There is substantial impact of HPV vaccination on reducing HPV-related outcomes

Models predicting the impact of HPV vaccination align with observed outcomes

We can trust models to inform cervical screening strategies in vaccinated populations.

We compared model predictions with independently published primary data from population-based studies on the impact of HPV vaccination on HPV prevalence, cervical cancer and its precursors.

We searched Cochrane Library, EMBASE, MEDLINE, Web of Science for studies concerning high-income countries published between 2005 to June 2, 2023. Relative risk (RR) for HPV-related outcomes comparing the pre-vaccination and post-vaccination periods were collected from observational and modelling studies. The relationship between vaccination coverage and observed relative reductions was determined using meta-regressions, and we compared model prediction to observations.

We identified a total of 5649 potential articles, of which one systematic review, 14 observational studies and 32 modelling studies met our inclusion criteria. A clear relation was found between the RR of HPV diseases related outcomes in the pre- versus post-vaccination era and the vaccination coverage, with 23 out of 28 data points and 19 out of 20 data points showing significant reductions in HPV prevalence and CIN2+ prevalence respectively. Around 67 % (n/N = 12/18) of model predictions were more optimistic on HPV prevalence reductions compared to the 95 % CI of the meta-regression derived from observational studies. For CIN2+ lesions, 48 % (n/N = 31/64) of model predictions for CIN2+ outcomes fell within the 95 % CI.

Model predictions and observational data agree that HPV vaccination can have a substantial impact on HPV related outcomes on a population level. Despite large heterogeneity in observational data and modelling studies, it is particularly encouraging that model predictions on the impact of HPV vaccination on CIN2+ model lesions align with observational studies.

Ontario Health (formerly known as Cancer Care Ontario).

HPV vaccination

Cervical cancer

meta-regression

bivalent vaccine against human papillomavirus

quadrivalent vaccine against human papillomavirus

nonavalent vaccine against human papillomavirus

cervical intraepithelial neoplasia

randomized controlled trial

squamous cell carcinoma

© 2025 The Authors. Published by Elsevier Inc.