Epidemiology and Modelling of Antibiotic Evasion Unit, Institut Pasteur, 75475 Paris, France.
Université Paris-Saclay, UVSQ, Inserm, CESP, Anti-Infective Evasion and Pharmacoepidemiology Team, 78180 Montigny-Le-Bretonneux, France.
Epidemiol Infect. 2023 Feb 2;151:e31. doi: 10.1017/S0950268823000122.
Genital human papillomavirus (HPV) infections are caused by a broad diversity of genotypes. As available vaccines target a subgroup of these genotypes, monitoring transmission dynamics of nonvaccine genotypes is essential. After reviewing the epidemiological literature on study designs aiming to monitor those dynamics, we evaluated their abilities to detect HPV-prevalence changes following vaccine introduction. We developed an agent-based model to simulate HPV transmission in a heterosexual population under various scenarios of vaccine coverage and genotypic interaction, and reproduced two study designs: post--prevaccine and vaccinated--unvaccinated comparisons. We calculated the total sample size required to detect statistically significant prevalence differences at the 5% significance level and 80% power. Although a decrease in vaccine-genotype prevalence was detectable as early as 1 year after vaccine introduction, simulations indicated that the indirect impact on nonvaccine-genotype prevalence (a decrease under synergistic interaction or an increase under competitive interaction) would only be measurable after >10 years whatever the vaccine coverage. Sample sizes required for nonvaccine genotypes were >5 times greater than for vaccine genotypes and tended to be smaller in the post--prevaccine than in the vaccinated--unvaccinated design. These results highlight that previously published epidemiological studies were not powerful enough to efficiently detect changes in nonvaccine-genotype prevalence.
生殖器人乳头瘤病毒（HPV）感染是由广泛多样的基因型引起的。由于可用的疫苗针对这些基因型的亚组，监测非疫苗基因型的传播动态至关重要。在回顾了旨在监测这些动态的研究设计的流行病学文献后，我们评估了它们在疫苗接种后检测 HPV 流行率变化的能力。我们开发了一个基于代理的模型，以模拟在不同疫苗覆盖率和基因型相互作用情况下异性恋人群中的 HPV 传播，并复制了两种研究设计：疫苗前和疫苗后-未接种疫苗的比较。我们计算了在 5%显着性水平和 80%功效下检测显着流行率差异所需的总样本量。尽管在疫苗接种后 1 年内就能检测到疫苗基因型流行率的下降，但模拟表明，非疫苗基因型流行率的间接影响（协同作用下的下降或竞争作用下的上升）只有在 >10 年后才会被测量到，无论疫苗覆盖率如何。非疫苗基因型所需的样本量大于疫苗基因型的 5 倍，并且在疫苗后-未接种疫苗的设计中往往比在疫苗前的设计中更小。这些结果表明，以前发表的流行病学研究还不够强大，无法有效地检测非疫苗基因型流行率的变化。
