With partial natural
immunity to type-specific infection, if a vaccinated girl loses
vaccine-induced protection and becomes susceptible at a later
age when the risk of cancer may be higher, an increased risk
of cervical cancer is plausible. There are no empirical data
to show whether reinfection or reactivation of a previous infection
predominates in older women; as previously described,
17 which
one of these predominates will influence the implications of
waning vaccine protection. There are other important uncertainties.
Although HPV infections may be independent from one another,
56 our exploratory analysis showed that replacement of the vaccine-targeted
types of HPV with other high-risk types could be influential.
Vaccination against HPV may also alter sexual behavior in the
population or lead to a misperception that screening is no longer
necessary. These uncertainties highlight the priorities for
surveillance of epidemiologic characteristics and behaviors
after vaccination against HPV.
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