Background: In Australia, the government-funded human papillomavirus (HPV) vaccination programme was introduced in April, 2007, for girls and young women, and in February, 2013, for boys. As of Dec 31, 2018, all Australian-born female individuals younger than 38 years and male individuals younger than 21 years have been eligible for the free quadrivalent or nonavalent HPV vaccine. We aimed to examine the trends in genital wart diagnoses among Australian-born female and heterosexual male individuals who attended sexual health clinics throughout Australia before and after the introduction of the gender-neutral HPV vaccination programme in February, 2013. Methods: We did a serial cross-sectional analysis of genital wart diagnoses among Australian-born female and heterosexual male individuals attending a national surveillance network of 35 clinics between Jan 1, 2004, and Dec 31, 2018. We calculated prevalence ratios of genital warts, using log-binomial regression models, for the female-only vaccination period (July 1, 2007, to Feb 28, 2013), gender-neutral vaccination period (March 1, 2013, to Dec 31, 2018), and the whole vaccination period (July 1, 2007, to Dec 31, 2018) compared with the pre-vaccination period (Jan 1, 2004, to June 30, 2007). Findings: We included 121 038 men and 116 341 women in the analysis. Overall, we observed a 58% reduction (prevalence ratio 0·42, 95% CI 0·40–0·44) in genital wart diagnoses in female individuals and a 45% reduction (0·55, 0·53–0·57) in genital wart diagnoses in heterosexual male individuals after the introduction of the vaccination programme in 2007. The largest reduction in genital warts was observed in younger individuals, and there was a decreasing magnitude of reduction with increasing age (80%, 72%, 61%, 41%, and 16% reductions in female individuals aged 15–20 years, 21–25 years, 26–30 years, 31–35 years, and ≥36 years, respectively; 70%, 61%, 49%, 37%, and 29% reductions in male individuals aged 15–20 years, 21–25 years, 26–30 years, 31–35 years, and ≥36 years, respectively). Significant reductions observed in female individuals (0·32, 0·28–0·36) and male individuals (0·51, 0·43–0·61) aged 15–20 years in the female-only vaccination period were followed by a more substantial reduction in female individuals (0·07, 0·06–0·09) and male individuals (0·11, 0·08–0·15) aged 15–20 years in the gender-neutral vaccination period. Interpretation: The national gender-neutral HPV vaccination programme has led to substantial and ongoing reduction in genital warts among Australian female and heterosexual male individuals, with a marked reduction in young individuals who received the vaccine at school. Funding: Seqirus Australia and the Australian Government Department of Health.
Bibliographical noteFunding Information:
EPFC has received educational grants from Seqirus Australia and bioCSL to assist with education, training, and academic purposes in human papillomavirus (HPV) research. EPFC has received speaker's honoraria from Merck and has been the principal investigator on Merck investigator-initiated studies and received funding for HPV studies. EPFC is supported by an Australian National Health and Medical Research Council Emerging Leadership Investigator Grant (GNT1172873). CKF has received research funding from CSL Biotherapies, owns shares in CSL Biotherapies, and is a co-investigator on Merck investigator-initiated studies. BD, DGR, and AEG have received occasional speaker's honoraria from Merck. BD, LK, DAM, and RJG have been investigators on the Extended Surveillance of Genital Warts Program funded by the Australian Government Department of Health, outside the submitted work. BD, AEG, and DGR have received funding from Seqirus Australia for genital wart surveillance. DGR has received occasional speaker's honoraria from CSL Biotherapies. LK, DAM, and RJG have received funding from Seqirus Australia for a Delphi study on genital wart elimination. DAM reports travel grants from Seqirus and travel funding and honoraria to her institution from Merck Sharp & Dohme, outside the submitted work. All other authors declare no competing interests.
The Genital Warts Surveillance Network is funded by Seqirus Australia (formerly CSL Biotherapies) and the Australian Government Department of Health (Agreement ID 4-5546NZX).
We would like to thank the following clinic staff for providing the data for this study: Alison Ward, Charlotte Bell, and Dr Bin (Mikko) Li at Adelaide Sexual Health Centre, Adelaide; Darren Russell at Dolls' House Sexual Health Clinic, Cairns; Emanuel Vlahakis at Coffs Harbour Sexual Health Clinic, Coffs Harbour; Manoji Gunathilake at Darwin Clinic 34, Darwin; Maree O'Sullivan at Gold Coast Sexual Health, Gold Coast; Nathan Ryder at Hunter New England Sexual Health Service, Hunter New England Local Health District; David Smith at Lismore Sexual Health; Christopher Carmody at Liverpool Sexual Health Clinic, Liverpool; Christopher Fairley, Marcus Chen, and Afrizal Afrizal at Melbourne Sexual Health Centre, Melbourne; Eva Jackson at Nepean and Blue Mountains Sexual Health Clinic, Katoomba; Jenny McCloskey at Royal Perth Hospital Sexual Health Clinic, Perth; David Templeton at RPA Hospital Sexual Health Clinic, Sydney; Anna McNulty and Heng Lu at Sydney Sexual Health Centre, Sydney; Phillip Read at Kirketon Road Centre, Sydney; David Lewis at Western Sydney Sexual Health Clinic, Sydney; Kim Grant at Western NSW Sexual Health (Bourke, Dubbo, Orange, Lightning Ridge), Sydney; Jo Lenton at Far West NSW Sexual Health (Broken Hill and Dareton) Sexual Health Clinics, Sydney; and GRHANITE and CaraData for their help with data extraction. The Genital Warts Surveillance Network is funded by Seqirus Australia (formerly CSL Biotherapies) and the Australian Government Department of Health (Agreement ID 4-5546NZX).
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