Exploring monitoring strategies for population surveillance of HPV vaccine impact using primary HPV screening

Louiza S Velentzis; David Hawkes; Michael Caruana; Julia Ml Brotherton; Megan A Smith; Lara Roeske; Khurram A Karim; Suzanne M Garland; C David Wrede; Jeffery Tan; Cosette Wheeler; Philip E Castle; Marion Saville; Karen Canfell

doi:10.1016/j.tvr.2023.200255

Exploring monitoring strategies for population surveillance of HPV vaccine impact using primary HPV screening

Tumour Virus Res. 2023 Jun:15:200255. doi: 10.1016/j.tvr.2023.200255. Epub 2023 Feb 1.

Authors

Affiliations

¹ The Daffodil Centre, The University of Sydney, a Joint venture with Cancer Council NSW, Sydney, NSW, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia. Electronic address: louizav@nswcc.org.au.
² Australian Centre for the Prevention of Cervical Cancer, 265 Faraday Street, Carlton South, Victoria, Australia; Department of Biochemistry and Pharmacology, University of Melbourne, Victoria, Australia; Department of Pathology, University of Malaya, Kuala Lumpur, Malaysia.
³ The Daffodil Centre, The University of Sydney, a Joint venture with Cancer Council NSW, Sydney, NSW, Australia.
⁴ Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia; Australian Centre for the Prevention of Cervical Cancer, 265 Faraday Street, Carlton South, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur 50603, Malaysia.
⁵ Royal Australian College of General Practitioners, East Melbourne, Victoria, Australia.
⁶ Australian Centre for the Prevention of Cervical Cancer, 265 Faraday Street, Carlton South, Victoria, Australia.
⁷ Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia; Centre Women's Infectious Diseases Research, Royal Women's Hospital, Melbourne, Victoria, Australia.
⁸ Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia; Department of Oncology & Dysplasia, Royal Women's Hospital, Melbourne, Victoria, Australia.
⁹ University of New Mexico Cancer Center, Albuquerque, NM, USA.
¹⁰ Division of Cancer Prevention, National Cancer Institute, NIH, Rockville, MD, USA; Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD, USA.
¹¹ Australian Centre for the Prevention of Cervical Cancer, 265 Faraday Street, Carlton South, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur 50603, Malaysia.

Abstract

Australia's cervical screening program transitioned from cytology to HPV-testing with genotyping for HPV16/18 in Dec'2017. We investigated whether program data could be used to monitor HPV vaccination program impact (commenced in 2007) on HPV16/18 prevalence and compared estimates with pre-vaccination benchmark prevalence. Pre-vaccination samples (2005-2008) (n = 1933; WHINURS), from 25 to 64-year-old women had been previously analysed with Linear Array (LA). Post-vaccination samples (2013-2014) (n = 2989; Compass pilot), from 25 to 64-year-old women, were analysed by cobas 4800 (cobas), and by LA for historical comparability. Age standardised pre-vaccination HPV16/18 prevalence was 4.85% (95%CI:3.81-5.89) by LA; post-vaccination estimates were 1.67% (95%CI:1.21-2.13%) by LA, 1.49% (95%CI:1.05-1.93%) by cobas, and 1.63% (95%CI:1.17-2.08%) for cobas and LA testing of non-16/18 cobas positives (cobas/LA). Age-standardised pre-vaccination oncogenic HPV prevalence was 15.70% (95%CI:13.79-17.60%) by LA; post-vaccination estimates were 9.06% (95%CI:8.02-10.09%) by LA, 8.47% (95%CI:7.47-9.47%) by cobas and cobas/LA. Standardised rate ratios between post-vs. pre-vaccination rates were significantly different for HPV16/18, non-16/18 HPV and oncogenic HPV: 0.34 (95%CI:0.23-0.50), 0.68 (95%CI:0.55-0.84) and 0.58 (95%CI:0.48-0.69), respectively. Additional strategies (LA for all cobas positives; combined cobas and LA results on all samples) had similar results. If a single method is applied consistently, it will provide important data on relative changes in HPV prevalence following vaccination.

Keywords: Cobas 4800; HPV vaccination; HPV-Based screening; Linear array; Prevalence; Surveillance.

MeSH terms

Adult
Early Detection of Cancer / methods
Female
Human papillomavirus 16
Human papillomavirus 18 / genetics
Humans
Middle Aged
Papillomavirus Infections* / diagnosis
Papillomavirus Vaccines*
Population Surveillance
Uterine Cervical Dysplasia* / diagnosis
Uterine Cervical Neoplasms* / diagnosis

Substances

Papillomavirus Vaccines