Single-dose HPV vaccination in the United States - a multi-modeling analysis

Area of Science:

• Public Health
• Epidemiology
• Vaccinology

Background:

• Emerging evidence supports the non-inferior efficacy of single-dose human papillomavirus (HPV) vaccination.
• This has led to reevaluation of current multi-dose HPV vaccination schedules.
• Policy decisions require understanding the long-term health impact of single-dose HPV vaccination in the U.S.

Purpose of the Study:

• To evaluate the long-term health impact of adopting single-dose HPV vaccination in the United States.
• To inform policy deliberations regarding HPV vaccination schedules.
• To project the impact of switching from two-dose to single-dose HPV vaccination.

Main Methods:

• Utilized two validated individual-based simulation models of HPV transmission and cervical cancer.
• Simulated scenarios included continuation of two-dose vaccination and alternative single-dose strategies with varying efficacy and duration.
• Projected outcomes included age-standardized incidence rates of HPV-16 infection and cervical cancer from 2005-2099.

Main Results:

• Both two-dose and single-dose HPV vaccination schedules are projected to nearly eliminate HPV-16 infections and reduce cervical cancer incidence by over 90% by 2099.
• Scenarios with lower single-dose efficacy or waning protection showed minimal increases in cervical cancer incidence (less than 2 percentage points).
• The timeframe for cervical cancer elimination remained unaffected even under pessimistic assumptions for single-dose strategies.

Conclusions:

• Switching to a single-dose HPV vaccination schedule is projected to sustain cervical cancer reductions.
• This holds true even when considering pessimistic assumptions regarding vaccine efficacy and durability.
• Continuous monitoring of single-dose HPV vaccine efficacy over time is crucial for public health policy.