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Review
. 2014 Sep 1;111(35-36):584-91.
doi: 10.3238/arztebl.2014.0584.

The Efficacy and Duration of Vaccine Protection Against Human Papillomavirus: A Systematic Review and Meta-Analysis

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Free PMC article
Review

The Efficacy and Duration of Vaccine Protection Against Human Papillomavirus: A Systematic Review and Meta-Analysis

Yvonne Deleré et al. Dtsch Arztebl Int. .
Free PMC article

Abstract

Background: The German Standing Committee on Vaccination (STIKO) recommends vaccination against human papillomaviruses (HPV) of the high-risk types 16 and 18. The duration of protection afforded by HPV vaccines has been reported in multiple studies to date but has not been systematically evaluated.

Method: Systematic literature review and meta-analysis on the efficacy of vaccination, with assessment of evidence by the GRADE criteria (Grading of Recommendations Assessment, Development and Evaluation).

Results: 15 studies were identified: 10 randomized controlled trials (RCTs) and 5 observational studies. The RCTs included a total of 46 436 participants. The duration of follow-up was short (median, 3 years) in 8 RCTs and long (median, 6 years) in 2 RCTs. During the period of short-term follow up, the pooled efficacy of vaccination for the study endpoint of incident HPV infection (percentage of infections prevented) was 83% (95% confidence interval [CI]: 70-90% ), while the pooled efficacy against persistent HPV infection was 90% (95% CI: 79-95% ). In this period, CIN 2+ lesions were prevented with 84% efficacy (95% CI: 50-95% ), and CIN 3+ lesions with 94% efficacy (95% CI: 83-98% ). During the period of long-term follow-up, incident infections were prevented with 94% efficacy (95% CI: 80-98% ) and persistent infections with 95% efficacy (95% CI: 84-99% ). The long-term efficacy against CIN 2+ lesions was 86% (95% CI: -166-99% ). No data are available on the long-term efficacy of vaccination against CIN 3+ lesions.

Conclusion: Long-term observation does not indicate any loss of antiviral protection after vaccination against HPV 16 and 18, although the evidence for long-term protection is of lesser quality than that for short-term protection.

Figures

Figure 1
Figure 1
Flow diagram showing procedure used to search literature
Figure 2
Figure 2
Forest plots for follow-up <5 years (RCTs)
Figure 3
Figure 3
Forest plots for follow-up ≥5 years (RCTs)

Comment in

  • Unethical approach.
    Fridrich J. Fridrich J. Dtsch Arztebl Int. 2015 Mar 20;112(12):209. doi: 10.3238/arztebl.2015.0209a. Dtsch Arztebl Int. 2015. PMID: 25838023 Free PMC article. No abstract available.
  • Questionable pooling of data.
    Schenk S. Schenk S. Dtsch Arztebl Int. 2015 Mar 20;112(12):209-10. doi: 10.3238/arztebl.2015.0209b. Dtsch Arztebl Int. 2015. PMID: 25838024 Free PMC article. No abstract available.
  • In reply.
    Harder T, Deleré Y. Harder T, et al. Dtsch Arztebl Int. 2015 Mar 20;112(12):210. doi: 10.3238/arztebl.2015.0210. Dtsch Arztebl Int. 2015. PMID: 25838025 Free PMC article. No abstract available.

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