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Drolet M, Bénard E et al. Lancet Infect Dis 2015; 15: 565–580

As background, 1) most high-income countries use the quadrivalent vaccine (GARDASIL® – as used in the UK from September 2012) which targets both HPV types 16 and 18 that are associated with 70-80% of cervical cancers, and HPV types 6 and 11 that are associated with 85-95% of anogenital warts; 2) the bivalent vaccine (Cervarix™) targets only HPV types 16 and 18; and 3) HPV vaccination programmes are directed at girls, but have recently included boys in the USA and Australia. In 2007, the first HPV vaccination programmes began. This systematic review and meta-analysis examined the effect of both the HPV vaccines on markers of infection. The investigators identified 20 eligible studies, representing more than 140 million person-years. When female vaccination coverage exceeded 50% only (almost 90% girl coverage in England 2013-14), the percentage differences between pre- and post-vaccination were: 1) HPV type 16 and 18 infections decreased significantly by 68% in girls, 2) anogenital warts decreased significantly by 61% in girls, and 3) significant reductions in anogenital warts in boys and in women suggesting herd effects.