Measuring vaccine effectiveness against persistent HPV infections: a comparison of different statistical approaches

R. Donken*, J. Hoes, M. J. Knol, G. S. Ogilvie, S. Dobson, A. J. King, J. Singer, P. J. Woestenberg, J. A. Bogaards, C. J.L.M. Meijer, H. E. De Melker

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Persistent high-risk human papillomavirus (HPV) infection is endorsed by the World Health Organization as an intermediate endpoint for evaluating HPV vaccine effectiveness/efficacy. There are different approaches to estimate the vaccine effectiveness/efficacy against persistent HPV infections. Methods: We performed a systematic literature search in Pubmed to identify statistical approaches that have been used to estimate the vaccine effectiveness/efficacy against persistent HPV infections. We applied these methods to data of a longitudinal observational study to assess their performance and compare the obtained vaccine effectiveness (VE) estimates. Results: Our literature search identified four approaches: the conditional exact test for comparing two independent Poisson rates using a binomial distribution, Generalized Estimating Equations for Poisson regression, Prentice Williams and Peterson total time (PWP-TT) and Cox proportional hazards regression. These approaches differ regarding underlying assumptions and provide different effect measures. However, they provided similar effectiveness estimates against HPV16/18 and HPV31/33/45 persistent infections in a cohort of young women eligible for routine HPV vaccination (range VE 93.7-95.1% and 60.4-67.7%, respectively) and seemed robust to violations of underlying assumptions. Conclusions: As the rate of subsequent infections increased in our observational cohort, we recommend PWP-TT as the optimal approach to estimate the vaccine effectiveness against persistent HPV infections in young women. Confirmation of our findings should be undertaken by applying these methods after longer follow-up in our study, as well as in different populations.

Original languageEnglish
Article number482
JournalBMC Infectious Diseases
Volume20
Issue number1
DOIs
Publication statusPublished - 8 Jul 2020

Cite this

Donken, R., Hoes, J., Knol, M. J., Ogilvie, G. S., Dobson, S., King, A. J., ... De Melker, H. E. (2020). Measuring vaccine effectiveness against persistent HPV infections: a comparison of different statistical approaches. BMC Infectious Diseases, 20(1), [482]. https://doi.org/10.1186/s12879-020-05083-7