Kirby Institute, University of New South Wales, Wallace Wurth Building, High St, Kensington, NSW 2052, Australia.
Kirby Institute, University of New South Wales, Wallace Wurth Building, High St, Kensington, NSW 2052, Australia.
Vaccine. 2018 Jul 5;36(29):4311-4316. doi: 10.1016/j.vaccine.2018.05.104. Epub 2018 Jun 5.
Cervical cancer occurrence and mortality are strongly correlated with socioeconomic disadvantage, largely due to unequal access to screening and treatment. Universal human papillomavirus (HPV) vaccination provides the opportunity to greatly reduce this global health disparity. Australian Indigenous women have substantially higher rates of cervical cancer than non-Indigenous women, primarily due to under-screening. We investigated HPV infection rates in Indigenous women 7 years after implementation of the national HPV vaccination program.
We used a repeat cross-sectional design, with the baseline being provided by an HPV prevalence survey among Indigenous women attending clinics for cervical cytology screening, prior to the start of the vaccination program in 2007. We returned to clinics in four locations during 2014-15, and invited women aged 18-26 years attending for screening to provide a cervical specimen for HPV testing, as well as to complete a short questionnaire and consent to allow access of their records in the National HPV Vaccination Program Register. We used well-established laboratory methods to test specimens for specific HPV genotypes.
A total of 142 women were recruited at participating sites and compared to 155 who had been recruited at the same locations in the 2007 pre-vaccine survey. The two groups were identical in regard to age, with the more recent group having a higher proportion of hormonal contraception users, and a lower proportion of smokers. The proportion found to have any HPV type fell from 58 to 36% with the decline being entirely due to reductions in vaccine types, which fell by 94% from 24 to 1.4%.
Australia's national HPV vaccination program appears to be successfully protecting a very high proportion of Indigenous women against vaccine targeted HPV types, who have in the past been at elevated risk of cervical cancer.
宫颈癌的发生和死亡与社会经济劣势密切相关，主要是因为获得筛查和治疗的机会不平等。普遍接种人乳头瘤病毒（HPV）疫苗为大大减少这一全球健康差距提供了机会。澳大利亚土著妇女的宫颈癌发病率远高于非土著妇女，主要原因是筛查不足。我们调查了全国 HPV 疫苗接种计划实施 7 年后土著妇女的 HPV 感染率。
我们采用重复横断面设计，基线数据来自于 2007 年 HPV 疫苗接种计划开始前，在接受宫颈癌细胞学筛查的诊所中进行的 HPV 流行率调查。我们于 2014-15 年期间返回四个地点的诊所，邀请年龄在 18-26 岁之间、正在接受筛查的妇女提供宫颈标本进行 HPV 检测，并填写一份简短的问卷，并同意允许访问其在国家 HPV 疫苗接种计划登记册中的记录。我们使用成熟的实验室方法检测标本中的特定 HPV 基因型。
共有 142 名妇女在参与的地点被招募，并与在 2007 年疫苗接种前调查中在同一地点招募的 155 名妇女进行了比较。两组在年龄方面完全相同，最近一组中使用激素避孕药的比例较高，而吸烟的比例较低。发现任何 HPV 类型的比例从 58%降至 36%，下降完全是由于疫苗类型的减少，疫苗类型从 24 种降至 1.4%，减少了 94%。
澳大利亚国家 HPV 疫苗接种计划似乎成功地保护了绝大多数土著妇女免受疫苗针对的 HPV 类型的感染，这些妇女过去患宫颈癌的风险较高。
