苏格兰全国二价人乳头瘤病毒疫苗接种计划后 HPV 感染流行率的变化：一项为期 7 年的横断面研究。

Changes in the prevalence of human papillomavirus following a national bivalent human papillomavirus vaccination programme in Scotland: a 7-year cross-sectional study.

机构信息

University of Strathclyde, Glasgow, UK.

Health Protection Scotland, Glasgow, UK.

出版信息

Lancet Infect Dis. 2017 Dec;17(12):1293-1302. doi: 10.1016/S1473-3099(17)30468-1. Epub 2017 Sep 28.

DOI:10.1016/S1473-3099(17)30468-1

PMID:28965955

Abstract

BACKGROUND

On Sept 1, 2008, Scotland launched routine vaccination for human papillomavirus (HPV) types 16 and 18, targeted at 12-13-year-old girls, of whom 92·4% were fully vaccinated in 2008-09. In this study, we report on vaccine effectiveness of the bivalent vaccine in these vaccinated women who attended for routine cervical screening at age 20-21 years.

METHODS

In this 7-year cross-sectional study (covering birth cohorts 1988-1995), we sampled approximately 1000 samples per year from those attending cervical screening at age 20-21 years and tested each for HPV. By linkage to vaccination records we ascertained prevalence by birth cohort and vaccination status. Estimates of vaccine effectiveness for HPV types 16 and 18, HPV types 31, 33, and 45, other high-risk types, and any HPV were calculated using logistic regression.

FINDINGS

In total, 8584 samples were HPV genotyped. Prevalence of HPV types 16 and 18 reduced substantially from 30·0% (95% CI 26·9-33·1) in the 1988 cohort to 4·5% (3·5-5·7) in the 1995 cohort, giving a vaccine effectiveness of 89·1% (85·1-92·3) for those vaccinated at age 12-13 years. All cross-protective types showed significant vaccine effectiveness (HPV type 31, 93·8% [95% CI 83·8-98·5]; HPV type 33, 79·1% [64·2-89·0]; HPV type 45, 82·6% [61·5-93·9]). Unvaccinated individuals born in 1995 had a reduced odds of HPV types 16 and 18 infection compared with those born in 1988 (adjusted odds ratio 0·13 [95% CI 0·06-0·28]) and reduced odds of HPV types 31, 33, and 45 (odds ratio 0·45 [0·23-0·89]).

INTERPRETATION

Bivalent vaccination has led to a startling reduction in vaccine and cross-protective HPV types 7 years after vaccination. There is also evidence of herd protection against the vaccine-specific and cross-protective types in unvaccinated individuals born in 1995. These findings should be considered in cost-effectiveness models informing vaccine choice and models to shape the future of cervical screening programmes.

FUNDING

Scottish Government and Chief Scientists Office.

摘要

背景

2008 年 9 月 1 日，苏格兰启动了针对人乳头瘤病毒（HPV）型 16 和 18 的常规疫苗接种，目标人群为 12-13 岁的女孩，其中 92.4%在 2008-09 年期间完成了全程接种。本研究报告了在这些接种疫苗的女性中，二价疫苗的疫苗有效性，这些女性在 20-21 岁时参加了常规的宫颈癌筛查。

方法

在这项为期 7 年的横断面研究（涵盖 1988-1995 年的出生队列）中，我们每年从参加 20-21 岁宫颈癌筛查的人群中抽取约 1000 个样本，并对每个样本进行 HPV 检测。通过与疫苗接种记录的关联，我们按出生队列和疫苗接种状况确定了 HPV 的流行率。使用逻辑回归计算了 HPV 型 16 和 18、HPV 型 31、33 和 45、其他高危型和任何 HPV 的疫苗有效性估计值。

结果

共对 8584 个样本进行了 HPV 基因分型。HPV 型 16 和 18 的流行率从 1988 年出生队列的 30.0%（95%CI 26.9-33.1）显著下降至 1995 年出生队列的 4.5%（3.5-5.7），表明 12-13 岁接种疫苗的人群疫苗有效性为 89.1%（85.1-92.3）。所有交叉保护型均显示出显著的疫苗有效性（HPV 型 31，93.8%[95%CI 83.8-98.5]；HPV 型 33，79.1%[64.2-89.0]；HPV 型 45，82.6%[61.5-93.9]）。与 1988 年出生的人群相比，1995 年出生且未接种疫苗的人群 HPV 型 16 和 18 感染的可能性降低（调整后的优势比 0.13[95%CI 0.06-0.28]），HPV 型 31、33 和 45 的感染可能性也降低（优势比 0.45[0.23-0.89]）。