Anil K. Chaturvedi and Barry I. Graubard, Division of Cancer Epidemiology and Genetics, National Cancer Institute; National Institutes of Health, Rockville; Lisa Kahle, Information Management Systems, Silver Spring, MD; Tatevik Broutian, Robert K.L. Pickard, Zhen-Yue Tong, and Weihong Xiao, The Ohio State University, Columbus, OH; and Maura L. Gillison, The MD Anderson Cancer Center, Houston, TX.
J Clin Oncol. 2018 Jan 20;36(3):262-267. doi: 10.1200/JCO.2017.75.0141. Epub 2017 Nov 28.
Purpose The incidence of human papilloma virus (HPV)-positive oropharyngeal cancers has risen rapidly in recent decades among men in the United States. We investigated the US population-level effect of prophylactic HPV vaccination on the burden of oral HPV infection, the principal cause of HPV-positive oropharyngeal cancers. Methods We conducted a cross-sectional study of men and women 18 to 33 years of age (N = 2,627) within the National Health and Nutrition Examination Survey 2011 to 2014, a representative sample of the US population. Oral HPV infection with vaccine types 16, 18, 6, or 11 was compared by HPV vaccination status, as measured by self-reported receipt of at least one dose of the HPV vaccine. Analyses accounted for the complex sampling design and were adjusted for age, sex, and race. Statistical significance was assessed using a quasi-score test. Results Between 2011 and 2014, 18.3% of the US population 18 to 33 years of age reported receipt of at least one dose of the HPV vaccine before the age of 26 years (29.2% in women and 6.9% in men; P < .001). The prevalence of oral HPV16/18/6/11 infections was significantly reduced in vaccinated versus unvaccinated individuals (0.11% v 1.61%; P = .008), corresponding to an estimated 88.2% (95% CI, 5.7% to 98.5%) reduction in prevalence after model adjustment for age, sex, and race. Notably, the prevalence of oral HPV16/18/6/11 infections was significantly reduced in vaccinated versus unvaccinated men (0.0% v 2.13%; P = .007). Accounting for vaccine uptake, the population-level effect of HPV vaccination on the burden of oral HPV16/18/6/11 infections was 17.0% overall, 25.0% in women, and 6.9% in men. Conclusion HPV vaccination was associated with reduction in vaccine-type oral HPV prevalence among young US adults. However, because of low vaccine uptake, the population-level effect was modest overall and particularly low in men.
近年来，美国男性中人类乳头瘤病毒（HPV）阳性口咽癌的发病率迅速上升。我们研究了 HPV 预防性疫苗接种对口腔 HPV 感染负担（HPV 阳性口咽癌的主要病因）的美国人群水平效应。
我们对 2011 年至 2014 年期间参加国家健康和营养检查调查的 18 至 33 岁的男性和女性（N=2627）进行了横断面研究，这是美国人群的代表性样本。通过自我报告接种至少一剂 HPV 疫苗的情况，比较了疫苗型 16、18、6 或 11 型的口腔 HPV 感染情况。分析考虑了复杂的抽样设计，并按年龄、性别和种族进行了调整。采用拟似然比检验评估统计学意义。
2011 年至 2014 年期间，18 至 33 岁的美国人群中，有 18.3%（女性为 29.2%，男性为 6.9%；P＜0.001）在 26 岁之前报告至少接种过一剂 HPV 疫苗。与未接种疫苗者相比，接种疫苗者的口腔 HPV16/18/6/11 感染率显著降低（0.11%比 1.61%；P=0.008），经模型调整年龄、性别和种族后，估计接种疫苗可使感染率降低 88.2%（95%CI，5.7%~98.5%）。值得注意的是，与未接种疫苗者相比，接种疫苗者的口腔 HPV16/18/6/11 感染率在男性中显著降低（0.0%比 2.13%；P=0.007）。考虑到疫苗接种率，HPV 疫苗接种对口腔 HPV16/18/6/11 感染负担的人群水平效应总体为 17.0%，女性为 25.0%，男性为 6.9%。
HPV 疫苗接种与美国年轻成年人中疫苗型口腔 HPV 流行率降低有关。但是，由于疫苗接种率低，总体人群水平效应较小，男性尤其如此。
