High impact of quadrivalent human papillomavirus vaccine across racial/ethnic groups - National Health and Nutrition Examination Survey, 2003–2006 and 2015–2018

Sep 21, 2026

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Human papillomavirus (HPV) drives cervical cancer risk and other malignancies, with well-established racial and ethnic disparities in the United States. Using National Health and Nutrition Examination Survey data, quadrivalent HPV vaccine-type (HPV6/11/16/18) and nonvaccine-type cervicovaginal HPV prevalences were estimated for 2015–2018 and 2003–2006. Prevalence ratios were calculated among sexually experienced Non-Hispanic White, Non-Hispanic Black, and Mexican American females aged 14–24 years. Quadrivalent vaccine-type prevalence declined substantially, forecasting future reductions across groups.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Abstract

Introduction

Methods

Study data and sampling

Specimen collection and HPV genotyping

Article history and keywords

Contact and publication notes

BRIEF REPORT High impact of quadrivalent human papillomavirus vaccine across racial/ethnic groups: National Health and Nutrition Examination Survey, 2003–2006 and 2015–2018 Ruth Stefanosa,b, Rayleen M. Lewisa, Troy D. Querecc, Julia W. Garganoa, Elizabeth R. Ungerc, and Lauri E. Markowitza aDivision of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; bEpidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; cDivision of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA ABSTRACT Human papillomavirus (HPV) causes cervical as well as other cancers. Racial and ethnic disparities in cervical cancer incidence and mortality in the United States are well documented. HPV vaccination has been recommended in the United States since 2006 and is expected to prevent HPV-attributable cancersin all racial/ethnic groups. Quadrivalent HPV vaccine-type (HPV6/11/16/18) and nonvaccine-type cervicovaginal HPV prevalences were estimated from National Health and Nutrition Examination Surveys in 2015–2018 (vaccine era) and 2003–2006 (prevaccine era) data. Prevalence ratios comparing 2015–2018 to 2003–2006 were calculated among sexually experienced Non-Hispanic White (NHW), Non-Hispanic Black (NHB), and Mexican American (MA) females aged 14–24 years. Quadrivalent HPV vaccine-type prevalence declined 82%(CI: 60%–92%) among NHW, 86%(CI: 64%–95%) among NHB, and 100% among MA females, forecasting future reductions in cervical cancer across racial/ethnic groups. ARTICLE HISTORY Received 7 November 2023 Revised 10 January 2024 Accepted 18 January 2024 KEYWORDS HPV vaccine; cervical cancer; race/ethnicity; National Health and Nutrition Examination Survey; adolescents and young adult females Introduction Human papillomavirus (HPV) is the most common sexually transmitted infection; 1 high-risk types can cause cervical cancer and other anogenital and oropharyngeal cancers. Low-risk types can cause anogenital warts.2,3 Underlying historical and current societal factors in the United States have resulted in cancer health disparities by racial/ethnic group, including disparities in cervical cancer incidence and outcomes that continue to persist.4–7 In 2016–2020, the age-adjusted cervical cancer incidence and mortality rates were higher in NonHispanic Black and Hispanic females compared to NonHispanic White females.8 The Advisory Committee on Immunization Practices recommends routine HPV vaccination for females at age 11– 12 years with catch-up through age 26 years.9 Quadrivalent HPV vaccine (4vHPV) targeting HPV6/11/16/18 was licensed in 2006; 9-valent HPV vaccine (9vHPV), which targets an additional 5 types, HPV31/33/45/52/58, was licensed in 2014. Most HPV vaccine administered in the United States through 2015 was 4vHPV; since the end of 2016, only 9vHPV has been available in the United States. 10 Cervicovaginal HPV prevalence monitoring in the National Health and Nutrition Examination Survey (NHANES) has demonstrated HPV vaccine impact in the United States. In 2015–2018, 4vHPV-type prevalence among sexually experienced females aged 14–24 years was 85% lower compared to 2003–2006.11 Given the racial/ethnic group disparities in cervical cancer, ongoing monitoring is important to evaluate continued impact of HPV vaccination by race/ethnicity. This study provides estimates of vaccine impact by race/ethnicity on 4vHPV-type prevalence and evaluates changes in prevalence of HPV31/33/45/52/58 using 2015–2018 data, the mostrecent NHANES data. Methods NHANES is a nationally representative survey conducted by the National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention (CDC) . 12 NHANES uses a complex multi-stage cluster sampling survey design. Specific subgroups are o

FAQs

What data sources and time periods were used to assess HPV vaccine impact?

The study used National Health and Nutrition Examination Survey (NHANES) data comparing the prevaccine period (2003–2006) with the vaccine era (2015–2018).

Which HPV vaccine types and populations were analyzed?

Quadrivalent HPV vaccine-type (HPV6/11/16/18) and nonvaccine-type cervicovaginal HPV prevalences were estimated among sexually experienced Non-Hispanic White, Non-Hispanic Black, and Mexican American females aged 14–24 years.

How did quadrivalent HPV vaccine-type prevalence change across racial/ethnic groups?

Quadrivalent vaccine-type prevalence declined by 82% among Non-Hispanic White females, 86% among Non-Hispanic Black females, and 100% among Mexican American females, comparing 2015–2018 to 2003–2006.

Sep 21, 2026

Uploaded by Anda