Effectiveness of 1, 2, AND 3 Human Papillomavirus Vaccine doses against HPV-16/18 positive High-grade Cervical Lesions.

Before 2016, human papillomavirus (HPV) vaccination was recommended in a three-dose schedule; however, many vaccine-eligible U.S. females received <3 doses, providing an opportunity to evaluate real-world vaccine effectiveness (VE) of 1, 2, and 3 doses. We analyzed data on cervical intraepithelial neoplasia grades 2-3 and adenocarcinoma in situ (CIN2+) from the HPV Vaccine Impact Monitoring Project (HPV-IMPACT), 2008-2014. Archived tissue from CIN2+ lesions was tested for 37 HPV types. Women were classified by number of doses received ≥24 months before CIN2+ detection. Using a test-negative design, VE was estimated as 1-adjusted odds ratio from a logistic regression model that compared vaccination history for women whose lesions tested positive for HPV-16/18 (vaccine-type cases) with all other CIN2+ (controls). Among 3,300 women with CIN2+, typing results, and vaccine history available, 1,561 (47%) were HPV-16/18 positive, 136 received (4%) 1 dose, 108 (3%) 2 doses, and 325 (10%) 3 doses. Adjusted odds ratios for vaccination with 1, 2, and 3 doses were 0.53 (95% confidence interval: 0.37, 0.76; VE=47%), 0.45 (95% confidence interval: 0.30, 0.69; VE=55%), and 0.26 (95% confidence interval 0.20, 0.35; VE=74%). We found significant VE against vaccine-type CIN2+ after 3 doses of HPV vaccine and lower but significant VE with 1 or 2 doses.

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