{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T15:24:45Z","timestamp":1789053885663,"version":"build-2803163510"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T00:00:00Z","timestamp":1738108800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","award":["2023-01809"],"award-info":[{"award-number":["2023-01809"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Swedish Research Council for Health"},{"name":"Working Life, and Welfare","award":["2023-01221"],"award-info":[{"award-number":["2023-01221"]}]},{"DOI":"10.13039\/501100002794","name":"Swedish Cancer Society","doi-asserted-by":"publisher","award":["24 3862"],"award-info":[{"award-number":["24 3862"]}],"id":[{"id":"10.13039\/501100002794","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004047","name":"Karolinska Institutet","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sweden introduced human papillomavirus (HPV) vaccination in 2006 via opportunistic, subsidized, catch-up, and school-based programs. Notably, genital warts (GW) are the first observable clinical outcome following HPV-6\/11 infection, the strains targeted by vaccination. We aim to assess the incidence of GW in Sweden and its change throughout vaccination programs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This ecological study used Swedish registers to obtain national population data and cases of GW from 2006 to 2018 in 15- to 44-year-old men and women. We used Poisson models to estimate GW incidence change after vaccination compared to a prevaccination period, stratified by age and sex, and incidence change of GW in birth cohorts eligible for vaccination compared to a prevaccination cohort. Finally, we estimated GW cases averted in each vaccinated cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The incidence of GW decreased during periods following HPV vaccination. In 2016\u20132018, over a decade after vaccination availability, incidence decreased by 89% (95% confidence interval [CI], 83%\u201393%), 73% (95% CI, 71%\u201375%), 50% (95% CI, 43%\u201356%), and 20% (95% CI, 10%\u201328%) in women aged 15\u201319, 20\u201324, 25\u201329, and 30\u201334 years, respectively. A similar reduction was observable in men, although of lower magnitude. We estimated 18 890 and 12 343 GW cases averted among vaccinated cohorts of women and men, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We report on population-level decreases of GW incidence in women and men following increased vaccination coverage. Cohorts eligible for school-based vaccination recorded the largest decrease in GW incidence in Sweden to date. For the period under study, decreases among men could be attributed to herd effects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/infdis\/jiaf052","type":"journal-article","created":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T07:26:48Z","timestamp":1738049208000},"page":"e54-e63","source":"Crossref","is-referenced-by-count":10,"title":["Population-Level Impact of Human Papillomavirus Vaccination on the Incidence of Genital Warts in Sweden"],"prefix":"10.1093","volume":"232","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-3149-4325","authenticated-orcid":false,"given":"Ana Martina","family":"Astorga Alsina","sequence":"first","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3876-7453","authenticated-orcid":false,"given":"Eva","family":"Herweijer","sequence":"additional","affiliation":[{"name":"Institute of Environmental Medicine, Karolinska Institutet , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4718-1414","authenticated-orcid":false,"given":"Jiayao","family":"Lei","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet , Stockholm ,","place":["Sweden"]},{"name":"Department of Clinical Science, Intervention, and Technology, Karolinska Institutet , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,1,29]]},"reference":[{"key":"2025073007422985600_jiaf052-B1","author":"World Health Organization"},{"key":"2025073007422985600_jiaf052-B2","doi-asserted-by":"crossref","first-page":"19119","DOI":"10.2807\/ese.14.06.19119-en","article-title":"Introduction of human papillomavirus (HPV) vaccination in Sweden","volume":"14","author":"Tegnell","year":"2009","journal-title":"Euro Surveill"},{"key":"2025073007422985600_jiaf052-B3","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1093\/jnci\/djt032","article-title":"Quadrivalent human papillomavirus vaccine effectiveness: a Swedish national cohort study","volume":"105","author":"Leval","year":"2013","journal-title":"J Natl Cancer Inst"},{"key":"2025073007422985600_jiaf052-B4","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1056\/NEJMoa1917338","article-title":"HPV vaccination and the risk of invasive cervical cancer","volume":"383","author":"Lei","year":"2020","journal-title":"N Engl J Med"},{"key":"2025073007422985600_jiaf052-B5","doi-asserted-by":"crossref","first-page":"1917","DOI":"10.1016\/j.vaccine.2018.02.097","article-title":"Substantially reduced incidence of genital warts in women and men six years after HPV vaccine availability in Sweden","volume":"36","author":"Herweijer","year":"2018","journal-title":"Vaccine"},{"key":"2025073007422985600_jiaf052-B6","author":"Folkh\u00e4lsomyndigheten"},{"key":"2025073007422985600_jiaf052-B7","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1086\/597071","article-title":"Natural history of genital warts: analysis of the placebo arm of 2 randomized phase III trials of a quadrivalent human papillomavirus (types 6, 11, 16, and 18) vaccine","volume":"199","author":"Garland","year":"2009","journal-title":"J Infect Dis"},{"key":"2025073007422985600_jiaf052-B8","author":"World Health Organization"},{"key":"2025073007422985600_jiaf052-B9","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1007\/s12325-015-0178-4","article-title":"Early direct and indirect impact of quadrivalent HPV (4HPV) vaccine on genital warts: a systematic review","volume":"32","author":"Mariani","year":"2015","journal-title":"Adv Ther"},{"key":"2025073007422985600_jiaf052-B10","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1097\/OLQ.0000000000000418","article-title":"Significant reduction in the incidence of genital warts in young men 5 years into the Danish human papillomavirus vaccination program for girls and women","volume":"43","author":"Bollerup","year":"2016","journal-title":"Sex Transm Dis"},{"key":"2025073007422985600_jiaf052-B11","doi-asserted-by":"crossref","first-page":"e0267646","DOI":"10.1371\/journal.pone.0267646","article-title":"Incidence of anogenital warts after the introduction of the quadrivalent HPV vaccine program in Manitoba, Canada","volume":"17","author":"Righolt","year":"2022","journal-title":"PLoS One"},{"key":"2025073007422985600_jiaf052-B12","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1016\/S1473-3099(21)00071-2","article-title":"Effect on genital warts in Australian female and heterosexual male individuals after introduction of the national human papillomavirus gender-neutral vaccination programme: an analysis of national sentinel surveillance data from 2004\u201318","volume":"21","author":"Chow","year":"2021","journal-title":"Lancet Infect Dis"},{"key":"2025073007422985600_jiaf052-B13","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/S0140-6736(19)30298-3","article-title":"Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis","volume":"394","author":"Drolet","year":"2019","journal-title":"Lancet"},{"key":"2025073007422985600_jiaf052-B14","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1093\/infdis\/jis405","article-title":"Incidence of genital warts in Sweden before and after quadrivalent human papillomavirus vaccine availability","volume":"206","author":"Leval","year":"2012","journal-title":"J Infect Dis"},{"key":"2025073007422985600_jiaf052-B15","author":"Folkh\u00e4lsomyndigheten"},{"key":"2025073007422985600_jiaf052-B16","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1007\/s10654-016-0117-y","article-title":"Registers of the Swedish total population and their use in medical research","volume":"31","author":"Ludvigsson","year":"2016","journal-title":"Eur J Epidemiol"},{"key":"2025073007422985600_jiaf052-B17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2458-11-450","article-title":"External review and validation of the Swedish national inpatient register","volume":"11","author":"Ludvigsson","year":"2011","journal-title":"BMC Public Health"},{"key":"2025073007422985600_jiaf052-B18","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1002\/pds.1294","article-title":"The new Swedish Prescribed Drug Register\u2014opportunities for pharmacoepidemiological research and experience from the first six months","volume":"16","author":"Wettermark","year":"2007","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"2025073007422985600_jiaf052-B19","first-page":"2060","article-title":"Observational studies and the difficult quest for causality: lessons from vaccine effectiveness and impact studies","volume":"45","author":"Lipsitch","year":"2016","journal-title":"Int J Epidemiol"},{"key":"2025073007422985600_jiaf052-B20","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1177\/1536867X1101000405","article-title":"Age-period-cohort modeling","volume":"10","author":"Rutherford","year":"2010","journal-title":"Stata J"},{"key":"2025073007422985600_jiaf052-B21","doi-asserted-by":"crossref","first-page":"3018","DOI":"10.1002\/sim.2764","article-title":"Age-period-cohort models for the lexis diagram","volume":"26","author":"Carstensen","year":"2007","journal-title":"Stat Med"},{"key":"2025073007422985600_jiaf052-B22","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1177\/1536867X221106437","article-title":"Stata tip 146: using margins after a Poisson regression model to estimate the number of events prevented by an intervention","volume":"22","author":"Falcaro","year":"2022","journal-title":"Stata J"},{"key":"2025073007422985600_jiaf052-B23","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1093\/jncimonographs\/lgae042","article-title":"A prospective cohort study comparing efficacy of 1 dose of quadrivalent human papillomavirus vaccine to 2 and 3 doses at an average follow up of 12 years postvaccination","volume":"2024","author":"Malvi","year":"2024","journal-title":"J Natl Cancer Inst"},{"key":"2025073007422985600_jiaf052-B24","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1111\/bjd.20964","article-title":"Incidence and trends of basal cell carcinoma in Sweden: a population-based registry study","volume":"186","author":"Kappelin","year":"2022","journal-title":"Br J Dermatol"},{"issue":"8 Suppl 1","key":"2025073007422985600_jiaf052-B25","first-page":"S4","article-title":"Molluscum contagiosum: epidemiology, considerations, treatment options, and therapeutic gaps","volume":"16","author":"Hebert","year":"2023","journal-title":"J Clin Aesthet Dermatol"},{"key":"2025073007422985600_jiaf052-B26","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1111\/jdv.16856","article-title":"2020 European guideline on the management of genital molluscum contagiosum","volume":"35","author":"Edwards","year":"2021","journal-title":"J Eur Acad Dermatol Venereol"}],"container-title":["The Journal of Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jid\/advance-article-pdf\/doi\/10.1093\/infdis\/jiaf052\/61685718\/jiaf052.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jid\/article-pdf\/232\/1\/e54\/61685718\/jiaf052.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jid\/article-pdf\/232\/1\/e54\/61685718\/jiaf052.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:42:38Z","timestamp":1753875758000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jid\/article\/232\/1\/e54\/7989402"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,29]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,29]]},"published-print":{"date-parts":[[2025,7,30]]}},"URL":"https:\/\/doi.org\/10.1093\/infdis\/jiaf052","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2024.09.19.24313952","asserted-by":"object"}]},"ISSN":["0022-1899","1537-6613"],"issn-type":[{"value":"0022-1899","type":"print"},{"value":"1537-6613","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,7,15]]},"published":{"date-parts":[[2025,1,29]]}}}