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 Infectious Diseases

Research Article

Johannes Horn¹  Rafael Mikolajczyk²  Kathrin Thöne³ 

[1] Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany;Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany;Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany;Institute for Medical Epidemiology, Biometrics, and Informatics, Medical Faculty of the Martin-Luther University Halle-Wittenberg, 06112, Halle (Saale), Germany;Leibniz-Institute for Prevention Research and Epidemiology – BIPS, Achterstr. 30, 28359, Bremen, Germany;Hubertus Wald Tumor Center, University Cancer Center Hamburg (UCCH)/ University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany;

关键词: Human papillomavirus (HPV) vaccine;    Anogenital warts (AGWs);    Vaccine coverage;    Herd immunity;    Indirect vaccination effect;   

DOI  :  10.1186/s12879-017-2663-7

 received in 2016-10-21, accepted in 2017-08-01,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundShortly after the human papillomavirus (HPV) vaccine recommendation and hence the reimbursement of vaccination costs for the respective age groups in Germany in 2007, changes in the incidence of anogenital warts (AGWs) were observed, but it was not clear at what level the incidence would stabilize and to what extent herd immunity would be present. Given the relatively low HPV vaccination coverage in Germany, we aimed to assess potential vaccination herd immunity effects in the German setting.MethodsA retrospective open cohort study with data from more than nine million statutory health insurance members from 2005 to 2010 was conducted. AGW cases were identified using ICD-10-codes. The incidence of AGWs was estimated by age, sex, and calendar quarter. Age and sex specific incidence rate ratios were estimated comparing the years 2009–2010 (post-vaccination period) with 2005–2007 (pre-vaccination period).ResultsIncidence rate ratio of AGWs for the post-vaccination period compared to the pre-vaccination period showed a u-shaped decrease among the 14- to 24-year-old females and males which corresponds well with the reported HPV vaccination uptake in 2008. A maximum reduction of up to 60% was observed for the 16- to 20-year-old females and slightly less pronounced (up to 50%) for the 16- and 18-year-old males. Age groups outside of the range 14–24 years demonstrated no decrease. The decrease of incidence occurred in both sexes early after the vaccine recommendation and stabilized at lower levels in 2009–2010.ConclusionsA relative reduction of up to 50% among males of approximately similar age groups as that of females receiving the HPV vaccination suggests herd protection resulting from assortative mixing by age. The early decrease among males can be reduced over time due to partner change.

【 授权许可】

CC BY   
© The Author(s). 2017