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    David Nardo, PharmD | University of Kentucky
    While I am by no means an expert in vaccine immunology, I find that this article, suggesting that a single vaccination toward HPV results in similar disease prevalence as the recommended three vaccination series, is lacking in crucial details. The authors did not report power calculations, which are generally important in epidemiological studies, especially in diseases with low incidence. They also do not report the amount of time between the patient's vaccinations and infection. Antibody titers tend to wane over time and the time from vaccination in these patients could have contributed to the results observed in the study. Such a decline in antibody titers was observed for HPV18 in at study from 2017 comparing 2 vs. 3 vaccinations at 4.5 years from immunizations (J Infect Dis. 2017 Feb 1;215(3):359-367.) Overall, I think the suggestion that a single vaccine could result in optimal outcomes is irresponsible without clear clinical studies to substantiate the claim and could result in inappropriate vaccination practices in the uneducated public.
    CONFLICT OF INTEREST: None Reported
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    Research Letter
    Infectious Diseases
    December 27, 2019

    Prevalence of Human Papillomavirus Infection by Number of Vaccine Doses Among US Women

    Author Affiliations
    • 1Center for Healthcare Data, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, Texas
    • 2Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, Texas
    • 3Center for AIDS Intervention Research, Clinical Cancer Center, Medical College of Wisconsin, Milwaukee
    • 4Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston
    • 5Department and Biostatistics and Data Science, UTHealth School of Public Health, Houston, Texas
    JAMA Netw Open. 2019;2(12):e1918571. doi:10.1001/jamanetworkopen.2019.18571

    More than a decade after the introduction of the human papillomavirus (HPV) vaccine in the United States, only 51.1% of adolescents have completed the vaccine series, while a greater number (68.1%) received at least 1 dose.1 The suboptimal series completion rate in the United States is partly attributable to the barriers, including unawareness of or forgetting the need for additional doses, lack of insurance coverage or health care professional recommendations, and less frequent contact with the medical system.2,3 To simplify the recommendations, trials are evaluating the efficacy of a single-dose regimen.4 In this study, we investigated HPV infection prevalence among women by number of vaccine doses received.

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