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Vaccination Strategies against HPV Infection and Cervical Cancer in China: A Transmission Modeling Study
Yuanyuan Shi1,2, Ning Sun1,2, Jingyi Ren1
1School of Mathematics and Computing Science, Guangxi Colleges and Universities Key Laboratory of Data Analysis and Computation, Guilin University of Electronic Technology, Guilin, China.
Summary
Human papillomavirus (HPV) vaccination is crucial for cervical cancer elimination in China. Expanding vaccination to all females aged 15 and older accelerates elimination timelines, even with single-year coverage providing long-term protection.
Area of Science:
- Epidemiology and Public Health
- Infectious Disease Modeling
- Oncology
Background:
- Cervical cancer, primarily caused by persistent high-risk human papillomavirus (HPV) infections, is a significant global health concern for women.
- China faces challenges in meeting the World Health Organization's 2030 cervical cancer elimination goals due to low vaccination uptake and demographic complexities.
- Optimizing intervention strategies is essential to expedite the elimination of cervical cancer in China.
Purpose of the Study:
- To develop and utilize an age-stratified deterministic compartmental model to simulate HPV transmission dynamics and cervical cancer progression in China.
- To evaluate the impact of various HPV vaccination scenarios on cervical cancer incidence and elimination timelines.
- To identify optimal vaccination strategies for accelerating the achievement of cervical cancer elimination targets.
Main Methods:
- An age-stratified deterministic compartmental model was created, incorporating demographic data and HPV transmission dynamics, accounting for age, sex, sexual activity, and intervention efficacy.
- The model simulated the natural history of cervical cancer, from HPV infection to invasive disease, calibrated with epidemiological data.
- Multiple vaccination scenarios, varying coverage rates, age groups, and durations, were assessed to project incidence, estimate elimination timelines, and calculate the basic reproduction number (R0).
Main Results:
- Without vaccination, HPV infection is projected to become endemic (R0 = 1.38), leading to an estimated 2.92 million cervical cancer cases in China between 2021 and 2070.
- Maintaining 2020 vaccination rates could prevent 1.01 million cases during the same period; however, prioritizing females aged 15-26 maximizes per-dose impact.
- Expanding vaccination to all females aged 15 and older is crucial for achieving elimination before 2040. Higher annual vaccination rates (0.09, 0.15, 0.21) among this group accelerate elimination to 2037, 2035, and 2034, respectively, significantly faster than targeting only 15-26 year olds.
Conclusions:
- HPV vaccination is a critical intervention for reducing the burden of cervical cancer in China.
- Prioritizing vaccination for women aged 15-26 offers optimal per-dose effectiveness, but broader vaccination of all women aged 15 and older is necessary for timely elimination.
- Expanding HPV vaccination coverage to all females aged 15 and older is essential for accelerating progress towards the WHO's cervical cancer elimination targets.
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