Impact of catch-up human papillomavirus vaccination on cervical conization rate in a real-life population in France

Antoine Eliès; Claire Bonneau; Sophie Houzard; Roman Rouzier; Delphine Héquet

doi:10.1371/journal.pone.0264821

Peer Review History

Original SubmissionApril 7, 2021
11 Jun 2021 Decision Letter - Ivan Sabol, Editor PONE-D-21-11439 Impact of catch-up human papillomavirus vaccination on cervical conization rate in a real-life population in France PLOS ONE Dear Dr. Elies, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Beyond the minor language corrections and improvements this would be a good opportunity to expand the discussion on the indicated points as well as the limitations of the study. Please submit your revised manuscript by Jul 26 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Ivan Sabol Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. 3. Thank you for stating in the text of your manuscript "Data were extracted from the French National Health Insurance database called Echantillon Généraliste des Bénéficiaires (EGB), which is a permanent sample of the population covered by national health insurance". Please clarify whether this data was anonymized before researchers accessed it. Please also add all of this information to your ethics statement in the online submission form." 4. Thank you for including your manuscript text: "An institutional committee validates each research project." Please amend your current ethics statement to state: a) whether ethics committee approval was specifically granted for this study b) if so, include the full name of the ethics committee/institutional review board(s) that approved your specific study. 5. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. We will update your Data Availability statement on your behalf to reflect the information you provide. Additional Editor Comments (if provided): P5L100 space issue “(24) .” P6 L110 decimal comma used in table 1 P7 L141 Fig 2 flowchart is unclear. Right side box 1 requires women to be older than 25 in 2007. Next box states those are women born before 1991. However, a woman born in 1990 would be only 17 in 2007 instead of 25 as required by preceding box P7 L147 statistical test used for Table 2 (for example) is not listed. Please consider stating all p values without an exponent and list the test used at least once for each stretch of p values shown. P8 L159. Fig 3 lacks legend at least for panels/parts of the figure P9 L171 Table 2 uses a thousand separator for large numbers, Tables 1 and 3 dont. Standard deviation is mentioned in the footer but not shown in Table 2. P9 L187 Fig 4 uses decimal points and decimal comma inconsistently P10L200 Table 3 it should probably be “mean age AT Pap/conization” instead of mean age of conization. In the header, non-vaccinated group is listed as “No-vaccinated” P11 L208 inconsistent use of brackets for references “[26–28].” P12 L246 it should probably be highlighted that most studies by other authors discussed in the discussion focused on 3 vaccine doses, while the current study mostly highlighted 1+ vaccine dose results [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: I Don't Know ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Re. the manuscript: Impact of catch-up human papillomavirus vaccination on 2 cervical conization rate in a real-life population in France This is a retrospective real-life cohort study based on data collected by the French National Health Insurance. The aim of the study is to evaluate the impact of catch-up HPV vaccination on the rates of conization in France in a large population-based study. page 3, line 39: It is stated that “Conization is part of the treatment of cervical dysplasia and cancer” … should probably be “Conization is part of the treatment of cervical dysplasia and early stage cancer page 3, line 49: “group immunity” should rather be “herd protection” or “group pretection” page 3, line 55-57: Relevant to mention that recently published papers on real world effectiveness against cervical cancer from Sweden and Denmark. page 7, line 131: it is stated “The main outcome was a reduction of the conization rate between the 132 non-vaccinated and vaccinated populations” should probably be “The main outcome was a comparison of the conization rate between the 132 non-vaccinated and vaccinated populations” Nice study, however, based on very few exposed cases (N=16). The limitations should also include the fact that it was not possible to adjust for differences between vaccinated and non-vaccinated. In addition, it was not possible to consider age at vaccination, which has turned out to be an important factor when looking at effectiveness. Have the authors tried to restrict the analysis even further to birth cohorts with higher coverage – e.g. birth cohorts 1989-1991? or will you then loose too much power. The women belonging to birth cohorts with a low coverage may have specific reasons to be vaccinated – in other words, they may have a different behavior/risk factor profile linked to a higher or lower exposure to HPV pre-vaccination Reviewer #2: An interesting article which describes a potential clinical impact of HPV vaccine in France through the observation of conisation data derived from a national source The article is well written and in general the data support the conclusions drawn There are some issues with the manuscript, however, that would benefit from address: The authors state on p5 that Gardasil AND Cervarix were the vaccines offered over the period of the evaluation, but I could not see any information as to what the estimated relevant proportions of the separate vaccines were. This would be valuable data as there is some evidence to indicate differential performance of the vaccines particularly in relation to cervical disease outcomes The authors do not present information on deprivation - was a proxy of this not available from the national data set? I understand that it is not a key deliverable of the manuscript but some more discussion of why vaccine uptake rates are low in France compared to other countries would be welcome and also implications for herd immunity (or lack thereof) There are a couple of unusual phrases - eg page 12, line 250 "HPV contamination" arguably should be "HPV exposure" - I am also not sure what a "General scheme population" is, as described on page 13 ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: Yes:** Kate Cuschieri [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. 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Revision 1
18 Nov 2021 Author Response Editor Comments: 3. Thank you for stating in the text of your manuscript "Data were extracted from the French National Health Insurance database called Echantillon Généraliste des Bénéficiaires (EGB), which is a permanent sample of the population covered by national health insurance". Please clarify whether this data was anonymized before researchers accessed it. Please also add all of this information to your ethics statement in the online submission form." EGB data is pseudonymized before researchers access it. There is one identifier per patient, but no identifying data. 4. Thank you for including your manuscript text: "An institutional committee validates each research project." Please amend your current ethics statement to state: a) whether ethics committee approval was specifically granted for this study b) if so, include the full name of the ethics committee/institutional review board(s) that approved your specific study. The Institut Curie, as a cancer center, has access to EGB data. Access is however restricted to researchers from the Institute who have validated training provided by the Health Insurance. Each project with analysis of these data is reviewed by an internal committee of Ethics and Science in Institut Curie. 5. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. We will update your Data Availability statement on your behalf to reflect the information you provide. This study involved third-party data (National Health Insurance – EGB). Therefore, we do not have the rights to share these third-party data, in accordance with regulations SNDS (Système National des Données de Santé). Law governing the dissemination of SNDS data : L. 1461-1 III du code de la santé publique R. 1461-1 du code de la santé publique For more information : https://www.snds.gouv.fr/SNDS/Finalites-autorisees Therefore we are in the “a)” situation, with legal restictions on sharing a de-identified data set. To access the EGB data, please visit this website to apply for dataset : https://documentation-snds.health-data-hub.fr/introduction/03-acces-snds.html#les-acces-permanents Additional Editor Comments (if provided): P5L100 space issue “(24) .” Corrected P6 L110 decimal comma used in table 1 Corrected P7 L141 Fig 2 flowchart is unclear. Right side box 1 requires women to be older than 25 in 2007. Next box states those are women born before 1991. However, a woman born in 1990 would be only 17 in 2007 instead of 25 as required by preceding box This is a typo, in the box to the right must be at least 25 years old in 2016 to be eligible for screening P7 L147 statistical test used for Table 2 (for example) is not listed. Please consider stating all p values without an exponent and list the test used at least once for each stretch of p values shown. All statistical tests were added in methods and in each table. The R software cannot calculate a p-value lower than 2.210-16, as this value would not be very readable in a table we have replaced <2.210-16 by the value <10-5, which has a largely sufficient statistical value P8 L159. Fig 3 lacks legend at least for panels/parts of the figure Corrected P9 L171 Table 2 uses a thousand separator for large numbers, Tables 1 and 3 dont. Standard deviation is mentioned in the footer but not shown in Table 2. Corrected P9 L187 Fig 4 uses decimal points and decimal comma inconsistently Corrected P10L200 Table 3 it should probably be “mean age AT Pap/conization” instead of mean age of conization. In the header, non-vaccinated group is listed as “No-vaccinated” Corrected P11 L208 inconsistent use of brackets for references “[26–28].” Corrected P12 L246 it should probably be highlighted that most studies by other authors discussed in the discussion focused on 3 vaccine doses, while the current study mostly highlighted 1+ vaccine dose results A paragraph was added on this point to discuss the effect according to the number of doses administered P14 L263 Reviewers' comments: Reviewer #1: page 3, line 39: It is stated that “Conization is part of the treatment of cervical dysplasia and cancer” … should probably be “Conization is part of the treatment of cervical dysplasia and early stage cancer The sentence has been corrected page 3, line 49: “group immunity” should rather be “herd protection” or “group pretection” Replaced by herd immunity page 3, line 55-57: Relevant to mention that recently published papers on real world effectiveness against cervical cancer from Sweden and Denmark. The reference has been added with a comment P3 L57 page 7, line 131: it is stated “The main outcome was a reduction of the conization rate between the 132 non-vaccinated and vaccinated populations” should probably be “The main outcome was a comparison of the conization rate between the 132 non-vaccinated and vaccinated populations” The sentence has been corrected Nice study, however, based on very few exposed cases (N=16). The limitations should also include the fact that it was not possible to adjust for differences between vaccinated and non-vaccinated. In addition, it was not possible to consider age at vaccination, which has turned out to be an important factor when looking at effectiveness. The manuscript has been revised to discuss these two points P14 L273 and 259 Have the authors tried to restrict the analysis even further to birth cohorts with higher coverage – e.g. birth cohorts 1989-1991? or will you then loose too much power. The exclusion of cohorts poses several problems: decrease of power, the study is no longer addressing all catch-up vaccination but just a part, increase of family-wise error rate. The women belonging to birth cohorts with a low coverage may have specific reasons to be vaccinated – in other words, they may have a different behavior/risk factor profile linked to a higher or lower exposure to HPV pre-vaccination The increase of the vaccine coverage in time is explained by the fact that there is no vaccine campaign but a vaccine by individual approach (coming from the doctor or the patient), therefore the implementation of the vaccination is slow. This low vaccine coverage is addressed in the introduction, we have developed this "French" problem in the discussion P15 L302 with references added Reviewer #2: The authors state on p5 that Gardasil AND Cervarix were the vaccines offered over the period of the evaluation, but I could not see any information as to what the estimated relevant proportions of the separate vaccines were. This would be valuable data as there is some evidence to indicate differential performance of the vaccines particularly in relation to cervical disease outcomes Unfortunately, the only information available in the data extracted from this reimbursement database was the number of dose and the dates of dispensing. The type of vaccine was not included in the data. The authors do not present information on deprivation - was a proxy of this not available from the national data set? The EGB is a health database that does not contain socio-economic data I understand that it is not a key deliverable of the manuscript but some more discussion of why vaccine uptake rates are low in France compared to other countries would be welcome and also implications for herd immunity (or lack thereof) There is no vaccine campaign in France but a vaccine by individual approach (coming from the doctor or the patient). This low vaccine coverage is addressed in the introduction, we have developed this "French" problem in the discussion P15 L302 There are a couple of unusual phrases - eg page 12, line 250 "HPV contamination" arguably should be "HPV exposure" - I am also not sure what a "General scheme population" is, as described on page 13 The word has been replaced. The notion of general regime was clarified in the discussion: it corresponds to more than 92% of the population, i.e. less than 8% excluded Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0264821.r002
4 Feb 2022 Decision Letter - Ivan Sabol, Editor PONE-D-21-11439R1Impact of catch-up human papillomavirus vaccination on cervical conization rate in a real-life population in FrancePLOS ONE Dear Dr. Elies, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, the reviewers brought up a minor issue in the discussion that should be addressed before acceptance. Therefore, we invite you to submit a revised version of the manuscript that likely will not undergo another round with the reviewers. Please submit your revised manuscript by Mar 21 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Ivan Sabol Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: No ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The authors have adequately responded to the comments. However, the new sentence on p. 3: "More recently, a large Swedish cohort study showed a reduced risk of invasive cervical cancer among girls and women vaccinated (20)" should be something like ... So far, only two large cohort studies studies - one from Swedish (20) and one from Denmark (ref) have shown a reduced risk of invasive cervical cancer among girls and women vaccinated" Ref: Real-World Effectiveness of Human Papillomavirus Vaccination Against Cervical Cancer. Kjaer SK, Dehlendorff C, Belmonte F, Baandrup L. J Natl Cancer Inst. 2021 Oct 1;113(10):1329-1335 As cervical cancer is the ultimate end point, it is important to mention both of the only two papers which have currently documented effectiveness in this regard. Reviewer #2: The manuscript is improved as a result of the revision(s) - i also accept the limitations the authors explain in relation to dissemination of the original data ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0264821.r003
Revision 2
10 Feb 2022 Author Response Response to Reviewers 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: No Response : The reviewer did not specify in his comments why he disagrees on this point. All necessary information has been provided in the texts and forms regarding restrictions on publicly sharing data ________________________________________ 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The authors have adequately responded to the comments. However, the new sentence on p. 3: "More recently, a large Swedish cohort study showed a reduced risk of invasive cervical cancer among girls and women vaccinated (20)" should be something like ... So far, only two large cohort studies studies - one from Swedish (20) and one from Denmark (ref) have shown a reduced risk of invasive cervical cancer among girls and women vaccinated" Ref: Real-World Effectiveness of Human Papillomavirus Vaccination Against Cervical Cancer. Kjaer SK, Dehlendorff C, Belmonte F, Baandrup L. J Natl Cancer Inst. 2021 Oct 1;113(10):1329-1335 As cervical cancer is the ultimate end point, it is important to mention both of the only two papers which have currently documented effectiveness in this regard. Response : The Danish study has been added to the manuscript, thank you for this comment. Reviewer #2: The manuscript is improved as a result of the revision(s) - i also accept the limitations the authors explain in relation to dissemination of the original data Thank you. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0264821.r004
18 Feb 2022 Decision Letter - Ivan Sabol, Editor Impact of catch-up human papillomavirus vaccination on cervical conization rate in a real-life population in France PONE-D-21-11439R2 Dear Dr. Elies, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Ivan Sabol Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0264821.r005
Formally Accepted
2 Mar 2022 Acceptance Letter - Ivan Sabol, Editor PONE-D-21-11439R2 Impact of catch-up human papillomavirus vaccination on cervical conization rate in a real-life population in France Dear Dr. Eliès: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Ivan Sabol Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0264821.r006

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