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- W2034791845 abstract "Sir, We thank Frank Hulstaert and Christ De Laet for their valuable comments to our paper. We agree with them. Assuming a 65% reduction in the risk of CIN2+ in vaccinated women is probably too optimistic. We have based our estimate on the reported distribution of HPV 16/18 in CIN2+. However, many women with HPV 16/18 have additional HPV high-risk infections (1) and they may therefore develop CIN2+ from other HPV infections than HPV 16/18. Thus, the relative low overall estimated effect of the HPV 16/18 vaccine on CIN2+ may be caused by high prevalence of concurrent HPV infections. Such reasoning is theoretical projections, and we agree with Frank Hulstaert and Chris De Laet that randomized controlled trials provide the best evidence of the overall impact of the HPV 16/18 vaccines on CIN2+. The Future II study reported 27% (95% confidence interval 4–44%) overall effect on CIN2+ (2). In their analyses, however, some women may have been infected by non-HPV 16/18 genotypes prior to study inclusion. In the discussion in our paper we presented estimates of the HPV 16/18 vaccination effect, assuming 27% overall effect on CIN2+ and 80% vaccination coverage. This effect was, of course, much lower than in the estimations we presented in the results (3). The main focus of our paper was not to make true estimates of the impact of a vaccination program on preterm delivery, but to demonstrate the factors influencing such an effect. A reliable estimate requires not only knowledge of the overall vaccination effect on CIN2+ (now and according to future changes in HPV genotype distribution), but also knowledge of the vaccination coverage and the prevalence of cervical cone excision in pregnant women. Despite the uncertainty of the values used in our estimations, we hope that our model may contribute to our understanding of the potential effect of HPV 16/18 vaccination on preterm birth risk." @default.
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- W2034791845 date "2009-01-01" @default.
- W2034791845 modified "2023-10-16" @default.
- W2034791845 title "CIN2+lesions and HPV 16/18 vaccination" @default.
- W2034791845 cites W1991640469 @default.
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- W2034791845 doi "https://doi.org/10.1080/00016340903002899" @default.
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