Many (young) sexually active Dutch women and men become infected with HPV. Since 2010, 12-year-old girls are vaccinated with the bivalent vaccine through the National Immunisation Programme (NIP) to prevent HPV16- and HPV18-related cervical cancer. A catch up programme was implemented for girls aged 13-16 years in 2009. Implementation of routine HPV-vaccination in the NIP in The Netherlands is accompanied with monitoring of vaccine effectiveness and side effects in a population-based setting.
Monitoring to obtain insight into (future) effects of HPV-vaccination include: Monitoring of vaccine coverage using individual based registration of vaccinations (Praeventis database); Safety of vaccination through enhanced passive surveillance of adverse events through the National Pharmacovigilance Center Lareb as well as specific studies in response to adverse events signals; Cohort studies among young women eligible for HPV-vaccination to obtain insight into immunogenicity and vaccine-effectiveness against type-specific HPV infection; and a repeated cross-sectional survey on HPV prevalence in STI-clinic visitors. Mathematical modelling is performed on long term impact on disease burden and (cost)effectiveness.
Vaccine uptake increased from 52% (2009) to 61% (2014-2015), but preliminary data suggest a decrease in 2016. Local reactions and systemic adverse events are commonly reported after HPV vaccination, but are mostly mild and transient. As of yet, there is no evidence of a statistically significant association with serious adverse events. Vaccine effectiveness estimates for 12-month persistent high-risk (hr) HPV-infections among young females hrHPV-negative at time of HPV-vaccination was above 95% for vaccine types 16/18. Among female STI-visitors vaccine-effectiveness against prevalent HPV16/18 infection was 90%. Both studies showed indications for cross-protection.
Monitoring of HPV-vaccination programme shows high vaccine-effectiveness against (persistent) HPV16/18-infections. No evidence was found for serious adverse events associated with vaccination. The current programme for girls is expected to lead in the future to annually 350 fewer women with cervical cancer and 100 fewer female deaths due to this cancer. Efforts to increase vaccination coverage need to be emphasized. In the past years, the occurrence of HPV-related cancers in males has steadily increased. Recent findings show the vaccine protects also against penile, anal, vaginal and vulvar cancer. There are indications for the prevention of oropharyngeal cancers. In response to these novel insights, the Ministry of Health asked the Health Council to prepare an update of their advice in 2008.
*on behalf of the HPV-research team RIVM: Birgit van Benthem, Hans Bogaards, Robine Donken, Jeanet Kemmeren, Audrey King, Fiona van der Klis, Birthe Lehmann, Scott McDonald, Hester de Melker, Liesbeth Mollema, Hella Pasmans, Venetia Qendri, Marianne van der Sande,Tessa Schurink, Hans van Vliet, Pascal van der Weele, Petra Woestenberg