Bivalent Vaccine Effectiveness Against Type-Specific HPV Positivity: Evidence for Cross-Protection Against Oncogenic Types Among Dutch STI Clinic Visitors.

Observational postmarketing studies are important to assess vaccine effectiveness (VE). We estimated VE from the bivalent human papillomavirus (HPV) vaccine against HPV positivity of vaccine and nonvaccine types in a high-risk population

Les espérances de vie sans incapacité en France : une tendance récente moins favorable que dans le passé

Contexte.En 2008, l’espérance de vie (EV) des hommes et des femmes était respectivement de 78 ans et 84 ans. Devant l’allongement de l’espérance de vie, comprendre si les années de vie gagnées le sont en bonne santé est devenu un enjeu de santé publique afin de mieux planifier les besoins en matière de soins et d’assistance. C’est aussi dorénavant un enjeu économique et social avec les attentes grandissantes pour la participation sociale des plus âgés. Combien de ces années sont-elles vécues en bonne santé fonctionnelle ? Que peut-on dire des évolutions récentes ? Pour répondre à ces questions, cette étude présente les nouvelles estimations espérances de vie sans incapacité (EVSI) en France. Méthode. A la base de ces estimations, nous avons mobilisé 5 enquêtes nationales ou européennes conduites en 2008 et différents indicateurs d’incapacité complémentaires présents dans ces enquêtes : d’une part dans le domaine des limitations fonctionnelles physiques, sensorielles et cognitives ; d’autre part dans le domaine des restrictions dans les activités de la vie quotidienne. Nous avons ajouté ces estimations à celles produites dans les années précédentes, soit à partir des mêmes enquêtes et indicateurs, soit à partir de sources différentes. L’ensemble fournit un tableau de la situation passée et présente. Les EVSI ont été calculées avec la méthode de Sullivan. Nous présentons des EVSI à 50 ans et à 65 ans. Nous présentons aussi des EVSI partielles sur la tranche d’âges 50-65 ans de manière à évaluer les risques d’incapacité et de mortalité prématurée, pouvant gêner la participation sociale notamment sur le marché du travail. Résultats. Les dernières estimations d’EVSI indiquent que près de la moitié de l’EV50 des hommes, et 40 % de l’EV50 des femmes sont des années de bonne santé fonctionnelle. Les années d’incapacité sont pour bon nombre des années de troubles fonctionnels physiques ou sensorielles qui ne s’accompagnent pas de répercussions sur les activités du quotidien. En effet, 60% de l’EV50 des hommes et des femmes sont ressenties comme des années sans limitation d’activité. Les femmes vivent bien plus d’années que les hommes avec des limitations fonctionnelles mais aussi avec des gênes dans les activités, notamment domestiques (25% de leur EV50 contre 13% de celle des hommes). Ces différences sont importantes déjà parmi les quinquagénaires. Les différences sont moins marquées pour les activités de soins personnels. On montre aussi que les limitations fonctionnelles et restrictions d’activités sont plus fréquentes aux âges élevés mais qu’elles surviennent bien avant 65 ans, attestant d’une période critique pour la santé parmi les quinquagénaires. Enfin, il semble que dans les années les plus récentes, les tendances pour les EV sans restrictions d’activité soient moins favorables que celles observées précédemment ; particulièrement parmi les 50-65 ans. Les tendances apparaissent aussi différentes pour les hommes et les femmes. Les EV sans difficultés pour les activités domestiques semblent plutôt en recul pour les femmes et les EV sans restrictions pour les activités de soins personnels en recul pour les hommes. La part des années de vie sans limitations fonctionnelles diminue aussi légèrement, comme dans le passé. Discussion. Si l’estimation des évolutions d’EVSI reste délicate, du fait de ruptures dans la plupart des séries, les tendances générales apparaissent pour la première fois assez différentes pour les deux sexes. Ces résultats suggèrent l’importance de ne pas se focaliser qu’aux âges élevés, mais d’étudier la santé fonctionnelle bien avant, en particulier en fin de vie active. Ils suggèrent aussi d’aborder différentes dimensions de l’incapacité, de manière à mieux anticiper les besoins. Enfin, la mise en perspective des estimations passées et récentes montrent une certaine stagnation des EVSI dans la période récente. Cette tendance, plus défavorable pour les femmes, pourrait s’expliquer par une plus grande survie des personnes qui ont des maladies et limitations fonctionnelles. Elle pourrait aussi s’expliquer par la perception d’un état de santé fonctionnel plus dégradé ou par une réelle dégradation. Concernant les femmes, cette tendance touche les générations qui ont été plus nombreuses à travailler et qui sont aujourd’hui en fin de vie active ou jeunes retraitées. Évolution des perceptions ou dégradation de la santé fonctionnelle parmi les quinquagénaires ? Des analyses complémentaires devront être réalisées pour préciser ce constat et mieux décrire cette nouvelle situation pour la France

Aging and health in France: an unexpected expansion of disability in mid-adulthood over recent years

International audienceThe study presents new disability-free life expectancies (DFLE) estimates for France and discusses recent trends in the framework of the three ‘health and aging’ theories of compression, dynamic equilibrium and expansion of disability. The objectives are to update information for France and to compare two methods to analyse recent trends. Methods: DFLE at ages 50, 65 and in the 50–65 age group are computed for several disability dimensions, using data from five French surveys over the 2000s. Owing to scarce time series, we used two methods to assess trends and consolidate our conclusions: (i) decomposition of the DFLE changes using the available time series; (ii) linear regression using all the available estimates, classified by disability dimensions. Results: Trends in DFLE65 prolonged the dynamic equilibrium of the previous decades: increasing life expectancy with functional limitations but not with activity restrictions. Meanwhile, partial DFLE50–65 has decreased for various disability dimensions, including some activity restrictions, especially for women. Conclusion: France has recently experienced an unexpected expansion of disability in mid-adulthood while it is still on a trend of dynamic equilibrium at older ages. The study highlights the importance of monitoring trends in DFLE for various disability dimensions and broadens the scope of interest to the mid-adulthood

Effect of the bivalent HPV vaccine on viral load of vaccine and non-vaccine HPV types in incident clearing and persistent infections in young Dutch females.

HPV vaccination with the bivalent vaccine is efficacious against HPV16 and 18 infections and cross-protection against non-vaccine HPV types has been demonstrated. Here, we assessed (cross-) protective effects of the bivalent HPV16/18 vaccine on incident and persistent infections and viral load (VL) of fifteen HPV types in an observational cohort study monitoring HPV vaccine effects. Vaginal samples were obtained annually. Type-specific VL assays were developed for HPV6,11,31 33,35,39,45,51,52,56,58,59 and 66 and used in addition to existing HPV16 and 18 assays. Rate differences of incident clearing and persistent infections were correlated with differences in VL and vaccination status. HPV16/18 vaccination resulted in significantly lower incidence of HPV16/18 infections and significantly lower VL in breakthrough HPV16 (p<0.01) and 18 infections (p<0.01). The effects of vaccination on non-vaccine type VL were ambiguous. Incidence and/or persistence rates of HPV31, 33, 35 and 45 were reduced in the vaccinated group. However, no significant type specific VL effects were found against HPV31, 33, 45, 52 in the vaccinated group. For HPV 6, 59 and 66 no significant reductions in numbers of incident and persistent infections were found, however borderline) VL reductions following vaccination were observed for HPV6 (p = 0.01), 59 (p = 0.10) and 66 (p = 0.03), suggesting a minor effect of the vaccine on the VL level of these HPV types. Overall, vaccination resulted in infections with slightly lower VL, irrespective of HPV type. In conclusion, vaccination with the bivalent HPV16/18 vaccine results in significantly reduced numbers of HPV16 and 18 incidence rates and reduced VL in breakthrough infections. Significant reductions in incident and/or persistent HPV31, 33, 35 and 45 infections were found, but no significant effect was observed on the VL for infections with these types. For the other non-vaccine HPV types no reduction in incident and/or persistent infections were found, but overall the VL tended to be somewhat lower in vaccinated women

Persisting Antibody Response Nine Years after Bivalent HPV Vaccination in A Cohort of Dutch Women: Immune Response and the Relation with Genital HPV Infections.

The bivalent human papillomavirus (HPV) vaccine is highly effective and induces robust serological responses. Using a Dutch prospective cohort initiated in 2009, including 744 vaccinated and 294 unvaccinated girls (1993-1994) who provide a vaginal self-swab sample, serum sample, and questionnaire yearly, we report a high, persisting antibody response up to 9 years after vaccination for vaccine types HPV-16 or HPV-18. Antibodies against nonvaccine HPV types 31, 33, 45, 52, and 58 were lower but still significantly higher than in unvaccinated individuals. This was also reflected in the seroprevalence. We compared participant characteristics and antibody levels between vaccinated women with and those without HPV infections 1 year before infection (204 incident and 64 persistent infections), but we observed no consistent difference in type-specific antibody levels. Having a high-risk HPV infection was associated with sexual risk behavior and smoking 1 year before infection. Although high antibody levels are necessary for protection, our study suggests that on the individual level other factors such as HPV exposure or antibody avidity could be important

No evidence for cross-protection of the HPV-16/18 vaccine against HPV-6/11 positivity in female STI clinic visitors

OBJECTIVES: Data from a vaccine trial and from post-vaccine surveillance in the United Kingdom have suggested that the bivalent HPV-16/18 vaccine offers cross-protection against HPV-6/11 and protection against anogenital warts (AGW). We studied the effect of the bivalent vaccine on genital HPV-6/11 positivity and AGW in the Netherlands. METHODS: We included all vaccine-eligible women from the PASSYON study, a biennial cross-sectional study among 16- to 24-year-old sexually transmitted infection (STI) clinic attendants. Vaginal self-swabs were analyzed for type specific HPV and AGW were diagnosed at the STI-clinic. Prevalence of HPV-6 and/or HPV-11 and AGW were compared between self-reported vaccinated and unvaccinated women by log-binomial regression analysis, adjusted for demographics and risk behavior. RESULTS: Of the 1198 women included, 56% reported to be vaccinated at least once. Relative to unvaccinated women, the adjusted prevalence ratio (PR) for HPV-6/11 was 1.03 (95% confidence interval [CI] 0.74-1.43) for women vaccinated at least once. The crude PR for AGW was 0.67 (95% CI 0.22-2.07) for women vaccinated at least once. Adjustment did not change these results. CONCLUSIONS: We observed no cross-protective effect of the bivalent vaccine on genital HPV-6/11 positivity and a non-significant partially protective effect on AGW

Bivalent Vaccine Effectiveness Against Type-Specific HPV Positivity: Evidence for Cross-Protection Against Oncogenic Types Among Dutch STI Clinic Visitors.

Observational postmarketing studies are important to assess vaccine effectiveness (VE). We estimated VE from the bivalent human papillomavirus (HPV) vaccine against HPV positivity of vaccine and nonvaccine types in a high-risk population

Bivalent Vaccine Effectiveness Against Type-Specific HPV Positivity : Evidence for Cross-Protection Against Oncogenic Types among Dutch STI Clinic Visitors

Background. Observational postmarketing studies are important to assess vaccine effectiveness (VE). We estimated VE from the bivalent human papillomavirus (HPV) vaccine against HPV positivity of vaccine and nonvaccine types in a high-risk population. Methods. We included all vaccine-eligible women from the PASSYON study, a biennial cross-sectional survey in Dutch sexually transmitted infection clinics. Vaginal swabs were analyzed using a polymerase chain reaction-based assay (SPF10-LiPA25) able to detect the 12 high-risk HPV (hrHPV) types 16/18/31/33/35/39/45/51/52/56/58/59. We compared hrHPV positivity between self-reported vaccinated (.1 dose) and unvaccinated women, and estimated VE by a logistic mixed model. Results. We included 1087 women of which 53% were hrHPV positive and 60% reported to be vaccinated. The adjusted pooled VE against HPV-16/18 was 89.9% (81.7%.94.4%). Moreover, we calculated significant VE against nonvaccine types HPV-45 (91%), HPV-35 (57%), HPV-31 (50%), and HPV-52 (37%). Among women who were offered vaccination 5/6 years ago, we estimated similar VE against HPV-16/18 (92%) and all hrHPV types (35%) compared to women who were offered vaccination <5 years ago (83% and 33%, respectively). Conclusion. We demonstrated high VE of the bivalent vaccine against HPV-16/18 and cross-protection against HPV-45/35/31/52. Protection against HPV-16/18 was sustained up to 6 years postvaccination