Oliphant Jeannie, Perkins Nicky
Auckland Sexual Health Service, Greenlane Clinical Centre, Private Bag 92024, Auckland, New Zealand.
N Z Med J. 2011 Jul 29;124(1339):51-8.
To review cases of genital warts diagnosed at Auckland Sexual Health Service (ASHS) and to document any change following the introduction of the human papillomavirus (HPV) vaccination. The national HPV immunisation programme, using the quadrivalent vaccine Gardasil, commenced on 1 September 2008. The publically funded programme provides for the ongoing vaccination of girls in year 8 with an initial catch-up programme for young women born after 1 January 1990 until the end of 2010. Monitoring rates of diagnosis of genital warts should provide the earliest clinical indicator of a population response to the vaccine.
The proportion of new clients attending ASHS who were diagnosed with genital warts from 1 January 2007 to 31 December 2008 was compared to the proportion diagnosed from 1 January 2009 to 30 June 2010.
40,793 new clients attended the ASHS between 2007 and June 2010 and genital warts were diagnosed in 3125 (7.7%). Genital warts were diagnosed in 9.2% of new clients in 2007 decreasing to 6.6% for the first 6 months of 2010. Analysis of the subgroup of clients under the age of 20 years, found genital warts in males decreased from 11.5% in 2007 to 6.9% in 2010 while in females the rates decreased from 13.7% to 5.1% over the same time period. In comparison, the rates decreased from 7.5% in 2007 to 5.9% in 2010 for females aged 20 years and over. Thus there was evidence of a significant difference, in the pre to post vaccination era, in the proportion of female clinic visits for genital warts in those aged less than 20 years and those aged 21 years or older (p=0.02) and further a borderline significant difference for males aged less than 20 years (p=0.05).
A significant decline in the incidence of genital warts in the target population suggests an early response to the HPV vaccination programme with some evidence of an effect for males aged less than 20 years.
回顾奥克兰性健康服务中心(ASHS)诊断的尖锐湿疣病例,并记录引入人乳头瘤病毒(HPV)疫苗接种后的变化情况。全国HPV免疫计划于2008年9月1日启动,使用四价疫苗加德西。该公共资助计划规定对八年级女生进行持续疫苗接种,并对1990年1月1日以后出生的年轻女性开展初始追赶计划,直至2010年底。监测尖锐湿疣的诊断率应能提供人群对该疫苗反应的最早临床指标。
比较2007年1月1日至2008年12月31日期间在ASHS就诊并被诊断为尖锐湿疣的新患者比例与2009年1月1日至2010年6月30日期间的相应比例。
2007年至2010年6月期间,40793名新患者到ASHS就诊,其中3125人(7.7%)被诊断为尖锐湿疣。2007年新患者中9.2%被诊断为尖锐湿疣,到2010年的前6个月降至6.6%。对20岁以下患者亚组的分析发现,男性尖锐湿疣的诊断率从2%降至6.9%,而女性在同一时期从13.7%降至5.1%。相比之下,20岁及以上女性的诊断率从2007年的7.5%降至2010年的5.9%。因此,有证据表明,在接种疫苗前后,20岁以下和21岁及以上女性因尖锐湿疣到诊所就诊的比例存在显著差异(p=0.02),20岁以下男性也存在临界显著差异(p=0.05)。
目标人群中尖锐湿疣发病率显著下降,表明对HPV疫苗接种计划有早期反应,有证据显示对20岁以下男性也有一定效果。