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Open AccessArticle

Defining Elimination of Genital Warts—A Modified Delphi Study

1
The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia
2
Centre for Women’s Infectious Diseases, the Royal Women’s Hospital, Parkville, VIC 3052, Australia
3
School of Population and Global Health, University of Melbourne, Parkville, VIC 3053, Australia
4
Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW 2000, Australia
*
Author to whom correspondence should be addressed.
Co-last authorship.
Vaccines 2020, 8(2), 316; https://doi.org/10.3390/vaccines8020316
Received: 27 May 2020 / Revised: 12 June 2020 / Accepted: 16 June 2020 / Published: 18 June 2020
Background: Substantial declines in genital warts (GW) have been observed in countries with quadrivalent HPV vaccination programmes, with Australia showing the highest reductions due to early commencement and high vaccination coverage. There is a real potential to achieve GW elimination; however, no GW elimination definition exists. Taking Australia as a case study, we aimed to reach expert consensus on a proposed GW elimination definition using a modified Delphi process. Method: We used modelling and epidemiological data to estimate the expected number of new GW cases, from pre-vaccination (baseline) in 2006 to the year 2060 in Australian heterosexuals, men who have sex with men (MSM), and newly arrived international travellers and migrants. We used these data and the literature, to develop a questionnaire containing ten elimination-related items, each with 9-point Likert scales (1—strongly disagree; 9—strongly agree). The survey was completed by 18 experts who participated in a full day face-to-face modified Delphi study, in which individuals and then small groups discussed and scored each item. The process was repeated online for items where consensus (≥70% agreement) was not initially achieved. Median and coefficient of variation (COV) were used to describe the central tendency and variability of responses, respectively. Findings: There was a 95% participation rate in the face-to-face session, and 84% response rate in the final online round. The median item score ranged between 7.0 and 9.0 and the COV was ≤0.30 on all items. Consensus was reached that at ≥80% HPV vaccination coverage, GW will be eliminated as a public health problem in Australia by 2060. During this time period there will be a 95% reduction in population-level incidence compared with baseline, equivalent to <1 GW case per 10,000 population. The reductions will occur most rapidly in Australian heterosexuals, with 73%, 90% and 97% relative reductions by years 2021, 2030 and 2060, respectively. The proportion of new GW cases attributable to importation will increase from 3.6% in 2006 to ~49% in 2060. Interpretation: Our results indicate that the vaccination programme will minimise new GW cases in the Australian population, but importation of cases will continue. This is the first study to define GW elimination at a national level. The framework developed could be used to define GW elimination in other countries, with thresholds particularly valuable for vaccination programme impact evaluation. Funding: LK supported through an Australian Government Research Training Programme Scholarship; unconditional funding from Seqirus to support the Delphi Workshop. View Full-Text
Keywords: human papillomavirus HPV; quadrivalent HPV vaccine; nonavalent HPV vaccine; 9-valent vaccine; genital warts; elimination; Australia’s HPV vaccination programme; elimination target; elimination as a public health problem; Delphi study human papillomavirus HPV; quadrivalent HPV vaccine; nonavalent HPV vaccine; 9-valent vaccine; genital warts; elimination; Australia’s HPV vaccination programme; elimination target; elimination as a public health problem; Delphi study
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Khawar, L.; Machalek, D.A.; Regan, D.G.; Donovan, B.; McGregor, S.; Guy, R.J. Defining Elimination of Genital Warts—A Modified Delphi Study. Vaccines 2020, 8, 316.

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