המכון הלאומי לחקר שירותי הבריאות ומדיניות הבריאות (ע”ר)

The Israel National Institute For Health Policy Research

Policies for vaccination against Human Papilloma Virus in the Israeli multi-cultural population

Researchers: Anat Maoz1, Baruch Velan2, Amit Huppert3
  1. Gertner Institute for Epidemiology and Health Policy Research
Background: The human papilloma virus (HPV) infecton, the most common sexually transmitted infection, is associate with cancer types as cervical, vulvar, vaginal, anal, oropharyngeal and penile cancer. It can also cause genital warts and recurrent respiratory papillomatosis. Female vaccination against HPV is part of national vaccination programs in many countries. However, several countries including Israel, decided to include also male vaccination in their vaccination programs. The rationale is both to protect males directly and to decrease the circulating virus to increase herd immunity for the entire population.
Objectives: 1. Find a rule-based policy to decrease total (males and females) virus prevalence;
2. Analyze how different characteristics in sexual behaviors of different sub-groups in the Israeli population may influence the optimal vaccination policy.
Method: We extended the classical Susceptible, Infected and Recovered model for infectious diseases to model sexually transmitted infections among heterosexuals.
We used both methods of computational simulations and analytical mathematical solving of the dynamic system.
Findings: 1. We found the minimum vaccination coverage for virus elimination and showed that for eradication, it does not matter which gender is being vaccinated.
2. We constructed a rule-based policy for optimal decrease in virus prevalence.
3. We modeled sub-groups of the Israeli population by their assumed sexual behavior and implemented it by varying the level of virus importation from other sub-group.
We found that even low importation could switch the decision of which gender to vaccinate.
Conclusions: Pre-vaccine prevalence is a good proxy to be used for the rule-based policy system developed here. Importation plays a major role in policy decisions as well. This model shows the importance of using a simplified mathematical model and demonstrates the insights that may be gained by using such a model.
Recommendations: In sub-groups where importation is high, male vaccination should be positively considered.
Research number: A/128/2013
Research end date: 11/2017
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