Reduced doses of human papillomavirus vaccine may be effective in preventing condyloma

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1. Three doses of the quadrivalent HPV vaccine are best at preventing incidence of condyloma related to HPV 6 or 11. 

2. In women younger than 17 at first vaccination, two doses of vaccine showed considerable reduction in condyloma risk. 

Evidence Rating Level: 2 (Good)            

Study Rundown: Current recommendations for the HPV vaccine include 3-doses given at 0, 2, and 6 months, however, population studies to determine this regimen’s effectiveness are limited. The HPV vaccine is effective in preventing condyloma related to HPV types 6 and 11 and is one of the earliest measurable preventable disease outcomes due to its short intubation time. This study looked at women in Sweden between the ages of 10 and 24 to see first incidence of condyloma in relation to the dosage of vaccine. For first vaccination from ages 10 to 19, three doses of the HPV vaccine was found to be most effective at preventing condyloma. Also, if the first vaccination was between ages 10 and 16, two doses also cause significant reduction in the incidence of condyloma. Because the study was able to use a national population database, there is strength in the population size and the applicability to practice, as often patients do not receive the full course of the vaccine.  Limitations of this study include the possibility of not detecting all condyloma cases if some do not seek medical treatment.  Furthermore, the study does not take into account sexual activity which may be related to the incidence of condyloma.

Click to read the study, published today in JAMA

Relevant Reading: Immunogenicity of Quadrivalent HPV Vaccine Among Girls 11 to 13 Years of Age Vaccinated Using Alternative Dosing Schedules: Results 29 to 32 Months After Third Dose

In-Depth [retrospective cohort study]: This study assesses the association between the dose of vaccinations of quadrivalent HPV vaccine and the first incident of condyloma. A total of 1,045,165 females between ages of 10 and 24 were followed up for HPV vaccination and condyloma occurrence. Of those that were vaccinated, 322 cases of condylomas were identified after the vaccine was given, 76 after the first dose, 79 after the second dose and 167 after three doses.  For ages 10 to 16 at first vaccination, compared to those who were unvaccinated the incidence risk ratio (IRR) for condyloma after 3 doses was 0.18 (0.15-0.22, p <0.001), after 2 doses was 0.29 (0.21-0.40, p < 0.001) and after 1 dose 0.31 (0.20-0.49, p < 0.001). In this age group, comparing 2 doses to 1 dose showed little difference (IRR 0.91, 0.52-1.59, p = 0.74) however for 3 doses versus 2 doses, IRR was 0.63 (0.42-0.93, p = 0.02).  For ages 17 to 19 at first vaccination, IRR for 3 versus 2 doses was 0.66 (0.45-0.95, p = 0.03).  Overall, the number of prevented cases with three doses of vaccine compared to two doses in the combined age groups was 66 cases (CI 95%, 23 to 109) per 100,000 person-years.

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