Cintia Irene Parellada

Impact of HPV vaccination on the hospitalizations for anogenital warts and high-grade cervical intraepithelial neoplasia in Brazil: A national analysis

The HPV vaccination program in Brazil, introduced in 2014 for girls and 2017 for boys, aims to reduce HPV-related diseases, including anogenital warts (AGW) and high-grade cervical intraepithelial neoplasia (CIN). This descriptive ecological study evaluated the program's impact on hospitalizations for AGW and high-grade-CIN using interrupted time series analysis of data from the Brazilian Hospital Information System from 2011 to 2019. From 2011 to 2019, there were 4,312 AGW hospitalizations among females, 7,295 AGW hospitalizations among males, and 84,306 hospitalizations for high-grade CIN. Following the implementation of the HPV vaccination program, significant reductions in hospitalizations for AGW and high-grade CIN were observed, particularly in the targeted 15-19-year-old age group. In this group, the median number of hospitalizations prevented was 174 (95% CI: 154-193) for AGW among females, 116 (95% CI: 86-147) for AGW among males, and 217 (95% CI: 94-339) for high-grade CIN, with strong model fits. Downward trends were also noted in older age groups, though with poorer model fits. The HPV vaccination program has significantly reduced hospitalizations for AGW and high-grade CIN in Brazil, particularly among the targeted age group. Local evidence of early disease benefits reinforces the importance of HPV immunization in reducing the burden of HPV-related diseases and support expanding vaccination efforts for broader public health benefits. Reductions of AGW and high-grade CIN in older age groups may reflect indirect vaccination effects and treatment strategies, respectively.

Assessing the burden of HPV-associated cancers in Brazil: Hospitalization and mortality trends from 2011 to 2019

Human papillomavirus (HPV)-associated cancers represent a substantial public health burden. This study analyzed the national burden of hospitalization and mortality from HPV-associated cancers in Brazil between 2011 and 2019. Outcomes included average annual numbers, crude and age-standardized rates per 100,000 population, and trends estimated via joinpoint regression for cervical, vulvar, vaginal, penile, anal, and head and neck cancers (oropharynx, larynx, and oral cavity). Between 2011 and 2019, HPV-attributable cancers accounted for an average of 29,155 hospitalizations (14.3 per 100,000) and 7526 deaths (3.7 per 100,000) annually across both sexes. Among females, there were an average of 24,921 hospitalizations (24.0 per 100,000) and 6430 deaths annually, largely driven by cervical cancer. Among males, there were an estimated 4234 HPV-attributable hospitalizations and 1096 deaths per year (4.1 and 1.1 per 100,000, respectively), with penile, anal, and oropharyngeal cancers being the largest contributors. Cervical cancer accounted for 74.3% of HPV-attributable hospitalizations, followed by anal (10.4%), head and neck (9.2%), and penile cancers (3.4%). Most HPV-associated cancers showed stable hospitalization and mortality trends over time. For cervical cancer, hospitalizations rose by 3.9% annually between 2016 and 2019, while mortality rose by 0.7% annually over the entire period. Anal cancer showed significant increases in both hospitalizations (AAPC = 3.1%) and mortality (AAPC = 10.9%). These findings underscore the need for continued efforts to prevent and reduce the burden of HPV-associated cancers in Brazil, including expanded cohort vaccination, consideration of higher-valency vaccines, and improved access to early detection and timely treatment for both sexes.

Trends in the burden of HPV-associated cancers in Mexico: An analysis from 2011 to 2019

Human papillomavirus (HPV) is a major public health concern, responsible for multiple types of cancer. This study aimed to provide an overview of the burden and temporal trends of HPV-associated cancers in Mexico using national hospital discharge and mortality databases from 2011–2019, including cervical, vulvar, vaginal, penile, anal, oropharyngeal, oral cavity, and laryngeal cancers. Hospitalization and mortality rates per 100,000 population were estimated; HPV-attributable fractions applied, and age-standardized temporal trends evaluated using joinpoint regression. Cervical cancer was the leading contributor, accounting for 88.5% of hospitalizations and 90.9% of HPV-attributable deaths. Hospitalization rates for cervical cancer increased between 2011–2014 (APC = 7.5%, 95% CI: 2.3, 18.0), then declined (APC = −3.0%, 95% CI: −7.8, −0.9). Other HPV-associated cancers had lower hospitalization rates, generally below 1 per 100,000, except for penile and head and neck cancers in males. Significant increases in hospitalization rates were observed in males for anal cancer from 2011–2019 (APC = 7.1%, 95% CI: 0.8, 15.1) and oropharyngeal cancer from 2017–2019 (APC = 18.0%, 95% CI: 4.0, 31.6), while in females, for vaginal cancer from 2017–2019 (APC = 30.7%, 95% CI: 10.6, 45.3) and oral cavity cancer from 2011–2019 (APC = 8.4%, 95% CI: 2.4, 29.1). Mortality for most cancers showed decreasing or stable trends over the study period, except for vulvar cancer in females (AAPC = 1.9%, 95% CI: 0.4, 4.1) and oropharyngeal cancer in both sexes (AAPC = 4.0%, 95% CI: 0.7, 8.0). Across most cancers, males were hospitalized at older ages but died younger than females, except for anal cancer. Overall, the burden of HPV-associated cancers is substantial. While cervical cancer remains prevalent and requires continued elimination efforts, the rising burden of anal and oropharyngeal cancers among males, highlights the need to strengthen public health strategies and raise awareness of HPV’s broader impact across both sexes.

Sex disparities of vaccine-preventable cancer mortality in Latin America

This analysis estimated productivity losses and assessed sex disparities due to vaccine-preventable cancer deaths from hepatitis B virus (HBV) and human papillomavirus (HPV) in Latin America. The number of deaths and years of life lost (YLL) for 19 Latin American countries were sourced from the Institute for Health Metrics and Evaluation Global Burden of Disease (2019) for cervical, oral cavity, laryngeal, oropharyngeal, and HBV-related hepatic cancers. Attributable fractions were applied to estimate HPV-related mortality. The value of YLL (VYLL) was estimated using country-specific GDP per capita and discounted at 3%. Sensitivity and scenario analyses were conducted. In 2019, 38,786 vaccine-preventable cancer deaths resulted in over 1.1 million YLL and $5.9 billion VYLL across Latin America. Cervical cancer accounted for 81.6% of deaths and $4.9 billion in VYLL, with females representing 87.0% of the total VYLL. For males, hepatic cancer was the highest VYLL at $295 million and oral cavity the lowest ($94 million). AYLL was higher in females (30 years) than males (27 years). HBV- and HPV-related cancers impose a significant economic and mortality burden in Latin America, with marked sex disparities. Cervical cancer remains the dominant contributor among females, while males are disproportionately affected by head and neck and hepatic cancers. These findings underscore the need for sex-specific public health strategies, including expanded vaccination, improved screening, and timely treatment access across the region.