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Posted by / 06-May-2019 14:14

HPV vaccination has been recommended nationwide with funding to enhance coverage provided by the CDC Prevention and Public Health Fund (PPHF) (6).Vaccine cost, the availability of subsidies, and the supplementing of federal support with state and local funds have been shown to increase coverage significantly (7).Switching to 9v HPV while maintaining current coverage would achieve more substantial reductions, decreasing incidence by 73% (95% CI 62–81%) and mortality by 49% (95% CI 30–62%) (Table 1).Impact through 2050 of no vaccination (solid line), 2v HPV/4v HPV continued at current adolescent coverage (long dashed line), 9v HPV at current coverage (short dashed line), 2v HPV/4v HPV at 100% coverage (dotted line), and 9v HPV at 100% coverage (dashed and dotted line) on annual HPV-associated cervical cancers ( We quantified the cost-effectiveness both of expanded coverage and of switching to 9v HPV.

However, as a result of migration between states, 29–84% of the long-term health benefit of a state’s vaccination will be realized beyond its borders.Because of the impact of herd immunity, any expansion in coverage will be much more effective in reducing cancer incidence and healthcare costs if targeted in those states with the lowest coverage.Because of interstate migration and the long duration between HPV infection and resultant cervical cancer, much of the benefit of vaccination will be realized beyond a state’s borders.Bivalent and quadrivalent HPV vaccines protect against 66% of HPV-associated cervical cancers, and a new nonavalent vaccine protects against an additional 15% of cervical cancers.However, vaccination policy varies across states, and migration between states interdependently dilutes state-specific vaccination policies.

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Both of these vaccines are highly efficacious against HPV-16 and HPV-18 and are partially efficacious against other non–vaccine-targeted oncogenic serotypes (2, 3).