King, EM;
(2015)
Human papillomavirus epidemiology in men who have sex with men: implications for a vaccine programme at sexual health clinics in the UK.
Doctoral thesis , UCL (University College London).
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Abstract
Men who have sex with men (MSM) are at increased risk of human papillomavirus (HPV) infection and related disease. There are two licensed HPV vaccines against the high-risk HPV types, HPV16/18, one of which, the quadrivalent vaccine, additionally targets low-risk HPV types (HPV6/11). MSM will not benefit from the UK’s school-based HPV vaccine programme targeting girls. Sexual Health clinics (SHC) are the most feasible setting for vaccinating MSM. This thesis aimed to inform the policy decision on whether to vaccinate MSM attending SHCs in the UK by estimating underlying epidemiological parameters: HPV exposure in the MSM population attending SHCs, expected vaccine coverage and the effect of HPV16 vaccination on anal cancer incidence. A cross-sectional survey of 522 MSM was conducted at a SHC. Specimens (anal and external genital swabs, urine, oral rinse and serum) were tested for HPV and demographic, behavioural and clinical information was collected (HPV-MSM-MMC study). A static deterministic cohort model was developed of HPV16 infection and anal cancer in SHC-attending MSM. A substantial burden of HPV infection in MSM could be prevented at SHCs: a third of HPV-MSM-MMC participants were infected with ≥1 quadrivalent-vaccine HPV types yet none with all four. Therefore all had potential to benefit, at least partially, from vaccination. An additional third had evidence of prior exposure (seropositive or history of anogenital warts) to quadrivalent-vaccine types and a final third had no evidence of exposure. A targeted HPV vaccine programme at SHCs would result in ≥50% coverage of the UK’s MSM population. Vaccination at SHCs would efficiently interrupt HPV transmission because SHC-attenders represent MSM at high risk of HPV infection. Vaccination against HPV16 was predicted to substantially reduce anal cancer incidence, even without the effect of herd immunity. This thesis provides strong evidence for HPV vaccine effectiveness using a programme targeting MSM attending SHCs.
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