Mesher David, Panwar Kavita, Thomas Sara L, Beddows Simon, Soldan Kate
HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
Virus Reference Department, Public Health England, London, UK.
BMJ Open. 2016 Feb 11;6(2):e009915. doi: 10.1136/bmjopen-2015-009915.
The human papillomavirus (HPV) immunisation programme in England was introduced in 2008. Monitoring changes in type-specific HPV prevalence allows assessment of the population impact of this vaccination programme.
Residual vulva-vaginal swab specimens were collected from young sexually active women (aged 16-24 years) attending for chlamydia screening across England. Specimens were collected between 2010 and 2013 for type-specific HPV-DNA testing. HPV prevalence was compared to a similar survey conducted in 2008 prior to the introduction of HPV vaccination.
A total of 7321 specimens collected in the postvaccination period, and 2354 specimens from the prevaccination period were included in this analysis. Among the individuals aged 16-18 years, with an estimated vaccination coverage of 67%, the prevalence of HPV16/18 infection decreased from 17.6% in 2008 to 6.1% in the postvaccination period. Within the postvaccination period, there was a trend towards lower HPV16/18 prevalence with higher vaccination coverage and increasing time since vaccine introduction from 8.5% in the period 2-3 years postvaccination to 4.0% in the period 4-5 years postvaccination. The prevalence of HPV31 reduced from 3.7% in the prevaccination period to 0.9% after vaccine introduction, although this no longer reached statistical significance after additional consideration of the uncertainty due to the assay change. Smaller reductions were seen in the individuals aged 19-21 years with lower estimated vaccination coverage, but there was no evidence of a reduction in the older unvaccinated women. Some overall increase in non-vaccine types was seen in the youngest age groups (ORs (95% CI); 1.3 (1.0 to 1.7) and 1.5 (1.1 to 2.0) for individuals aged 16-18 and 19-21 years, respectively, when adjusted for known population changes and the change in assay) although this should be interpreted with caution given the potential unmasking effect.
These data demonstrate a reduction in the HPV vaccine types in the age group with the highest HPV vaccination coverage.
英国于2008年推行了人乳头瘤病毒（HPV）免疫接种计划。监测特定HPV型别流行率的变化有助于评估该疫苗接种计划对人群的影响。
收集了全英格兰前来接受衣原体筛查的年轻性活跃女性（年龄16 - 24岁）残留的外阴 - 阴道拭子样本。于2010年至2013年期间收集样本进行特定HPV - DNA检测。将HPV流行率与2008年HPV疫苗接种前进行的一项类似调查结果进行比较。
本分析纳入了疫苗接种后时期收集的7321份样本以及疫苗接种前时期的2354份样本。在估计疫苗接种覆盖率为67%的16 - 18岁人群中，HPV16/18感染率从2008年的17.6%降至疫苗接种后的6.1%。在疫苗接种后时期内，随着疫苗接种覆盖率的提高以及自疫苗引入时间的增加，HPV16/18流行率呈现下降趋势，从疫苗接种后2 - 3年的8.5%降至疫苗接种后4 - 5年的4.0%。HPV31流行率从疫苗接种前的3.7%降至疫苗引入后0.9%，不过在进一步考虑因检测方法改变导致的不确定性后，这一差异不再具有统计学意义。在估计疫苗接种覆盖率较低的19 - 21岁人群中，下降幅度较小，而在未接种疫苗的年长女性中未发现感染率下降。在最年轻年龄组中，非疫苗型别总体有所增加（调整已知人群变化和检测方法变化后，16 - 18岁和19 - 21岁人群的比值比（95%可信区间）分别为1.3（1.0至1.7）和1.5（1.1至2.0）），不过鉴于可能存在的暴露效应，对此应谨慎解读。
这些数据表明在HPV疫苗接种覆盖率最高的年龄组中，HPV疫苗型别感染率有所下降。
