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, 22 (1), 18-23

Human Papillomavirus Vaccination at a Time of Changing Sexual Behavior

Human Papillomavirus Vaccination at a Time of Changing Sexual Behavior

Iacopo Baussano et al. Emerg Infect Dis.

Abstract

Human papillomavirus (HPV) prevalence varies widely worldwide. We used a transmission model to show links between age-specific sexual patterns and HPV vaccination effectiveness. We considered rural India and the United States as examples of 2 heterosexual populations with traditional age-specific sexual behavior and gender-similar age-specific sexual behavior, respectively. We simulated these populations by using age-specific rates of sexual activity and age differences between sexual partners and found that transitions from traditional to gender-similar sexual behavior in women <35 years of age can result in increased (2.6-fold in our study) HPV16 prevalence. Our model shows that reductions in HPV16 prevalence are larger if vaccination occurs in populations before transitions in sexual behavior and that increased risk for HPV infection attributable to transition is preventable by early vaccination. Our study highlights the importance of using time-limited opportunities to introduce HPV vaccination in traditional populations before changes in age-specific sexual patterns occur.

Keywords: epidemiologic transition; heterosexuality; human papillomavirus 16; immunization; papillomavirus vaccines; sexual behavior; sexual partners; vaccination; viruses.

Figures

Figure 1
Figure 1
Relative reduction of prevalence of human papillomavirus type 16 at postvaccination equilibrium (i.e., 70 years after the introduction of vaccination) attributable to vaccination among women 20–34 years of age after vaccination of 11-year-old girls or 11-year-old girls and boys, by coverage and a population’s age-related sexual behavior. A) 30% vaccine coverage; B) 50% vaccine coverage. Traditional sexual behavior indicates a population in which genders have different age-specific sexual activity rates and a wide gap in ages (e.g., an average of 5.6 years, as observed in India) of spouses or cohabitating sexual partners. Gender-similar sexual behavior indicates a population in which genders have similar age-specific sexual activity rates and a narrow gap in ages (e.g., an average of 2.1 years, as observed in the United States) of spouses or cohabitating sexual partners.
Figure 2
Figure 2
Changes in prevalence of human papillomavirus type 16 among women 20–34 years of age in relation to the number of years since the beginning of a population’s transition from traditional to gender-similar age-related sexual behavior and the introduction of vaccination among 11-year-old girls (with assumption of 70% coverage) before and after transition. Shaded area shows an assumption of a 15-year transition period. Arrows show approximate timing of vaccination occurring before or after a transition has occurred. Traditional sexual behavior indicates a population in which genders have different age-specific sexual activity rates and a wide gap in ages (e.g., an average of 5.6 years, as observed in India) of spouses or cohabitating sexual partners. Gender-similar sexual behavior indicates a population in which genders have similar age-specific sexual activity rates and a narrow gap in ages (e.g., an average of 2.1 years, as observed in the United States) of spouses or cohabitating sexual partners.

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