Abstract
We developed a dynamic compartmental model to assess the impact of HPV Universal Mass Vaccination (UMV) with Cervarix™, which offers protection against HPV16/18 and cross-protection against other cancer-causing types, using up-to-date efficacy data. Analyses were performed in the UK because of the large amount of high quality epidemiological data available. For each HPV type/group of types considered, the model was calibrated to 14 epidemiological datasets (prevalence of HPV infection, cervical intraepithelial neoplasia (CIN): CIN1, CIN2, CIN3 pre-screening and cervical cancer (CC) incidence over 10 y post-screening). Impacts of cross-protection, female catch-up vaccination, and additional male vaccination on oncogenic infections, high-grade CIN (CIN2+) and CC were evaluated. Our results show that female UMV with 80% coverage and cross-protection against high-risk types resulted in 81% CIN2+ and 88% CC reductions vs. 57% and 75%, respectively, without cross-protection. Vaccinating 40% of males and 80% of females was equivalent to 90% female-only coverage regarding CIN2+ (87% and 87%, respectively) and CC (93% and 94%, respectively) reductions. Female-only coverage of 80% substantially reduced male HPV16 and 18 infection due to herd protection (74% and 89%, respectively). Increasing female coverage to 90% reduced HPV16 and HPV18 infections in males relatively similarly to 80% female combined with 40% male coverage. Model outcomes strengthen previous conclusions about the significant added value of Cervarix™ cross-protection for CC prevention, the primary HPV vaccination public health priority. Regarding female CC prevention and male HPV16/18 infection, small increases in female coverage induce similar benefits to those achieved by additionally vaccinating men with 40% coverage.