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Effects of a National Human Papillomavirus Vaccination Program in Australia

Rates of genital warts dropped in both young women and heterosexual men following widespread vaccination of girls and women aged 12 to 26.

In Australia, the quadrivalent human papillomavirus (HPV) vaccine has been provided free to adolescent girls and young women (age range, 12–26) since 2007; about 80% of eligible adolescent girls have received one dose, and 70% have received all three doses. To determine the effects of HPV vaccination at the population level, investigators assessed trends in clinical diagnoses of genital warts in 112,083 patients who attended sexual health centers in Australia for the first time from 2004 through 2009.

The overall rate of newly diagnosed genital warts remained steady from 2004 through 2006, but declined from 9.5% to 6.3% from 2007 through 2009. The reduction was most marked among female residents who were 26 and were eligible for vaccination; in this population, the number of cases fell by 59%. A 39% reduction in wart diagnoses also occurred among young male heterosexual residents (age range, 12–26). In contrast, minimal or no reductions were noted among older women and heterosexual men, men who had sex with men, and nonresident women. During the same period, diagnoses of genital herpes remained stable, and diagnoses of chlamydia rose.

Comment: These data constitute the first empirical evidence that the benefits of HPV vaccination extend to sexual contacts of vaccinated women through protection by herd immunity. Evidence of herd immunity likely will emerge for the oncogenic HPV types 16 and 18; thus, the results also support the benefits of the quadrivalent vaccine. Lowering the burden of genital warts should lessen healthcare costs associated with treatment (the most costly aspect of HPV-related medical care in countries that have widespread cytologic screening). Clinicians should encourage HPV vaccination in adolescent girls and young women, for their own protection and that of their male partners.

— Anna Wald, MD, MPH

Published in Journal Watch Women's Health December 9, 2010

Citation(s):

Donovan B et al. Quadrivalent human papillomavirus vaccination and trends in genital warts in Australia: Analysis of national sentinel surveillance data. Lancet Infect Dis 2010 Nov 9; [e-pub ahead of print]. (http://dx.doi.org/10.1016/S1473-3099(10)70225-5)

Reader Remarks:

Review and add to remarks on this article

• Men should get this vaccine, too
  Henry J. Farkas, MD, 10 Dec 2010 11:32 AM EST
  Specialty: Emergency Medicine
  Extending the benefits to men by herd immunity doesn't help for homosexual men. Boys should get the benefit of this... [more]

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