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Population-level impact of HPV vaccination: a global systematic review of ecological, cross-sectional, and cohort studies.

Addisu J Zeleke·Laura Reifferscheid·Umar Yunusa·Kelina Gandhi·Megan Kennedy·Manish Sadarangani·Shannon E MacDonald
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Abstract

BACKGROUND: Human papillomavirus (HPV) causes approximately 4.5% of cancers globally, with the highest burden in low- and middle-income countries (LMICs). Since their introduction in 2006, HPV vaccination programs have led to substantial declines in HPV-related outcomes, although impact varies across settings. RESEARCH DESIGN AND METHODS: We conducted a systematic review to evaluate the population-level impact of HPV vaccination on HPV infection, cervical intraepithelial neoplasia grade 2 or higher (CIN2+), genital warts, invasive cervical cancer (ICC), and oropharyngeal cancer (OPC), and examined the influence of coverage, age at initiation, and vaccine type. The review followed PRISMA 2020. RESULTS: Of 13,549 records screened, 63 were included: 9 assessed HPV infection, 24 on CIN2+, 25 on genital warts, and 7 on ICC. Greatest reductions were observed in settings with at least 70% coverage and early vaccination prior to sexual debut, typically achieved through school-based programs. Reported declines ranged from 58-100% for HPV infection, 30-88% for CIN2+, 60-90% for genital warts, and 70-88% for ICC. CONCLUSIONS: HPV vaccination offers strong protection, especially when delivered early and at high coverage within schools. Expanding access and prioritizing underserved populations are essential to achieving global cancer prevention goals. Limitations include heterogeneity across designs, outcome definitions, and follow-up.

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HumansFemalePapillomavirus VaccinesPapillomavirus InfectionsUterine Cervical NeoplasmsHuman Papillomavirus VirusesCondylomata AcuminataUterine Cervical DysplasiaVaccinationOropharyngeal NeoplasmsCross-Sectional StudiesCohort StudiesImmunization ProgramsVaccination CoverageAge at vaccinationHPV vaccinationgenital wartsinvasive cervical canceroropharyngeal cancerpopulation-level impactvaccine coveragevaccine typeJournal ArticleSystematic Review

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Addisu J Zeleke, Laura Reifferscheid, Umar Yunusa, Kelina Gandhi, Megan Kennedy, Manish Sadarangani, Shannon E MacDonald. 2026-05-10. Population-level impact of HPV vaccination: a global systematic review of ecological, cross-sectional, and cohort studies.. https://doi.org/10.1080/14760584.2026.2667734

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Journal Article; Systematic Review resourceAge at vaccination subjectCohort Studies subjectCondylomata Acuminata subjectCross-Sectional Studies subjectFemale subjectHPV vaccination subjectHuman Papillomavirus Viruses subjectHumans subjectImmunization Programs subjectJournal Article subjectOropharyngeal Neoplasms subjectPapillomavirus Infections subjectPapillomavirus Vaccines subjectSystematic reviews studygenital warts subject

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