OBJECTIVES: In 2012, quadrivalent human papillomavirus female only-vaccination (4vHPV FOV) was introduced in the National Immunization Program in Mexico. Currently, 11-year-old girls have access to 4vHPV. We estimated the expected public health impact for switching from a 4vHPV FOV to a nine-valent HPV vaccine (9vHPV) considering two scenarios: 11-year-old 9vHPV FOV and 11-year-old 9vHPV gender-neutral vaccination (GNV).

METHODS: A dynamic model of HPV disease transmission was calibrated to simulate the natural history of HPV and associated disease burden. The model assumed a two-dose schedule over a 100-year time horizon, lifetime immunity after vaccination, continuous cytology screening, 94% vaccine uptake for females in all scenarios, 1% for males (private market) in current 4vHPV FOV and 9vHPV FOV, 60% for males in 9vHPV GNV, and herd immunity. Mexico-specific data was used for calibration. Diseases in the model: cervical , head and neck, penile, anal, vaginal, vulvar cancers, genital warts, recurrent respiratory papillomatosis (RRP) and cervical intraepithelial neoplasia (CIN) 1-3.

RESULTS: After 100 years, both 9vHPV FOV and 9vHPV GNV scenarios are estimated to provide faster and greater reductions in the incidence of HPV 6/11/16/18/31/33/45/52/58 -related diseases compared with 4vHPV FOV. The greatest cumulative reductions of 6/11/16/18/31/33/45/52/58-related diseases were seen in 9vHPV GNV scenario: 101,424 avoided cancer cases (97,335 CC and 4,089 head and neck, penile, anal, vaginal, vulvar cancers), 42,779 deaths (34,217 due to CC and 8,562 head and neck, penile, anal, vaginal, vulvar cancers), 1.9 million CIN 2/3 cases, 1.5 million CIN 1, 172,325 RRP, and 5.2 million cases of genital warts (1.5 million cases in females and 4.7 million in males) compared to 4vHPV FOV at year 100.

CONCLUSIONS:

In Mexico, switching from 4vHPV FOV to 9vHPV FOV or GNV is projected to provide a substantial public health impact reducing HPV-related diseases and deaths in both genders compared to the current strategy.