British Medical Journal
11 May 2013 (Vol 346, Issue 7907)
http://www.bmj.com/content/346/7907

Editorial
HPV vaccination—reaping the rewards of the appliance of science
Simon Barton
Excerpt
National programmes could virtually eliminate certain diseases and substantially reduce costs
The optimism generated by scientific breakthroughs often turns to disappointment when applied to the real world of clinical care. It is therefore worth celebrating the extraordinary success of Australia’s national human papillomavirus (HPV) vaccination programme, which was implemented five years ago, as reported in the linked paper by Ali and colleagues (doi:10.1136/bmj.f2032).1 This analysis of data on 85 770 new patients from six Australian sexual health clinics shows a remarkable reduction in the proportion of women under 21 years of age presenting with genital warts—from 11.5% in 2007 to 0.85% in 2011 (P<0.001). Only 13 cases of genital warts were diagnosed in women under the age of 21 across all six health clinics in 2011. Such a reduction in this distressing disease caused by a sexually transmitted virus is a major public health achievement. Furthermore, the near eradication of genital warts in young Australian women will probably have a major impact on the costs of sexual healthcare…
http://www.bmj.com/content/346/bmj.f2184

Research
Genital warts in young Australians five years into national human papillomavirus vaccination programme: national surveillance data
Hammad Ali, lecturer1, Basil Donovan, professor12, Handan Wand, senior lecturer1, Tim R H Read, sexual health physician34, David G Regan, senior lecturer1, Andrew E Grulich, Professor1, Christopher K Fairley, professor34, Rebecca J Guy, associate professor1
Open Access: http://www.bmj.com/content/346/bmj.f2032

Abstract
Objective To measure the effect on genital warts of the national human papillomavirus vaccination programme in Australia, which started in mid-2007.

Design Trend analysis of national surveillance data.

Setting Data collated from eight sexual health services from 2004 to 2011; the two largest clinics also collected self-reported human papillomavirus vaccination status from 2009.

Participants Between 2004 and 2011, 85 770 Australian born patients were seen for the first time; 7686 (9.0%) were found to have genital warts.

Main outcome measure Rate ratios comparing trends in proportion of new patients diagnosed as having genital warts in the pre-vaccination period (2004 to mid-2007) and vaccination period (mid-2007 to the end of 2011).

Results Large declines occurred in the proportions of under 21 year old (92.6%) and 21-30 year old (72.6%) women diagnosed as having genital warts in the vaccination period—from 11.5% in 2007 to 0.85% in 2011 (P<0.001) and from 11.3% in 2007 to 3.1% in 2011 (P<0.001), respectively. No significant decline in wart diagnoses was seen in women over 30 years of age. Significant declines occurred in proportions of under 21 year old (81.8%) and 21-30 year old (51.1%) heterosexual men diagnosed as having genital warts in the vaccination period—from 12.1% in 2007 to 2.2% in 2011 (P<0.001) and from 18.2% in 2007 to 8.9% in 2011 (P<0.001), respectively. No significant decline in genital wart diagnoses was seen in heterosexual men over 30 years of age. In 2011 no genital wart diagnoses were made among 235 women under 21 years of age who reported prior human papillomavirus vaccination.

Conclusions The significant declines in the proportion of young women found to have genital warts and the absence of genital warts in vaccinated women in 2011 suggests that the human papillomavirus vaccine has a high efficacy outside of the trial setting. Large declines in diagnoses of genital warts in heterosexual men are probably due to herd immunity.