Significant decline of HPV 6 infection and genital warts despite low HPV vaccination coverage in young women in Germany: a long-term prospective, cohort data analysis

• Published in: BMC infectious diseases Vol. 21; no. 1; pp. 1 - 634
• Main Authors: Denecke, Agnieszka, Iftner, Thomas, Iftner, Angelika, Riedle, Sebastian, Ocak, Marion, Luyten, Alexander, Ãye, Isak, Tunc, Kübra, Petry, Karl Ulrich
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 02.07.2021; BioMed Central; BMC
• Subjects: Cervical cancer; Condyloma acuminatum; Condylomata acuminata; Contingency; Data analysis; Drug dosages; Epidemiology; Females; Genital warts; Health aspects; Herd immunity; HPV-vaccination; Human papillomavirus; Infections; Infectious diseases; Pap smear; Papillomavirus infections; Population; Risk factors; Statistical analysis; Statistics; Surveillance; Tumors; Vaccination; Vaccines; Viral infections; Warts; Wolves; Womens health; Young women; Germany
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-021-06139-y

The introduction of human papillomavirus (HPV) vaccination has resulted in a remarkable decline of genital warts in women and men, but in Germany historical rates of vaccination are relatively low. We report long-term surveillance data on changes in HPV 6 and HPV 11 infection and the prevalence of genital warts in young women in the Wolfsburg HPV epidemiological study (WOLVES). Women born in 1983/84, 1988/89, and 1993/94 participated in four cohorts between 2009/10 and 2014/15. Quadrivalent vaccination coverage and prevalence of HPV 6/11 infection and genital warts are reported for participants aged 19-22 years and 24-27 years at the time of sample collection. Statistical analyses were done to compare similarly aged participants using 2 x 2 contingency tables (Röhmel-Mansmann unconditional exact test; two-side alpha of 0.05). A total of 2456 women were recruited. Between 2010 and 2015, there was a statistically significant decrease in the prevalence of HPV 6 infection among women aged 24-27 years (2.1% versus 0.0%; P < 0.0001) and women aged 19-22 years (2.0% versus 0.0%; P = 0.0056). There was no significant decline in HPV 11 infection. In total, 52 of 2341 participants were diagnosed with genital warts. There was a statistically significant drop in the risk of developing genital warts in women aged 24-27 years between 2010 and 2015 (4.7% versus 1.7%, respectively; P = 0.0018). The overall risk of developing genital warts in women aged 19-27 years decreased from 3.1% in 2010 to 1.2% in 2015 (P = 0.0022). An increase in vaccination coverage was associated with a decreased prevalence of genital warts in young women. A protective effect greater than herd immunity alone was seen despite low vaccination rates. Quadrivalent vaccine had a protective effect on genital HPV 6 infection and an almost fully protective effect on the development of genital warts in the youngest population.