Efficacy of human papillomavirus 16 and 18 (HPV-16/18) AS04-adjuvanted vaccine against cervical infection and precancer in young women: Final event-driven analysis of the randomized, double-blind PATRICIA trial

Clinical and Vaccine Immunology

Volumn 22, Issue 4, 2015, Pages 361-373

  Apter, Dan ^a   Wheeler, Cosette M ^b   Paavonen, Jorma ^c   Castellsagué, Xavier ^d   Garland, Suzanne M ^e   Skinner, S Rachel ^f,g   Naud, Paulo ^h   Salmerón, Jorge ⁱ   Chow, Song Nan ^j   Kitchener, Henry C ^k   Teixeira, Julio C ^l   Jaisamrarn, Unnop ^m   Limson, Genara ⁿ   Szarewski, Anne ^o   Romanowski, Barbara ^p   Aoki, Fred Y ^q   Schwarz, Tino F ^r   Poppe, Willy A J ^s   Bosch, F Xavier ^d   Mindel, Adrian ^t   De Sutter, Philippe ^u   Hardt, Karin ^v   Zahaf, Toufik ^v   Descamps, Dominique ^v   Struyf, Frank ^v   Lehtinen, Matti ^w   Dubin, Gary ^x   more..

^a Vaestoliitto   (Finland)

^b UNIVERSITY OF NEW MEXICO HEALTH SCIENCES CENTER   (United States)

^c UNIVERSITY OF HELSINKI   (Finland)

^d HOSPITAL UNIVERSITARI DE BELLVITGE   (Spain)

^e UNIVERSITY OF MELBOURNE   (Australia)

^f UNIVERSITY OF WESTERN AUSTRALIA   (Australia)

^g UNIVERSITY OF SYDNEY   (Australia)

^h HOSPITAL DE CLÍNICAS DE PORTO ALEGRE   (Brazil)

ⁱ INSTITUTO MEXICANO DEL SEGURO SOCIAL   (Mexico)

^j NATIONAL TAIWAN UNIVERSITY   (Taiwan)

^k UNIVERSITY OF MANCHESTER   (United Kingdom)

^l UNIVERSITY OF CAMPINAS   (Brazil)

^m CHULALONGKORN UNIVERSITY   (Thailand)

ⁿ UNIVERSITY OF THE PHILIPPINES MANILA   (Philippines)

^o QUEEN MARY UNIVERSITY OF LONDON   (United Kingdom)

^p UNIVERSITY OF ALBERTA   (Canada)

^q UNIVERSITY OF MANITOBA   (Canada)

^r UNIVERSITY HOSPITAL WÜRZBURG   (Germany)

^s UNIVERSITY HOSPITALS LEUVEN   (Belgium)

^t UNIVERSITY OF KWAZULU NATAL   (South Africa)

^u UNIVERSITY HOSPITAL BRUSSELS   (Belgium)

^v GSK   (Belgium)

^w UNIVERSITY OF TAMPERE   (Finland)

^x GLAXOSMITHKLINE   (United States)

more..

Author keywords

[No Author keywords available]

Indexed keywords

VIRUS DNA; WART VIRUS VACCINE; ALUMINUM HYDROXIDE; ASO4 MIXTURE; IMMUNOLOGICAL ADJUVANT; LIPID A; VIRUS ANTIBODY;

ADOLESCENT; ADOLESCENT HEALTH; ADULT; ANTIBODY TITER; ARTICLE; CANCER GRADING; CANCER INCIDENCE; COHORT ANALYSIS; CONTROLLED STUDY; DISEASE ASSOCIATION; DRUG EFFICACY; FEMALE; FOLLOW UP; HIGH RISK POPULATION; HUMAN; HUMAN PAPILLOMAVIRUS TYPE 16; HUMAN PAPILLOMAVIRUS TYPE 18; HUMAN PAPILLOMAVIRUS TYPE 31; HUMAN PAPILLOMAVIRUS TYPE 33; HUMAN PAPILLOMAVIRUS TYPE 45; IMMUNOGENICITY; INFECTION RISK; NORMAL HUMAN; PAPILLOMAVIRUS INFECTION; PRIORITY JOURNAL; RANDOMIZED CONTROLLED TRIAL (TOPIC); RECURRENT INFECTION; UTERINE CERVICITIS; UTERINE CERVIX CARCINOMA IN SITU; VACCINATION; ANALOGS AND DERIVATIVES; ANIMAL; BLOOD; COMPLICATION; DOUBLE BLIND PROCEDURE; IMMUNOLOGY; ISOLATION AND PURIFICATION; PAPILLOMAVIRUS INFECTIONS; PATHOLOGY; PRECANCEROUS CONDITIONS; RANDOMIZED CONTROLLED TRIAL; TREATMENT OUTCOME; UTERINE CERVICAL NEOPLASMS; VIROLOGY; YOUNG ADULT;

ADJUVANTS, IMMUNOLOGIC; ADOLESCENT; ADULT; ALUMINUM HYDROXIDE; ANIMALS; ANTIBODIES, VIRAL; DNA, VIRAL; DOUBLE-BLIND METHOD; FEMALE; HUMAN PAPILLOMAVIRUS 16; HUMAN PAPILLOMAVIRUS 18; HUMANS; LIPID A; PAPILLOMAVIRUS INFECTIONS; PAPILLOMAVIRUS VACCINES; PRECANCEROUS CONDITIONS; TREATMENT OUTCOME; UTERINE CERVICAL NEOPLASMS; YOUNG ADULT;

EID: 84925408172     PISSN: 15566811     EISSN: 1556679X     Source Type: Journal    
DOI: 10.1128/CVI.00591-14     Document Type: Article

References (44)

1. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. 2012. GLOBOCAN v1.0, cancer incidence and mortality worldwide: IARC CancerBase no. 11. International Agency for Research on Cancer, Lyon, France. http://globocan.iarc.fr. Accessed 1 September 2014.
2. Bosch FX, Lorincz A, Muñoz N, Meijer CJ, Shah KV. 2002. The causal relation between human papillomavirus and cervical cancer. J Clin Pathol 55:244-265. http://dx.doi.org/10.1136/jcp.55.4.244.
3. de Sanjosé S, Quint WG, Alemany L, Geraets DT, Klaustermeier JE, Lloveras B, Tous S, Felix A, Bravo LE, Shin HR, Vallejos CS, de Ruiz PA, Lima MA, Guimera N, Clavero O, Alejo M, Llombart-Bosch A, Cheng-Yang C, Tatti SA, Kasamatsu E, Iljazovic E, Odida M, Prado R, Seoud M, Grce M, Usubutun A, Jain A, Suarez GA, Lombardi LE, Banjo A, Menendez C, Domingo EJ, Velasco J, Nessa A, Chichareon SC, Qiao YL, Lerma E, Garland SM, Sasagawa T, Ferrera A, Hammouda D, Mariani L, Pelayo A, Steiner I, Oliva E, Meijer CJ, Al-Jassar WF, Cruz E, Wright TC, Puras A, Llave CL, Tzardi M, Agorastos T, Garcia-Barriola V, Clavel C, Ordi J, Andujar M, Castellsague X, Sanchez GI, Nowakowski AM, Bornstein J, Munoz N, Bosch FX, Retrospective International Survey and HPV Time Trends Study Group. 2010. Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study. Lancet Oncol 11:1048-1056. http://dx.doi.org/10.1016/S1470-2045(10)70230-8.
4. Descamps D, Hardt K, Spiessens B, Izurieta P, Verstraeten T, Breuer T, Dubin G. 2009. Safety of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine for cervical cancer prevention: a pooled analysis of 11 clinical trials. Hum Vaccin 5:332-340. http://dx.doi.org/10.4161/hv.5.5.7211.
5. Verstraeten T, Descamps D, David MP, Zahaf T, Hardt K, Izurieta P, Dubin G, Breuer T. 2008. Analysis of adverse events of potential autoimmune aetiology in a large integrated safety database of AS04 adjuvanted vaccines. Vaccine 26:6630-6638. http://dx.doi.org/10.1016/j.vaccine.2008.09.049.
6. Pedersen C, Petaja T, Strauss G, Rumke HC, Poder A, Richardus JH, Spiessens B, Descamps D, Hardt K, Lehtinen M, Dubin G, HPV Vaccine Adolescent Study Investigators Network. 2007. Immunization of early adolescent females with human papillomavirus type 16 and 18 L1 virus-like particle vaccine containing AS04 adjuvant. J Adolesc Health 40:564-571. http://dx.doi.org/10.1016/j.jadohealth.2007.02.015.
7. Paavonen J, Jenkins D, Bosch FX, Naud P, Salmeron J, Wheeler CM, Chow SN, Apter DL, Kitchener HC, Castellsagué X, De Carvalho NS, Skinner SR, Harper DM, Hedrick JA, Jaisamrarn U, Limson GA, Dionne M, Quint W, Spiessens B, Peeters P, Struyf F, Wieting SL, Lehtinen MO, Dubin G, HPV PATRICIA Study Group. 2007. Efficacy of a prophylactic adjuvanted bivalent L1 virus-like-particle vaccine against infection with human papillomavirus types 16 and 18 in young women: an interim analysis of a phase III double-blind, randomised controlled trial. Lancet 369:2161-2170. http://dx.doi.org/10.1016/S0140-6736(07)60946-5.
8. Paavonen J, Naud P, Salmerón J, Wheeler CM, Chow SN, Apter D, Kitchener H, Castellsague X, Teixeira JC, Skinner SR, Hedrick J, Jaisamrarn U, Limson G, Garland S, Szarewski A, Romanowski B, Aoki FY, Schwarz TF, Poppe WA, Bosch FX, Jenkins D, Hardt K, Zahaf T, Descamps D, Struyf F, Lehtinen M, Dubin G, HPV PATRICIA Study Group. 2009. Efficacy of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA): final analysis of a double-blind, randomised study in young women. Lancet 374:301-314. http://dx.doi.org/10.1016/S0140-6736(09)61248-4.
9. Harper DM, Franco EL, Wheeler C, Ferris DG, Jenkins D, Schuind A, Zahaf T, Innis B, Naud P, De Carvalho NS, Roteli-Martins CM, Teixeira J, Blatter MM, Korn AP, Quint W, Dubin G, HPV Glaxo-SmithKline Vaccine Study Group. 2004. Efficacy of a bivalent L1 virus-like particle vaccine in prevention of infection with human papillomavirus types 16 and 18 in young women: a randomised controlled trial. Lancet 364:1757-1765. http://dx.doi.org/10.1016/S0140-6736(04)17398-4.
10. Harper DM, Franco EL, Wheeler CM, Moscicki AB, Romanowski B, Roteli-Martins CM, Jenkins D, Schuind A, Costa Clemens SA, Dubin G, HPV Vaccine Study Group. 2006. Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised control trial. Lancet 367:1247-1255. http://dx.doi.org/10.1016/S0140-6736(06)68439-0.
11. GlaxoSmithKline Vaccine HPV-007 Study Group. 2009. Sustained efficacy and immunogenicity of the human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine: analysis of a randomised placebo-controlled trial up to 6.4 years. Lancet 374:1975-1985. http://dx.doi.org/10.1016/S0140-6736(09)61567-1.
12. Lehtinen M, Paavonen J, Wheeler CM, Jaisamrarn U, Garland SM, Castellsagué X, Skinner SR, Apter D, Naud P, Salmerón J, Chow SN, Kitchener H, Teixeira JC, Hedrick J, Limson G, Szarewski A, Romanowski B, Aoki FY, Schwarz TF, Poppe WA, De Carvalho NS, Germar MJ, Peters K, Mindel A, De Sutter P, Bosch FX, David MP, Descamps D, Struyf F, Dubin G, HPV PATRICIA Study Group. 2012. Overall efficacy of HPV-16/18 AS04-adjuvanted vaccine against grade 3 or greater cervical intraepithelial neoplasia: 4-year end-of-study analysis of the randomised, double-blind PATRICIA trial. Lancet Oncol 13:89-99. http://dx.doi.org/10.1016/S1470-2045(11)70286-8.
13. Wheeler CM, Castellsagué X, Garland SM, Szarewski A, Paavonen J, Naud P, Salmerón J, Chow SN, Apter D, Kitchener H, Teixeira JC, Skinner SR, Jaisamrarn U, Limson G, Romanowski B, Aoki FY, Schwarz TF, Poppe WA, Bosch FX, Harper DM, Huh W, Hardt K, Zahaf T, Descamps D, Struyf F, Dubin G, Lehtinen M, HPV PATRICIA Study Group. 2012. Cross-protective efficacy of HPV-16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by non-vaccine oncogenic HPV types: 4-year end-of-study analysis of the randomised, double-blind PATRICIA trial. Lancet Oncol 13:100-110. http://dx.doi.org/10.1016/S1470-2045(11)70287-X.
14. Brown DR, Shew ML, Qadadri B, Neptune N, Vargas M, Tu W, Juliar BE, Breen TE, Fortenberry JD. 2005. A longitudinal study of genital human papillomavirus infection in a cohort of closely followed adolescent women. J Infect Dis 191:182-192. http://dx.doi.org/10.1086/426867.
15. Moscicki AB. 2007. HPV infections in adolescents. Dis Markers 23:229-234. http://dx.doi.org/10.1155/2007/136906.
16. Koulova A, Tsui J, Irwin K, Van DP, Biellik R, Aguado MT. 2008. Country recommendations on the inclusion of HPV vaccines in national immunization programmes among high-income countries, June 2006-January 2008. Vaccine 26:6529-6541. http://dx.doi.org/10.1016/j.vaccine.2008.08.067.
17. Agosti JM, Goldie SJ. 2007. Introducing HPV vaccine in developing countries - key challenges and issues. N Engl J Med 356:1908-1910. http://dx.doi.org/10.1056/NEJMp078053.
18. Wright TC, Jr, Huh WK, Monk BJ, Smith JS, Ault K, Herzog TJ. 2008. Age considerations when vaccinating against HPV. Gynecol Oncol 109(Suppl 2):S40-S47. http://dx.doi.org/10.1016/j.ygyno.2008.02.002.
19. Garland SM. 2014. The Australian experience with the human papillomavirus vaccine. Clin Ther 36:17-23. http://dx.doi.org/10.1016/j.clinthera.2013.12.005.
20. Lehtinen M, Apter D, Dubin G, Kosunen E, Isaksson R, Korpivaara EL, Kyhä-Osterlund L, Lunnas T, Luostarinen T, Niemi L, Palmroth J, Petäjä T, Rekonen S, Salmivesi S, Siitari-Mattila M, Svartsjö S, Tuomivaara L, Vilkki M, Pukkala E, Paavonen J. 2006. Enrolment of 22,000 adolescent women to cancer registry follow-up for long-term human papillomavirus vaccine efficacy: guarding against guessing. Int J STD AIDS 17:517-521. http://dx.doi.org/10.1258/095646206778145550.
21. van Doorn LJ, Molijn A, Kleter B, Quint W, Colau B. 2006. Highly effective detection of human papillomavirus 16 and 18 DNA by a testing algorithm combining broad-spectrum and type-specific PCR. J Clin Microbiol 44:3292-3298. http://dx.doi.org/10.1128/JCM.00539-06.
22. Dessy FJ, Giannini SL, Bougelet CA, Kemp TJ, David MP, Poncelet SM, Pinto LA, Wettendorff MA. 2008. Correlation between direct ELISA, single epitope-based inhibition ELISA and pseudovirion-based neutralization assay for measuring anti-HPV-16 and anti-HPV-18 antibody response after vaccination with the AS04-adjuvanted HPV-16/18 cervical cancer vaccine. Hum Vaccin 4:425-434. http://dx.doi.org/10.4161/hv.4.6.6912.
23. American Society for Colposcopy and Cervical Pathology. 2014. Guidelines and resources. http://www.igcs.org/professionalEducation/treatment Resources/ASCCP/ASCCPGuidelines.html. Accessed 19 August 2014.
24. Muñoz N, Kjaer SK, Sigurdsson K, Iversen OE, Hernandez-Avila M, Wheeler CM, Perez G, Brown DR, Koutsky LA, Tay EH, Garcia PJ, Ault KA, Garland SM, Leodolter S, Olsson SE, Tang GW, Ferris DG, Paavonen J, Steben M, Bosch FX, Dillner J, Huh WK, Joura EA, Kurman RJ, Majewski S, Myers ER, Villa LL, Taddeo FJ, Roberts C, Tadesse A, Bryan JT, Lupinacci LC, Giacoletti KE, Sings HL, James MK, Hesley TM, Barr E, Haupt RM. 2010. Impact of human papillomavirus (HPV)-6/11/16/18 vaccine on all HPV-associated genital diseases in young women. J Natl Cancer Inst 102:325-339. http://dx.doi.org/10.1093/jnci/djp534.
25. Dillner J, Kjaer S, Wheeler C, Sigurdsson K, Iversen O, Hernandez-Avila M, Perez G, Brown D, Koutsky LA, Tay EH, García P, Ault KA, Garland S, Leodolter S, Olsson S, Tang G, Ferris D, Paavonen J, Lehtinen M, Steben M, Bosch X, Joura EA, Kurman R, Majewski S, Muñoz N, Myers E, Villa L, Taddeo FJ, Roberts C, Tadesse A, Bryan J, Maanson R, Lu S, Vuocolo S, Hesley T, Barr E, Haupt R. 2010. Four year efficacy of prophylactic human papillomavirus (types 6/11/16/18) L1 virus-like particle vaccine against low-grade cervical, vulvar, and vaginal intraepithelial neoplasia and condylomata accuminata. BMJ 341:c3493. http://dx.doi.org/10.1136/bmj.c3493.
26. Garland SM, Hernandez-Avila M, Wheeler CM, Perez G, Harper DM, Leodolter S, Tang GW, Ferris DG, Steben M, Bryan J, Taddeo FJ, Railkar R, Esser MT, Sings HL, Nelson M, Boslego J, Sattler C, Barr E, Koutsky LA, Females United to Unilaterally Reduce Endo/Ectocervical Disease (FUTURE) I Investigators. 2007. Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. N Engl J Med 356:1928-1943. http://dx.doi.org/10.1056/NEJMoa061760.
27. FUTURE II Study Group. 2007. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med 356:1915-1927. http://dx.doi.org/10.1056/NEJMoa061741.
28. Ault KA, Future II Study Group. 2007. Effect of prophylactic human papillomavirus L1 virus-like-particle vaccine on risk of cervical intraepithelial neoplasia grade 2, grade 3, and adenocarcinoma in situ: a combined analysis of four randomised clinical trials. Lancet 369:1861-1868. http://dx.doi.org/10.1016/S0140-6736(07)60852-6.
29. Hildesheim A, Herrero R, Wacholder S, Rodriguez AC, Solomon D, Bratti MC, Schiller JT, Gonzalez P, Dubin G, Porras C, Jimenez SE, Lowy DR, HPV Costa Rican Vaccine Trial Group. 2007. Effect of human papillomavirus 16/18 L1 viruslike particle vaccine among women with preexisting infection: a randomized trial. JAMA 298:743-753. http://dx.doi.org/10.1001/jama.298.7.743.
30. Kitchener HC, Almonte M, Wheeler P, Desai M, Gilham C, Bailey A, Sargent A, Peto J, ARTISTIC Trial Study Group. 2006. HPV testing in routine cervical screening: cross sectional data from the ARTISTIC trial. Br J Cancer 95:56-61. http://dx.doi.org/10.1038/sj.bjc.6603210.
31. Briolat J, Dalstein V, Saunier M, Joseph K, Caudroy S, Prétet JL, Birembaut P, Clavel C. 2007. HPV prevalence, viral load and physical state of HPV-16 in cervical smears of patients with different grades of CIN. Int J Cancer 121:2198-2204. http://dx.doi.org/10.1002/ijc.22959.
32. Kjaer SK, Breugelmans G, Munk C, Junge J, Watson M, Iftner T. 2008. Population-based prevalence, type- and age-specific distribution of HPV in women before introduction of an HPV-vaccination program in Denmark. Int J Cancer 123:1864-1870. http://dx.doi.org/10.1002/ijc.23712.
33. Szarewski A, Skinner R, Garland S, Romanowski B, Schwarz T, Apter D, Chow S-N, Paavonen J, Rosario-Raymundo M, Teixeira J, De Carvalho N, Castro-Sanchez M, Castellsagué X, Poppe W, De Sutter P, Huh W, Chatterjee A, Tjalma J, Ackerman R, Martens M, Papp K, Bajo-Arenas J, Harper D, Torné A, David M-P, Struyf F, Lehtinen M, Dubin G. 2013. Efficacy of the HPV-16/18 AS04-adjuvanted vaccine against low risk HPV types (PATRICIA randomised trial): an unexpected observation. J Infect Dis 208:1391-1396. http://dx.doi.org/10.1093/infdis/jit360.
34. Lehtinen M, Dillner J. 2013. Clinical HPV vaccine trials and beyond. Nature Rev Clin Oncol 10:400-410. http://dx.doi.org/10.1038/nrclinonc.2013.84.
35. French KM, Barnabas RV, Lehtinen M, Kontula O, Pukkala E, Dillner J, Garnett GP. 2007. Strategies for the introduction of human papillomavirus vaccination: modelling the optimum age- and sex-specific pattern of vaccination in Finland. Br J Cancer 96:514-518. http://dx.doi.org/10.1038/sj.bjc.6603575.
36. Kim JJ, Goldie SJ. 2008. Health and economic implications of HPV vaccination in the United States.N Engl J Med 359:821-832. http://dx.doi.org/10.1056/NEJMsa0707052.
37. Carter JJ, Koutsky LA, Wipf GC, Christensen ND, Lee SK, Kuypers J, Kiviat N, Galloway DA. 1996. The natural history of human papillomavirus type 16 capsid antibodies among a cohort of university women. J Infect Dis 174:927-936. http://dx.doi.org/10.1093/infdis/174.5.927.
38. Kirnbauer R, Hubbert NL, Wheeler CM, Becker TM, Lowy DR, Schiller JT. 1994. A virus-like particle enzyme-linked immunosorbent assay detects serum antibodies in a majority of women infected with human papillomavirus type 16. J Natl Cancer Inst 86:494-499. http://dx.doi.org/10.1093/jnci/86.7.494.
39. Draper E, Bissett SJ, Howell-Jones R, Waight P, Soldan K, Jit M, Andrews N, Miller E, Beddows S. 2013. A randomized, observer-blinded immunogenicity trial of Cervarix® and Gardasil® human papillomavirus vaccines in 12-15 year old girls. PLoS One 8:e61825. http://dx.doi.org/10.1371/journal.pone.0061825.
40. Kavanagh K, Pollock KG, Potts A, Love J, Cuschieri K, Cubie H, Robertson C, Donaghy M. 2014. Introduction and sustained high coverage of the HPV bivalent vaccine leads to a reduction in prevalence of HPV 16/18 and closely related HPV types. BrJ Cancer 110:2804-2811. http://dx.doi.org/10.1038/bjc.2014.198.
41. European Centre for Disease Prevention and Control. 2012. Introduction of HPV vaccines in EU countries - an update. ECDC, Stockholm, Sweden. http://dx.doi.org/10.2900/60814.
42. Stokley S, Jeyarajah J, Yankey D, Cano M, Gee J, Roark J, Curtis RC, Markowitz L, Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention. 2014. Human papillomavirus vaccination coverage among adolescents, 2007-2013, and postlicensure vaccine safety monitoring, 2006-2014 - United States. Morb Mortal Wkly Rep 63:620-624. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6329a3.htm.
43. David MP, Van Herck K, Hardt K, Tibaldi F, Dubin G, Descamps D, Van Damme P. 2009. Long-term persistence of anti-HPV-16 and -18 antibodies induced by vaccination with the AS04-adjuvanted cervical cancer vaccine: modeling of sustained antibody responses. Gynecol Oncol 115:S1-S6. http://dx.doi.org/10.1016/j.ygyno.2009.01.011.
44. Liu PH, Hu FC, Lee PI, Chow SN, Huang CW, Wang JD. 2010. Cost-effectiveness of human papillomavirus vaccination for prevention of cervical cancer in Taiwan. BMC Health Serv Res 10:11. http://dx.doi.org/10.1186/1472-6963-10-11.