the Asia Pacific region. By sharing experiences and providing evidence-based guidance on key technical and strategic issues, we hope to generate a comprehensive understanding and new knowledge on factors impacting participation in, and the potential for effective scale up of, cervical cancer control programmes within the region. Presentation program Names of presenters -Dr Kate Simms is a Postdoctoral Research Fellow at Cancer Council NSW, Australia. Her research focusses on modelling the impact of HPV vaccination and cervical cancer screening across a range of settings, including predictions for the potential elimination of cervical cancer across 181 countries. -Associate Professor Julia Brotherton is a public health physician and Medical Director of VCS Population Health. She is involved in research and policy development informing the implementation and evaluation of HPV vaccination programs in Australia and is member of the WHO Director General's Expert Advisory Group on Cervical Cancer Elimination. -Assistant Professor Sharon Hanley is a cancer epidemiologist at Hokkaido University, Japan. Her research interests include HPV vaccine hesitancy and HPV self-sampling to increase cervical screening uptake in never/under screened Japanese women. - Associate Professor Lisa Whop is an Indigenous Senior Research Fellow at the Australian National University, Canberra, Australia. Her research focuses on improving health outcomes for Aboriginal and Torres Strait Islander people with cancer, with a key focus on equity. - Dr Megan Smith is a Postdoctoral Research Fellow whose research focuses on optimizing and successfully implementing cervical cancer prevention, at the population level and in different population subgroups. She has contributed to a large number of reports to government, including several evaluations that have directly informed policy in Australia, New Zealand and England. -Professor Andrew Vallely is a clinical epidemiologist at the Kirby Institute, University of New South Wales, Australia. He recently completed a field evaluation comparing point-of-care Xpert HPV testing using self-collected specimens with visual inspection of the cervix with acetic acid (VIA), to detect high-grade cervical disease. - Professor Woo Yin Ling is a Consultant Obstetrician and Gynaecologist at the University of Malaya. She is the programme designer of Project ROSE (Removal of Obstacles to Cervical Screening), a novel cervical screening research programme which employs HPV self-sampling and digital technology to increase access to cervical screening in Malaysia. Names of facilitator or chair Assistant Professor Sharon J.B. Hanley, Hokkaido University and Professor John Kaldor, Kirby Institute, University of New South Wales?

scholarly journals The minimal COVID-19 vaccination coverage and efficacy to compensate for potential increase of transmission contacts, and increased transmission probability of the emerging strains

2021 ◽  
Author(s):  
Biao Tang ◽  
Xue Zhang ◽  
Qian Li ◽  
Nicola Bragazzi ◽  
Dasantila Golemi-Kotra ◽  
...  
Keyword(s):  
Public Health ◽  
Vaccine Efficacy ◽  
Attack Rate ◽  
Vaccine Coverage ◽  
Public Health Intervention ◽  
Contact Tracing ◽  
Efficacy Rate ◽  
Case Scenario ◽  
Worst Case ◽  
The Impact

Abstract Background: Mass immunization is a potentially effective approach to finally control the local outbreak and global spread of COVID-19 pandemic. However, it can also lead to undesirable outcomes if mass vaccination results in increased transmission effective contacts and relaxation of other public health interventions due to the perceived immunity from the vaccine. Methods: We designed a mathematical model of COVID-19 transmission dynamics that takes into consideration the epidemiological status, public health intervention status (quarantined/isolated), immunity status of the population, and the strain variations. Comparing the control reproduction numbers and the final epidemic sizes (attack rate) in the cases with and without vaccination, we quantified some key factors determining when vaccination in the population is beneficial for preventing and controlling future outbreaks. Results: Our analyses predicted that there is a critical (minimal) vaccine efficacy rate (or a critical quarantine rate) below which the control reproduction number with vaccination is higher than that without vaccination, and the final attack rate in the population is also higher with the vaccination. We also predicted the worst case scenario occurs when a high vaccine coverage is achieved for a vaccine with lower efficacy rate and when the vaccines increase the transmission efficient contacts.Conclusions: The analyses show that an immunization program with a vaccine efficacy rate below the predicted critical values will not be as effective as simply investing in the contact tracing/quarantine/isolation implementation. We reached similar conclusions by considering the final epidemic size (or attack rates). This research then highlights the importance of monitoring the impact on transmissibility and vaccine efficacy of emerging strains.

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