Efficacy and long-term impact of HPV vaccination strategies: A Scoping review of clinical trials and follow-up studies
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Keywords
Human Papillomavirus, HPV- vaccine, Cervical Cancer, Efficacy, Safety, Clinical Trial
Abstract
Background: Human papillomavirus (HPV) is a leading cause of cervical cancer and other HPV-related cancers globally. Vaccination against HPV has proven to be a pivotal intervention in reducing the burden of these diseases. However, questions remain regarding long-term efficacy, dosing strategies, and real-world outcomes of HPV vaccines. Objective: We aim to synthesise evidence from randomised controlled trials and long-term follow-up studies on the efficacy, immunogenicity, safety, and real-world impact of HPV vaccines. Methodology: A comprehensive search was conducted in PubMed, Cochrane Library, Embase, Scopus, and Web of Science for studies published in English from 2019 to 2024. Eligible studies included randomised controlled trials and long-term follow-up analyses focusing on HPV vaccine efficacy, dosing regimens, and population-specific outcomes. Data were extracted and synthesised narratively, with findings organised into five thematic areas. Results: Seventeen studies met the inclusion criteria. Findings confirm the high efficacy of HPV vaccines in preventing HPV-related cancers and precancers, with durable immunogenicity observed up to 12 years post-vaccination. Evidence supports the potential of single-dose regimens, which could improve accessibility in resource-limited settings. Real-world data demonstrated significant reductions in HPV-related diseases across diverse populations, reinforcing the global impact of HPV vaccination programs. Conclusion: This review highlights the critical role of HPV vaccines in reducing the burden of HPV-related cancers, with robust efficacy, long-term protection, and favourable safety profiles. The findings underscore the need for continued research into optimised vaccination strategies and the expansion of global vaccination efforts.
References
2. Barnabas RV, Brown ER, Onono MA, Bukusi EA, Njoroge B, Winer RL, Galloway DA, Pinder LF, Donnell D, Wakhungu I, Congo O. Efficacy of single-dose human papillomavirus vaccination among young African women. NEJM Evidence. 2022 Apr 26;1(5):EVIDoa2100056.
3. Lehtinen M, Gray P, Luostarinen T, Eriksson T, Apter D, Bly A, Harjula K, Heikkilä K, Hokkanen M, Kuortti M, Nieminen P. Head-to-head comparison of two human papillomavirus vaccines for efficacy against cervical intraepithelial neoplasia grade 3 and adenocarcinoma in situ—population-based follow-up of two cluster-randomized trials. Frontiers in Cellular and Infection Microbiology. 2024 Sep 9;14:1437704.
4. Lehtinen M, Apter D, Eriksson T, Harjula K, Hokkanen M, Natunen K, Nieminen P, Paavonen J, Palmroth J, Petäjä T, Pukkala E. Effectiveness of various human papillomavirus vaccination strategies: A community randomized trial in Finland. Cancer Medicine. 2021 Nov;10(21):7759-71.
5. Zhao C, Zhao Y, Li J, Li M, Su Y, Mi X, La Tu SY, Shen D, Ren L, Li Y, Wang L. The eight-year long-term follow-up on the effectiveness of the quadrivalent human papillomavirus vaccine in Chinese women 20–45 years of age. Human Vaccines & Immunotherapeutics. 2022 Nov 30;18(5):2052700.
6. Kreimer AR, Sampson JN, Porras C, Schiller JT, Kemp T, Herrero R, Wagner S, Boland J, Schussler J, Lowy DR, Chanock S. Evaluation of durability of a single dose of the bivalent HPV vaccine: the CVT trial. JNCI: Journal of the National Cancer Institute. 2020 Oct;112(10):1038-46.
7. Artemchuk H, Eriksson T, Poljak M, Surcel HM, Dillner J, Lehtinen M, Faust H. Long-term antibody response to human papillomavirus vaccines: up to 12 years of follow-up in the Finnish maternity cohort. The Journal of Infectious Diseases. 2019 Jan 29;219(4):582-9.
8. Watson-Jones D, Changalucha J, Whitworth H, Pinto L, Mutani P, Indangasi J, Kemp T, Hashim R, Kamala B, Wiggins R, Songoro T. Immunogenicity and safety of one-dose human papillomavirus vaccine compared with two or three doses in Tanzanian girls (DoRIS): an open-label, randomised, non-inferiority trial. The Lancet Global Health. 2022 Oct 1;10(10):e1473-84.
9. Shing JZ, Hu S, Herrero R, Hildesheim A, Porras C, Sampson JN, Schussler J, Schiller JT, Lowy DR, Sierra MS, Carvajal L. Precancerous cervical lesions caused by non-vaccine-preventable HPV types after vaccination with the bivalent AS04-adjuvanted HPV vaccine: an analysis of the long-term follow-up study from the randomised Costa Rica HPV Vaccine Trial. The Lancet Oncology. 2022 Jul 1;23(7):940-9.
10. Shu Y, Yu Y, Ji Y, Zhang L, Li Y, Qin H, Huang Z, Ou Z, Huang M, Shen Q, Li Z. Immunogenicity and safety of two novel human papillomavirus 4- and 9-valent vaccines in Chinese women aged 20–45 years: a randomized, blinded, controlled with Gardasil (type 6/11/16/18), phase III non-inferiority clinical trial. Vaccine. 2022 Nov 15;40(48):6947-55.
11. Qiao YL, Wu T, Li RC, Hu YM, Wei LH, Li CG, Chen W, Huang SJ, Zhao FH, Li MQ, Pan QJ. Efficacy, safety, and immunogenicity of an Escherichia coli-produced bivalent human papillomavirus vaccine: an interim analysis of a randomized clinical trial. JNCI: Journal of the National Cancer Institute. 2020 Feb 1;112(2):145-53.
12. Lehtinen M, Lagheden C, Luostarinen T, Eriksson T, Apter D, Bly A, Gray P, Harjula K, Heikkilä K, Hokkanen M, Karttunen H. Human papillomavirus vaccine efficacy against invasive, HPV-positive cancers: population-based follow-up of a cluster-randomised trial. BMJ Open. 2021 Dec 1;11(12):e050669.
13. Ayatollahi H, Rajabi E, Yekta Z, Jalali Z. Efficacy of oral zinc sulfate supplementation on clearance of cervical human papillomavirus (HPV); a randomized controlled clinical trial. Asian Pacific Journal of Cancer Prevention. 2022 Apr;23(4):1285.
14. Olsson SE, Restrepo JA, Reina JC, Pitisuttithum P, Ulied A, Varman M, Van Damme P, Moreira Jr ED, Ferris D, Block S, Bautista O. Long-term immunogenicity, effectiveness, and safety of nine-valent human papillomavirus vaccine in girls and boys 9 to 15 years of age: Interim analysis after 8 years of follow-up. Papillomavirus Research. 2020 Dec 1;10:100203.
15. Long-term follow-up data on sustained immunogenicity and safety for Gardasil®9 published in Pediatrics. Merck.com. 2024 Dec 26. https://www.merck.com/news/long-term-follow-up-data-on-sustained-immunogenicity-and-safety-for-gardasil9-published-in-pediatrics/.
16. Restrepo J, Herrera T, Samakoses R, Reina JC, Pitisuttithum P, Ulied A, Bekker LG, Moreira Jr ED, Olsson SE, Block SL, Hammes LS. Ten-year follow-up of 9-valent human papillomavirus vaccine: immunogenicity, effectiveness, and safety. Pediatrics. 2023 Oct 1;152(4):e2022060993.
17. Montroy J, Salvadori MI, Forbes N, Dubey V, Almasri S, Jirovec A, Yan C, Gusic K, Stevens A, Young K, Tunis M. Efficacy, effectiveness and immunogenicity of reduced HPV vaccination schedules: A review of available evidence. Canada Communicable Disease Report. 2024 Jun 28;50(6):166.
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Sozan M. Abdelkhalig, 1Assistant Professor of Microbiology, Department of Basic Medical Sciences, College of Medicine, AlMaarefa University. P.O.Box 71666, Riyadh, 11597 Saudi Arabia, [email protected]. 2Research center, Deanship of Scientific Research and Post-Graduate Studies, AlMaarefa University, Diriyah, 13713, Riyadh
Assistant Professor of Microbiology, Department of Basic Sciences.