Potential impact of a nonavalent HPV vaccine on the occurrence of HPV-related diseases in France

Didier Riethmuller (1) , Anne-Carole Jacquard (2) , Jean Lacau St Guily (3) , François Aubin (4) , Xavier Carcopino (5) , Pierre Pradat (6) , André Dahlab (2) , Jean-Luc Prétet (7, 8, 9)

1 Service de gynécologie obstétrique
2 Sanofi Pasteur MSD
3 CHU Tenon [AP-HP]
4 Service de dermatologie
5 Service de gynécologie-obstétrique [Hôpital Nord - APHM]
6 Department of hepatology
7 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
8 UFC - Université de Franche-Comté
9 CEF2P / CARCINO - Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (UR 3181)

Background : Human Papillomavirus (HPV) infection is known to be associated with a number of conditions including cervical, vaginal, vulvar, penile, anal neoplasias and cancers, oropharynx cancers and genitals warts (GW). Two prophylactic vaccines are currently available: a bivalent vaccine designed to prevent HPV type 16 and 18 infection and a quadrivalent vaccine targeting HPV 6, 11, 16, and 18. In France, HPV vaccination is recommended in 11-14 year-old girls with a catch-up for girls aged 15-19. The objective of this study was to assess the potential impact of an HPV 6/11/16/18/31/33/45/52/58 nonavalent vaccine on anogenital and oropharyngeal HPV-related diseases in France. Methods : HPV genotype distributions from 6 multicentric retrospective studies (EDiTH I to VI) were analyzed including 516 cases of invasive cervical cancers (ICC), 493 high-grade cervical neoplasias (CIN2/3), 397 low-grade squamous intraepithelial lesions (LSIL), 423 GW, 366 anal cancer and 314 oropharyngeal carcinomas. Low and high estimates of HPV vaccine impact were calculated as follows: low estimate: prevalence of HPV 6/11/16/18/31/33/45/52/58 genotypes alone or in association but excluding presence of another HPV type; high estimate: prevalence of HPV 6/11/16/18/31/33/45/52/58 genotypes alone or in association, possibly in presence of another HPV type. Results : Estimates of potential impact varied from 85% (low estimate) to 92% (high estimate) for ICC, 77% to 90% for CIN2/3, 26% to 56% for LSIL, 69% to 90% for GW, 81% to 93% for anal cancer, and 41% to 44% for oropharyngeal carcinomas. Compared to the quadrivalent vaccine, the proportion of additional cases potentially prevented by the nonavalent vaccine was 9.9%-15.3% for ICC, 24.7%-33.3% for CIN2/3, 12.3%-22.7% for LSIL, 2.1%-5.4% for GW, 8.5%-10.4% for anal cancer, and 0.0%-1.6% for oropharyngeal carcinoma. Conclusions : The nonavalent HPV vaccine showed significant increased potential impact compared to the HPV 6/11/16/18 quadrivalent vaccine for ICC, CIN2/3 and LSIL. Considering a 100% vaccine efficacy and high vaccine coverage, about 90% of ICC, CIN2/3, GW or anal cancer cases could be prevented by a nonavalent HPV vaccine in France.

Mots clés: HPV; Human papillomavirus; Vaccine; Invasive cervical cancer; Cervical intraepithelial neoplasia; Genital warts; Anal cancer

Domaines: Médecine humaine et pathologie; Cancer

Didier Riethmuller, Anne-Carole Jacquard, Jean Lacau St Guily, François Aubin, Xavier Carcopino, et al.. Potential impact of a nonavalent HPV vaccine on the occurrence of HPV-related diseases in France. BMC Public Health, 2015, 15 (1), pp.453. ⟨10.1186/s12889-015-1779-1⟩. ⟨hal-01153727⟩