The Journal of infectious diseases · 2025
Population-Level Impact of Human Papillomavirus Vaccination on the Incidence of Genital Warts in Sweden.
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Astorga Alsina Ana Martina, Herweijer Eva, Lei Jiayao
Аннотация
BACKGROUND: Sweden introduced human papillomavirus (HPV) vaccination in 2006 via opportunistic, subsidized, catch-up, and school-based programs. Notably, genital warts (GW) are the first observable clinical outcome following HPV-6/11 infection, the strains targeted by vaccination. We aim to assess the incidence of GW in Sweden and its change throughout vaccination programs.
METHODS: This ecological study used Swedish registers to obtain national population data and cases of GW from 2006 to 2018 in 15- to 44-year-old men and women. We used Poisson models to estimate GW incidence change after vaccination compared to a prevaccination period, stratified by age and sex, and incidence change of GW in birth cohorts eligible for vaccination compared to a prevaccination cohort. Finally, we estimated GW cases averted in each vaccinated cohort.
RESULTS: The incidence of GW decreased during periods following HPV vaccination. In 2016-2018, over a decade after vaccination availability, incidence decreased by 89% (95% confidence interval [CI], 83%-93%), 73% (95% CI, 71%-75%), 50% (95% CI, 43%-56%), and 20% (95% CI, 10%-28%) in women aged 15-19, 20-24, 25-29, and 30-34 years, respectively. A similar reduction was observable in men, although of lower magnitude. We estimated 18 890 and 12 343 GW cases averted among vaccinated cohorts of women and men, respectively.
CONCLUSIONS: We report on population-level decreases of GW incidence in women and men following increased vaccination coverage. Cohorts eligible for school-based vaccination recorded the largest decrease in GW incidence in Sweden to date. For the period under study, decreases among men could be attributed to herd effects.
METHODS: This ecological study used Swedish registers to obtain national population data and cases of GW from 2006 to 2018 in 15- to 44-year-old men and women. We used Poisson models to estimate GW incidence change after vaccination compared to a prevaccination period, stratified by age and sex, and incidence change of GW in birth cohorts eligible for vaccination compared to a prevaccination cohort. Finally, we estimated GW cases averted in each vaccinated cohort.
RESULTS: The incidence of GW decreased during periods following HPV vaccination. In 2016-2018, over a decade after vaccination availability, incidence decreased by 89% (95% confidence interval [CI], 83%-93%), 73% (95% CI, 71%-75%), 50% (95% CI, 43%-56%), and 20% (95% CI, 10%-28%) in women aged 15-19, 20-24, 25-29, and 30-34 years, respectively. A similar reduction was observable in men, although of lower magnitude. We estimated 18 890 and 12 343 GW cases averted among vaccinated cohorts of women and men, respectively.
CONCLUSIONS: We report on population-level decreases of GW incidence in women and men following increased vaccination coverage. Cohorts eligible for school-based vaccination recorded the largest decrease in GW incidence in Sweden to date. For the period under study, decreases among men could be attributed to herd effects.