Decline in in-patient treatments of genital warts among young Australians following the national HPV vaccination program

Hammad Ali, Rebecca J Guy, Handan Wand, Tim Rh Read, David G Regan, Andrew E Grulich, Christopher K Fairley, Basil Donovan, Hammad Ali, Rebecca J Guy, Handan Wand, Tim Rh Read, David G Regan, Andrew E Grulich, Christopher K Fairley, Basil Donovan

Abstract

Background: There has been a rapid decline in the number of young heterosexuals diagnosed with genital warts at outpatient sexual health services since the national human papillomavirus (HPV) vaccination program started in Australia in 2007. We assessed the impact of the vaccination program on the number of in-patient treatments for genital warts.

Methods: Data on in-patient treatments of genital warts in all private hospitals were extracted from the Medicare website. Medicare is the universal health insurance scheme of Australia. In the vaccine period (2007-2011) and pre-vaccine period (2000-2007) we calculated the percentage change in treatment numbers and trends in annual treatment rates in private hospitals. Australian population data were used to calculate rates. Summary rate ratios of average annual trends were determined.

Results: Between 2000 and 2011, 6,014 women and 936 men aged 15-44 years underwent in-patient treatment for genital warts in private hospitals. In 15-24 year old women, there was a significant decreasing trend in annual treatment rates of vulval/vaginal warts in the vaccine period (overall decrease of 85.3% in treatment numbers from 2007 to 2011) compared to no significant trend in the pre-vaccine period (summary rate ratio (SRR) = 0.33, p < 0.001). In 25-34 year old women, declining trends were seen in both vaccine and pre-vaccine periods (overall decrease of 33% vs. 24.3%), but the rate of change was greater in the vaccine period (SRR = 0.60, p < 0.001). In 35-44 year old women, there was no significant change in both periods (SRR = 0.91, p = 0.14). In 15-24 year old men, there was a significant decreasing trend in annual treatment rates of penile warts in the vaccine period (decrease of 70.6%) compared to an increasing trend in the pre-vaccine period (SRR = 0.76, p = 0.02). In 25-34 year old men there was a significant decreasing trend in the vaccine period compared to no change in the pre-vaccine period (SRR = 0.81, p = 0.04) and in 35-44 year old men there was no significant change in rates of penile warts both periods, but the rate of change was greater in the vaccine period (SRR = 0.70, p = 0.02).

Conclusions: The marked decline in in-patient treatment of vulval/vaginal warts in the youngest women is probably attributable to the HPV vaccine program. The moderate decline in in-patient treatments for penile warts in men probably reflects herd immunity.

Figures

Figure 1
Figure 1
Numbers of in-patient treatments for vulval/vaginal warts in women by age-group, 2000–2011.
Figure 2
Figure 2
Numbers of in-patient treatments for penile warts in men by age-group, 2000–2011.
Figure 3
Figure 3
Numbers of in-patient treatments for anal warts in men by age-group, 2000–2011.

References

    1. Gertig DM, Brotherton JML, Saville M. Measuring human papillomavirus (HPV) vaccination coverage and the role of the National HPV Vaccination Program Register, Australia. Sex Health. 2011;8(2):171–178. doi: 10.1071/SH10001.
    1. Ball SLR, Winder DM, Vaughan K, Hanna N, Levy J, Sterling JC, Stanley MA, Goon PKC. Analyses of human papillomavirus genotypes and viral loads in anogenital warts. J Med Virol. 2011;83(8):1345–1350. doi: 10.1002/jmv.22111.
    1. Brotherton JML, Heywood A, Heley S. The incidence of genital warts in Australian women prior to the national vaccination program. Sex Health. 2009;6(3):178–184. doi: 10.1071/SH08079.
    1. Donovan B, Franklin N, Guy R, Grulich AE, Regan DG, Ali H, Wand H, Fairley CK. Quadrivalent human papillomavirus vaccination and trends in genital warts in Australia: analysis of national sentinel surveillance data. Lancet Infect Dis. 2011;11(1):39–44. doi: 10.1016/S1473-3099(10)70225-5.
    1. Read TRH, Hocking JS, Chen MY, Donovan B, Bradshaw CS, Fairley CK. The near disappearance of genital warts in young women 4 years after commencing a national human papillomavirus (HPV) vaccination programme. Sex Transm Infect. 2011;87(7):544–547. doi: 10.1136/sextrans-2011-050234.
    1. Brotherton JML, Fridman M, May CL, Chappell G, Saville AM, Gertig DM. Early effect of the HPV vaccination programme on cervical abnormalities in Victoria, Australia: an ecological study. Lancet. 2011;377(9783):2085–2092. doi: 10.1016/S0140-6736(11)60551-5.
    1. Pirotta M, Stein AN, Conway EL, Harrison C, Britt H, Garland S. Genital warts incidence and healthcare resource utilisation in Australia. Sex Transm Infect. 2010;86(3):181. doi: 10.1136/sti.2009.040188.
    1. Woodhall S, Ramsey T, Cai C, Crouch S, Jit M, Birks Y, Edmunds WJ, Newton R, Lacey CJN. Estimation of the impact of genital warts on health-related quality of life. Sex Transm Infect. 2008;84(3):161–166. doi: 10.1136/sti.2007.029512.
    1. Graziottin A, Serafini A. HPV infection in women: psychosexual impact of genital warts and intraepithelial lesions. J Sex Med. 2009;6(3):633–645. doi: 10.1111/j.1743-6109.2008.01151.x.
    1. Medicare Benefit Schedule (MBS) Online. .
    1. Medicare Benefits Schedule (MBS) Item Statistics Reports. .
    1. Australian Bureau of Statistics: Statistics. .
    1. Box GEP, Jenkins GM, Reinsel GC. Time series analysis. San Francisco: Holden-day; 1976.
    1. Newey W, West K. NBER technical paper series. Cambridge: National Bureau of Economic Research; 1986. A simple positive semi-definite heteroscedasticity and autocorrelation consistent covariance matrix.
    1. Smith A, Agius P, Mitchell A, Barrett CMP. Secondary Students and Sexual Health, 2008: Results of the 4th National Survey of Australian Secondary Students, HIV/AIDS and Sexual Health. Melbourne: Australian Research Centre in Sex Health & Society La Trobe University; 2009.
    1. Zablotska IB, Kippax S, Grulich A, Holt M, Prestage G. Behavioural surveillance among gay men in Australia: methods, findings and policy implications for the prevention of HIV and other sexually transmissible infections. Sex Health. 2011;8(3):272–279. doi: 10.1071/SH10125.
    1. Ali H, Guy RJ, Fairley CK, Wand H, Chen MY, Dickson B, O’Connor CC, Marshall L, Grulich AE, Kaldor JM, Understanding trends in genital Chlamydia trachomatis can benefit from enhanced surveillance: findings from Australia. Sex Transm Infect. 2012.
    1. The Kirby Institute. HIV/AIDS, Viral Hepatitis and Sexually Transmissible infections in Australia: Annual Surveillance Report 2012. Sydney: The Kirby Insititute University of New South Wales; 2012.
    1. Statistical Trends in Membership and Benefits Data Tables.
    1. Sexual Health Society of Victoria. National management guidelines for sexually transmitted infections. Melbourne: Sexual Health Society of Victoria; 2008.
    1. Waugh M. Condyloma acuminata. BMJ. 1972;2(5812):527–528.
    1. Heywood W, Smith A. Anal sex practices in heterosexual and male homosexual populations: a review of population-based data. Sex Health. 2012;9(6):517–526. doi: 10.1071/SH12014.
    1. The Hon Tanya Plibersek MP Minister for Health Australia. HPV vaccine extended to boys. .
    1. Brotherton JML, Kaldor JM, Garland SM. Monitoring the control of human papillomavirus (HPV) infection and related diseases in Australia: towards a national HPV surveillance strategy. Sex Health. 2010;7(3):310–319. doi: 10.1071/SH09137.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi