Marta Checchi

Background: In England, a national school-based human papillomavirus (HPV) vaccination programme was introduced in September 2008. Routine vaccination against HPV16/18 is offered to girls aged 12-13 and a ‘catch-up’ offer ran for girls aged 14-18 during the programme’s first two years. Methods: Data from 19,407 women aged 25-29yrs attending cervical screening across England 2016-2025 were collected and residual samples from 4,837 high-risk (HR) HPV-screening-positive women were genotyped to monitor type-specific HR-HPV prevalence and evaluate vaccination impact. Results: Type-specific HR-HPV results were available for 3,683 HR-HPV-screen-positive samples. Estimated age-adjusted prevalence of HPV16 and HPV18 was 91% (95% confidence interval [CI]: 87-94%) and 84% (95%CI: 65-93%) lower respectively among routine-eligible women than vaccination-ineligible women. Large declines were also observed for HPV31 (85% [95%CI: 72-92%]) and HPV45 (84% [95%CI: 73-90%]) but not for other HR-HPV types. Among 618 women with cytological abnormalities, HPV16/18 was present in samples from 53.9% (95%CI: 34.8-73.1%) of vaccination-ineligible, 18.1% (95%CI: 13.5-22.7%) of catch-up-eligible, and 6.5% (95%CI: 3.6-9.3%) of routine-eligible women. Conclusions: The early years of the HPV vaccination programme in England conferred strong protection against HPV16, 18, 31 and 45, and dramatically changed the target remaining for screening strategies to detect and reduce cervical disease.

Background: A national human papillomavirus (HPV) vaccination programme for gay, bisexual, and other men who have sex with men (GBMSM) in England began in 2016. We evaluated the impact of this programme by monitoring the prevalence of type-specific HPV infections over time. Methods: Residual rectal swab specimens were collected from GBMSM aged ≤45 years undergoing chlamydia and/or gonorrhoea screening at 10 SHS between 2017-19 (Phase 1) and 2021-24 (Phase 2). Specimens were linked to data on sociodemographic characteristics, previous STI diagnoses, and HPV vaccination reported to UKHSA’s national STI surveillance system. Anonymised specimens were tested for type-specific HPV DNA using an in-house multiplex PCR and Luminex-based genotyping test. We compared the prevalence of vaccine-type HPV in each phase, and in those with and without any reported HPV vaccinations. Results: Data from 5,787 rectal swab specimens with HPV testing results were analysed: 3,291 in Phase 1 and 2,496 in Phase 2. There was a 36% decline in the prevalence of anal HPV16/18 infection between Phase 1 and Phase 2. Overall, the prevalence of HPV16/18 was similar in GBMSM with (16.6%; 95% CI 15.2-18.1) and without reported HPV vaccination (15.8%; 95% CI 14.5-17.1). Conclusion: Eight years after HPV vaccination of GBMSM began, the prevalence of vaccine-type HPV in GBMSM has declined. Vaccine effectiveness estimates were uncertain, likely due to the combined effects of underreporting of vaccinations, herd protection, and bias in vaccination uptake. These findings, albeit ecological, bode well for this targeted programme meeting its aim of reducing HPV-related diseases amongst GBMSM and reducing health inequalities.

Chlamydia trachomatis (Ct) is a sexually transmitted infection (STI) linked to ectopic pregnancy, infertility, invasive lymphogranuloma venereum (LGV), and the blinding disease trachoma. STI, LGV, and trachoma are associated with disease-specific Ct genovars. Serology is an important surveillance tool for estimating exposure, but the impact of genome variation on the antigenicity of Ct proteins is unclear. Two-dimensional antigenicity profiling of Pgp3 antigens representing LGV, STI, and trachoma demonstrated differential antigenicity using antigen-specific murine sera, but geometric distances were not considered significant (≤2-fold) for human infection sera. Pgp3 should be considered a single serotype for the purposes of Ct serosurveillance.

Background/Objectives: In England, gay, bisexual, and other men who have sex with men (GBMSM) are eligible for vaccination at NHS sexual health services, including human papillomavirus (HPV), hepatitis A virus (HAV), and hepatitis B virus (HBV) vaccines. However, current research shows limited understanding of the factors influencing vaccination uptake among GBMSM. This study aimed to examine the barriers and facilitators affecting the offer and uptake of these vaccination programmes. Methods: A qualitative interview study following the Person-Based Approach (a systematic method for developing and optimising health interventions) involving GBMSM and sexual health service staff from two regions of England. Purposive sampling aimed to include GBMSM with diverse backgrounds and engagement with sexual health services. Patient and public involvement shaped the study design and interview topic guides. The interviews were recorded, transcribed, and thematically analysed to identify barriers and facilitators which were interpreted using the COM-B model of behaviour change. Results: Twenty GBMSM and eleven staff took part. The findings showed that opportunistic delivery of HPV, HAV, and HBV vaccination within sexual health services is mostly acceptable and feasible for GBMSM and staff, while also highlighting areas for optimization. Despite low knowledge of these viruses and their associated risks, willingness to be vaccinated was high, with healthcare provider recommendations and the convenience of vaccine delivery during routine clinic visits acting as important facilitators. However, the reach of opportunistic models was limited, particularly for individuals underserved by sexual health services or disengaged from GBMSM social networks. System-level barriers such as complex vaccine schedules (particularly when multiple schedules are combined), inconsistent access to vaccination histories, and limited system-level follow-up processes (e.g., automated invites and reminders) were also found to act as obstacles to vaccination uptake and delivery. Conclusions: To improve equitable uptake, sexual health services should explore the feasibility of addressing both individual and structural barriers through additional strategies, including targeted and persuasive communication to increase knowledge, leveraging regular contact with GBMSM to promote uptake, and implementing enhanced approaches to support vaccination completion (e.g., automated prompts or reminders).

HPV groupings. HPV genotypes used in different analysis groups and assay characteristics.

Characteristics of women in Natsal-2 and Natsal-3. Descriptive table including sociodemographic and behavioural characteristics of women aged 18 to 44 years in Natsal-2 (n = 1849) and Natsal-3 (n = 2407) surveys.

Characteristics associated with non-vaccine HPV infection among women in Natsal-2 and Natsal-3. Associations analysis showing age-adjusted odds ratios (aOR) between characteristics and non-vaccine-preventable HPV infection separately for Natsal-2 (n = 1849) and Natsal-3 (n = 2407), and differences in trends between the two surveys, as measured by a p-value

Prevalence of NVP-HPV (26/53/66/70/73) and HPV 16/18 by age group, 2008 to 2020. Graph demonstrates prevalence of NVP-HPV and HPV 16/18 between 2008 and 2020 by age grouping among 24,707 16 to 24 year old women included in UKHSA HPV surveillance.

Prevalence of NVP-HPV (26/53/66/70/73) and HPV 16/18 by birth cohort, 2008 to 2020. Graph demonstrates prevalence of NVP-HPV and HPV 16/18 by birth cohort among 24,707 16 to 24 year old women included in UKHSA HPV surveillance.

Associations between sexual behaviours and HPV groupings in Natsal-2 and Natsal-3. Sensitivity analysis showing age- and survey-adjusted odds ratios (aOR) between sexual behaviours and different non-vaccine HPV infection groupings among women aged 18 to 44 in Natsal-2 and Natsal-3 (n = 4256)