Human Papillomavirus Vaccine Effectiveness Against Incident Genital Warts among Female Health-Plan Enrollees, United States

Susan Hariri, Megan S. Schuler, Allison L. Naleway, Matthew F. Daley, Sheila Weinmann, Bradley Crane, Sophia R. Newcomer, Dennis Tolsma, Lauri E. Markowitz

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24 Scopus citations


We examined the effectiveness of human papillomavirus vaccination by dose number and spacing against incident genital warts in a cohort of 64,517 female health-plan enrollees in the United States during 2006-2012. Eligible recipients were classified into groups by regimen: 0, 1, 2 (<6 months apart), 2 (≥6 months apart), or 3 doses. They were followed until a genital wart diagnosis, loss to follow-up, or the end of study. Propensity score weights were used to balance baseline differences across groups. To account for latent genital warts before vaccination, we applied 6- and 12-month buffer periods from last and first vaccine dose, respectively. Incidence rates and hazard ratios were calculated using Poisson regression and Cox models. The propensity score-weighted incidence rate per 100,000 person-years was 762 among unvaccinated participants. Using 6- and 12-month buffer periods, respectively, incidence rates were 641 and 257 for 1 dose, 760 and 577 for the 2-dose (<6-month interval) regimen, 313 and 194 for the 2-dose (≥6-month interval) regimen, and 199 and 162 among 3-dose vaccinees; vaccine effectiveness was 68% and 76% for the 2-dose (≥6-month interval) regimen and 77% and 80% in 3-dose vaccinees compared with unvaccinated participants. Vaccine effectiveness was not significant among vaccinees receiving 1-dose and 2-dose (<6-month interval) regimens compared with unvaccinated participants. Our findings contribute to a better understanding of the real-world effectiveness of HPV vaccination.

Original languageEnglish
Pages (from-to)298-305
Number of pages8
JournalAmerican Journal of Epidemiology
Issue number2
StatePublished - Feb 1 2018


Author affiliations: Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia (Susan Hariri, Lauri E. Markowitz); Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts (Megan S. Schuler); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Allison L. Naleway, Sheila Weinmann, Bradley Crane); Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado (Matthew F. Daley, Sophia R. Newcomer); Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado (Matthew F. Daley); and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, Georgia (Dennis Tolsma). This work was funded by the Centers for Disease Control and Prevention. We thank Dr. Sean Schafer for his facilitation and conceptualization of the study and Dr. Kristina Lewis, Laura Schild, Michelle Panneton, Jo Ann Shoup, Kris Wain, and Kate Burniece for their contribution to data acquisition and management. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Conflicts of interest: A.L.N. has received funding from GlaxoSmithKline, Pfizer, MedImmune, and Merck & Co. for unrelated research studies. The other authors report no conflicts.

FundersFunder number
Centers for Disease Control and Prevention


    • genital warts
    • human papillomavirus vaccine
    • vaccine effectiveness


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