RE: Population-Level Impact of the Bivalent, Quadrivalent, and Candidate Nonavalent Human Papillomavirus Vaccines: A Comparative Model-Based Analysis

Extract

Suba et al. ( 1 ) raise concerns that prophylactic human papillomavirus (HPV) vaccines may increase the risk of high-grade cervical disease despite the overwhelming evidence to the contrary. The natural history of HPV ( 2 ) predicts the rise of early high-grade cervical disease in a cohort of women aged 20 to 29 years, as many have been previously infected with HPV, some several years before and now have persistent HPV infection, which is a strong predictor of high-grade cervical disease ( 3 ). A cohort of HPV-positive younger women is therefore expected to accumulate high-grade cervical disease over time. The median age of screen-detected high-grade cervical disease is typically in the late 20s and early 30s ( 4 ), 10 to 15 years after HPV infections are acquired. Notably, cervical cancer rates rise sharply with age until the mid-40s in the United States ( 5 ) ( http://seer.cancer.gov/ ) despite widespread cervical cancer screening primarily by Pap testing. By the same arguments presented by Suba et al. ( 1 ) against the use of HPV vaccines, one could conclude erroneously that Pap smears cause cervical cancer rather than prevent it, as is widely accepted based on ecological data.