Department of Microbiology and Infectious Diseases, Royal Women's Hospital, Australia; Department of Microbiology, Royal Children's Hospital, Australia; Murdoch Children's Research Institute, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Australia.
Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia.
Clin Microbiol Infect. 2015 Sep;21(9):834-41. doi: 10.1016/j.cmi.2015.05.038. Epub 2015 Jun 5.
In many countries now, vaccination of young adolescent girls with prophylactic human papillomavirus (HPV) vaccines has been rolled out as a public health programme. In countries where coverage has been high, this has led to dramatic reductions in cervical high-grade precancerous lesions, as well as genital warts. A reduction in circulating vaccine-related HPV types has also been demonstrated. With the introduction of gender-neutral approaches incorporating universal vaccination of pre-adolescent boys in some countries, implementation of post-vaccine monitoring will be critical to evaluate the incremental impact of male vaccination. In contrast to cervical screening programmes, population-wide screening for HPV infection or related disease in males is not recommended; hence real-time monitoring of HPV vaccine effectiveness in males will require dedicated surveillance strategies. Monitoring the prevalence of circulating genital HPV types using a sentinel surveillance model could offer a good surrogate marker of early vaccine effectiveness in males. However, such an approach requires careful consideration of the most appropriate anatomical sites from which to collect specimens, the best sampling methods and the most sensitive assays to use. Additionally, in assessing an accurate measure of the impact of HPV vaccination in the male population, the effect of herd protection will need to be assessed, as most male programmes will commence in the setting of established female programmes. This poses an interesting epidemiological challenge.
在许多国家，为年轻少女接种预防性人乳头瘤病毒（HPV）疫苗已作为公共卫生计划推出。在覆盖率较高的国家，这已导致宫颈癌前高级别病变以及生殖器疣的发病率显著下降。同时也证明了循环疫苗相关 HPV 型别的减少。随着一些国家引入包含普遍为青春期前男孩接种疫苗的性别中立方法，实施疫苗接种后的监测对于评估男性接种疫苗的额外影响至关重要。与宫颈癌筛查计划不同，不建议在男性中进行针对 HPV 感染或相关疾病的全人群筛查；因此，需要专门的监测策略来实时监测 HPV 疫苗在男性中的有效性。使用哨点监测模型监测循环中的生殖器 HPV 型别可以为男性疫苗早期有效性提供良好的替代标志物。然而，这种方法需要仔细考虑从何处采集标本、最佳采样方法以及使用最敏感的检测方法，以获得最合适的解剖部位。此外，在评估 HPV 疫苗接种对男性人群的影响的准确衡量标准时，需要评估群体保护的效果，因为大多数男性接种计划将在已建立的女性接种计划的背景下开始。这带来了一个有趣的流行病学挑战。
