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Trends in genital warts diagnoses in New Zealand five years following the quadrivalent human papillomavirus vaccine introduction

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Summary:

New Zealand introduced the quadrivalent human papillomavirus (4vHPV) vaccine (Gardasil®) on 1 September 2008 followed by the school-based arm of the vaccination programme from February 2009 and an initial catch-up programme through to the end of 2010, targeting women before they turned 20 years of age. This paper reports data on genital wart diagnoses among all new clients attending the Auckland Sexual Health Service (ASHS) from 1 January 2007 to 31 December 2013. Over the study period, 43,480 new clients were seen at ASHS and genital warts were diagnosed in 5,711 (13.1%). Of the 19,894 female new clients seen, ethnicity was recorded as: NZ European 39.5%, Māori 15.1%, Pacific Peoples 13.0%, Other 32.5%. There was a general decrease across time in the diagnoses of genital warts among all ethnic groups presenting to ASHS. For females, there was evidence of a difference in the rate of change over time in the proportion of genital warts diagnoses in the vaccine-eligible cohort compared to the vaccine-ineligible cohort (p=0.004). Whereas the proportion of females diagnosed with genital warts each year was fairly stable in the vaccine-eligible cohort pre-vaccine (RR=0.98), the risk of diagnosis decreased markedly over the 5 years after the introduction of the vaccine (RR=0.77). In comparison, there was only a small decrease in proportion of genital warts diagnoses among non-eligible females (pre-vaccine RR=0.87 vs post-vaccine RR=0.95). There was no such significant difference in rate change pre- to post-vaccine between younger and older men, eligible or not (p=0.53). Notably, Māori and Pacific young women had the largest decreases in genital warts diagnoses post-vaccine introduction (93.4% each) followed by NZ European (80.2%).

Comment:
Although vaccinations continue to receive bad press by some, I find the misinformation about vaccinations developed for women’s health particularly worrisome. Rates of genital warts are higher for Māori women than non-Māori. In my experience, patients with the condition describe it as being debilitating and stigmatising, and tell me that they would have chosen the vaccine if it had been available.
Reference: N Z Med J. 2017;130(1452):9-16
Independent commentary by Dr. Matire Hardwood

Dr Matire Harwood (Ngapuhi) has worked in Hauora Māori, primary health and rehabilitation settings as clinician and researcher since graduating from Auckland Medical School in 1994. She also holds positions on a number of boards, committees and advisory groups including the Health Research Council. Matire lives in Auckland with her whānau including partner Haunui and two young children Te Rangiura and Waimarie.

Research Review publications are intended for New Zealand health professionals.

Disclaimer: This publication is not intended as a replacement for regular medical education but to assist in the process. The reviews are a summarised interpretation of the published study and reflect the opinion of the writer rather than those of the research group or scientific journal. It is suggested readers review the full trial data before forming a final conclusion on its merits.

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