Imperial College London


Faculty of MedicineSchool of Public Health

Professor of Mathematical Epidemiology



+44 (0)20 7594 3263mc.boily




LG26Norfolk PlaceSt Mary's Campus






BibTex format

author = {Drolet, M and Benard, E and Perez, N and Boily, M-C and Hammad, A and Baldo, V and Brassard, P and Brotherton, J and Callandar, D and Checchi, M and Chow, E and Cocchio, S and Dalianis, T and Deeks, S and Dehlendorff, C and Donovan, B and Fairley, C and Flagg, E and Gargano, J and Garland, S and Grun, N and Hansen, B and Harrison, C and Herweijer, E and Imburgia, T and Johnson, A and Kahn, J and Brisson, M},
doi = {10.1016/S0140-6736(19)30298-3},
journal = {Lancet},
pages = {497--509},
title = {Population-level impact and herd effects following the introduction of human papillomavirus vaccination programs: updated systematic review and meta-analysis},
url = {},
volume = {394},
year = {2019}

RIS format (EndNote, RefMan)

AB - BackgroundMore than ten years have elapsed since human papillomavirus (HPV) vaccination was implemented. We performed a systematic review and meta-analysis of the population-level impact of female-only HPV vaccination on HPV infections, anogenital wart diagnoses (AGW) and cervical intraepithelial neoplasia grade 2+ (CIN2+) to summarise the most recent evidence about the effectiveness of HPV vaccines in real-world settings and to quantify the impact of multiple age-cohort vaccination.MethodsWe updated our prior review (01/01/2007–28/02/2014), by searching Medline and Embase (01/02/2014–11/10/2018) for studies that examined changes, between pre- and post-vaccination periods, in HPV infections, AGW, or CIN2+. We stratified all analyses by sex, age, and years since HPV vaccination introduction. We used random-effects models to estimate pooled relative risks and performed subgroup analysis to identify the main sources of heterogeneity. FindingsWe identified 65 eligible articles conducted in 14 high-income countries. After 5-8 years of vaccination, HPV-16/18, AGW, and CIN2+ decreased significantly by about 80%, 70%, and 50% among girls aged 15-19 years and by 65%, 55%, and 30% among women aged 20-24 years. Significant cross-protection and herd effects were also observed. HPV-31/33/45 decreased significantly by 50% among girls aged 15-19 years and AGW decreased significantly by 30-50% among boys/men aged 15-24 years. After 5-8 years of vaccination, countries with multi-cohort vaccination and high coverage (≥50%) had greater reductions in AGW, 44 and 85 percentage points among girls and boys aged 15-19 years, respectively, than countries with single-cohort vaccination and/or low vaccination coverage. InterpretationOur meta-analysis, including data from >60 million individuals from 14 high-income countries, shows a substantial impact of female-only HPV vaccination programs on AGW among girls/women and boys/men, and HPV infections and CIN2+ among girls/women
AU - Drolet,M
AU - Benard,E
AU - Perez,N
AU - Boily,M-C
AU - Hammad,A
AU - Baldo,V
AU - Brassard,P
AU - Brotherton,J
AU - Callandar,D
AU - Checchi,M
AU - Chow,E
AU - Cocchio,S
AU - Dalianis,T
AU - Deeks,S
AU - Dehlendorff,C
AU - Donovan,B
AU - Fairley,C
AU - Flagg,E
AU - Gargano,J
AU - Garland,S
AU - Grun,N
AU - Hansen,B
AU - Harrison,C
AU - Herweijer,E
AU - Imburgia,T
AU - Johnson,A
AU - Kahn,J
AU - Brisson,M
DO - 10.1016/S0140-6736(19)30298-3
EP - 509
PY - 2019///
SN - 0140-6736
SP - 497
TI - Population-level impact and herd effects following the introduction of human papillomavirus vaccination programs: updated systematic review and meta-analysis
T2 - Lancet
UR -
UR -
UR -
VL - 394
ER -