Sex Transm Dis. 2018 Apr;45(4):260-265. doi: 10.1097/OLQ.0000000000000731.
We examined non-vaccine-type human papillomavirus (HPV) prevalence in a community before and during the first 8 years after vaccine introduction, to assess for (1) type replacement with any non-vaccine-type HPV and (2) cross-protection with non-vaccine types genetically related to vaccine-type HPV.
Sexually experienced 13- to- 26-year-old women were recruited for 3 cross-sectional studies from 2006 to 2014 (N = 1180). Outcome variables were as follows: (1) prevalence of at least 1 of 32 anogenital non-vaccine-type HPVs and (2) prevalence of at least 1 HPV type genetically related to HPV-16 and HPV-18. We determined changes in proportions of non-vaccine-type HPV prevalence across the study waves using logistic regression with propensity score inverse probability weighting.
Vaccine initiation rates increased from 0% to 71.3%. Logistic regression demonstrated that from 2006 to 2014, there was no increase in non-vaccine-type HPV among vaccinated women (adjusted odds ratio [AOR], 1.02; 95% confidence interval [CI], 0.73-1.42), but an increase among unvaccinated women (AOR, 1.88; 95% CI, 1.16-3.04). Conversely, there was a decrease in types genetically related to HPV-16 among vaccinated (AOR, 0.57; 95% CI, 0.38-0.88) but not unvaccinated women (AOR, 1.33; 95% CI, 0.81-2.17).
We did not find evidence of type replacement, but did find evidence of cross-protection against types genetically related to HPV-16. These findings have implications for cost-effectiveness analyses, which may impact vaccine-related policies, and provide information to assess the differential risk for cervical cancer in unvaccinated and vaccinated women, which may influence clinical screening recommendations. The findings also have implications for public health programs, such as health messaging for adolescents, parents, and clinicians about HPV vaccination.
我们在疫苗引入前后的 8 年内，对社区中未接种疫苗的人乳头瘤病毒（HPV）流行情况进行了研究，以评估（1）是否存在与任何非疫苗型 HPV 的类型替代，以及（2）与疫苗型 HPV 具有遗传关系的非疫苗型 HPV 的交叉保护作用。
从 2006 年到 2014 年，我们招募了 13 至 26 岁有过性行为的女性参加了 3 项横断面研究（N=1180）。主要结局变量如下：（1）至少有 1 种 32 种肛门生殖器非疫苗型 HPV 的流行率，以及（2）至少有 1 种与 HPV-16 和 HPV-18 具有遗传关系的 HPV 类型的流行率。我们使用倾向评分逆概率加权的逻辑回归来确定研究波次中各非疫苗型 HPV 流行率的变化情况。
疫苗接种率从 0%增加到 71.3%。逻辑回归显示，2006 年至 2014 年，接种疫苗的女性中非疫苗型 HPV 并未增加（调整后的比值比[OR]，1.02；95%置信区间[CI]，0.73-1.42），但未接种疫苗的女性中非疫苗型 HPV 有所增加（OR，1.88；95%CI，1.16-3.04）。相反，在接种疫苗的女性中，与 HPV-16 具有遗传关系的 HPV 类型有所减少（OR，0.57；95%CI，0.38-0.88），而在未接种疫苗的女性中则没有减少（OR，1.33；95%CI，0.81-2.17）。
我们没有发现类型替代的证据，但确实发现了与 HPV-16 具有遗传关系的 HPV 类型具有交叉保护作用的证据。这些发现对成本效益分析有影响，这可能会影响与疫苗相关的政策，并为评估未接种疫苗和接种疫苗的女性宫颈癌的不同风险提供信息，这可能会影响临床筛查建议。这些发现还对公共卫生计划具有意义，例如为青少年、家长和临床医生提供关于 HPV 疫苗接种的健康信息。
