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标题：Prevalence of Anogenital Warts Among Participants in Private Health Plans in the United States, 2003–2010: Potential Impact of Human Papillomavirus Vaccination
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作者：Elaine W. Flagg ; Robert Schwartz ; Hillard Weinstock 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2013
卷号：103
期号：8
页码：1428-1435
DOI：10.2105/AJPH.2012.301182
语种：English
出版社：American Public Health Association
摘要：Objectives. We estimated anogenital wart prevalence from 2003 to 2010 by gender and age group in a large US cohort with private insurance to detect potential decreases among people most likely to be affected by human papillomavirus (HPV) vaccination. Methods. We restricted health care claims to those from individuals aged 10 to 39 years with continuous insurance within a given year. We derived anogenital wart diagnoses from a diagnosis of condyloma acuminata, or either a less specific viral wart diagnosis or genital wart medication combined with either a benign anogenital neoplasm or destruction or excision of a noncervical anogenital lesion. Results. Prevalence increased slightly in 2003 to 2006, then significantly declined in 2007 to 2010 among girls aged 15 to 19 years; increased in 2003 to 2007, remained level through 2009, and declined in 2010 among women aged 20 to 24 years; and increased through 2009 but not in 2010 for women aged 25 to 39 years. For males aged 15 to 39 years, prevalence for each 5-year age group increased in 2003 to 2009, but no increases were observed for 2010. Conclusions. These data indicate reductions in anogenital warts among US females aged 15 to 24 years, the age group most likely to be affected by introduction of the HPV vaccine. In mid-2006, a quadrivalent human papillomavirus (HPV) vaccine was licensed in the United States for females (Merck & Co., Inc., Whitehouse Station, NJ). This vaccine is specific against HPV types 16 and 18, which cause approximately 70% of cervical cancers worldwide, 1,2 as well as types 6 and 11, which are nononcogenic but can cause benign cervical lesions and anogenital warts. 1,3,4 A bivalent vaccine (GlaxoSmithKline, Research Triangle Park, NC), specific for only HPV types 16 and 18, was licensed in late 2009. These vaccines are routinely recommended for girls aged 11 to 12 years, with catch-up vaccination through age 26 years. 5,6 In late 2011, the quadrivalent vaccine was recommended for boys aged 11 to 12, with catch-up vaccination through age 21 years. 7,8 However, HPV vaccine uptake in the United States is relatively low. In 2011, a national survey found that 53% of girls aged 13 to 17 years had received at least 1 dose of the HPV vaccine series, but only 35% had received all 3 doses. 9 Vaccine uptake was extremely low among boys. 9 Postlicensure monitoring of new vaccines is important to assess the progress of immunization programs, demonstrate population impact, and evaluate policy needs. 10–14 Clinical trials have demonstrated the prophylactic efficacy of the quadrivalent HPV vaccine, 15,16 and questions of interest about currently available HPV vaccines now center on population effectiveness and cost-effectiveness. 17 However, several factors complicate efforts to monitor the population impact of HPV vaccine, including multiple clinical outcomes and variable, often extended, time to outcome development. 10,12,14 Cervical cancer is the most important anogenital outcome of HPV infection and may take several decades to develop. 18 Cervical intraepithelial neoplasia and adenocarcinoma in situ are the most common cervical cancer precursor lesions, often occurring 1 to 3 years after HPV infection. 19–22 In contrast to these outcomes, anogenital warts can develop within months of HPV infection, and therefore monitoring changes in anogenital wart diagnoses can be used to assess the most immediate impact of HPV vaccination. 19 The objective of this analysis was to estimate annual prevalence of anogenital wart diagnoses during 2003 to 2010 in a large group of privately insured patients, by gender and age group, to detect potential decreases among people most likely to be affected by quadrivalent HPV vaccination.