2008-2014 年宫颈前病变中人乳头瘤病毒 16 型和 18 型的流行趋势。
Trends in Human Papillomavirus Vaccine Types 16 and 18 in Cervical Precancers, 2008-2014.
机构信息
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.
出版信息
Cancer Epidemiol Biomarkers Prev. 2019 Mar;28(3):602-609. doi: 10.1158/1055-9965.EPI-18-0885. Epub 2019 Feb 21.
BACKGROUND
The impact of human papillomavirus (HPV) vaccination has been observed in the United States through declining cervical precancer incidence in young women. To further evaluate vaccine impact, we described trends in HPV vaccine types 16/18 in cervical precancers, 2008-2014.
METHODS
We analyzed data from a 5-site, population-based surveillance system. Archived specimens from women age 18-39 years diagnosed with cervical intraepithelial neoplasia grades 2-3 or adenocarcinoma (CIN2+) were tested for 37 HPV types. We described the proportion and estimated number of cases of CIN2+ by HPV-type groups over time. Trends in HPV16/18-positive CIN2+ were examined, overall and by vaccination status, age, histologic grade, and race/ethnicity, using Cochrane-Armitage tests.
RESULTS
In 10,206 cases, the proportion and estimated number of cases of HPV16/18-positive CIN2+ declined from 52.7% (1,235 cases) in 2008 to 44.1% (819 cases) in 2014 ( < 0.001). Declining trends in the proportion of HPV16/18-positive CIN2+ were observed among vaccinated (55.2%-33.3%, < 0.001) and unvaccinated (51.0%-47.3%, = 0.03) women; ages 18-20 (48.7%-18.8%, = 0.02), 21-24 (53.8%-44.0%, < 0.001), 25-29 (56.9%-42.4%, < 0.001), and 30-34 (49.8%-45.8%, = 0.04) years; CIN2 (40.8%-29.9%, < 0.001) and CIN2/3 (61.8%-46.2%, < 0.001); non-Hispanic white (59.5%-47.9%, < 0.001) and non-Hispanic black (40.7%-26.5%, < 0.001).
CONCLUSIONS
From 2008-2014, the proportion of HPV16/18-positive CIN2+ declined, with the greatest declines in vaccinated women; declines in unvaccinated women suggest herd protection.
IMPACT
The declining proportion of HPV16/18-positive CIN2+ provides additional evidence of vaccine impact in the United States.
背景
在美国，通过观察 HPV 疫苗接种对年轻女性宫颈癌前病变发病率的影响，已经发现了 HPV 疫苗的效果。为了进一步评估疫苗的效果，我们描述了 2008-2014 年间 HPV 疫苗 16/18 型在宫颈癌前病变中的趋势。
方法
我们分析了一个 5 个地点、基于人群的监测系统的数据。对年龄在 18-39 岁之间被诊断为宫颈上皮内瘤变 2-3 级或腺癌（CIN2+）的女性的存档标本进行了 37 种 HPV 型的检测。我们描述了随着时间的推移，不同 HPV 型组的 CIN2+病例比例和估计病例数。通过考科伦-阿密特检验，总体上和按疫苗接种状况、年龄、组织学分级和种族/族裔，对 HPV16/18 阳性 CIN2+的趋势进行了检查。
结果
在 10206 例病例中，HPV16/18 阳性 CIN2+的比例和估计病例数从 2008 年的 52.7%（1235 例）下降到 2014 年的 44.1%（819 例）（<0.001）。在接种疫苗（55.2%-33.3%，<0.001）和未接种疫苗（51.0%-47.3%，=0.03）的女性中，HPV16/18 阳性 CIN2+的比例下降趋势明显；年龄在 18-20 岁（48.7%-18.8%，=0.02）、21-24 岁（53.8%-44.0%，<0.001）、25-29 岁（56.9%-42.4%，<0.001）和 30-34 岁（49.8%-45.8%，=0.04）；CIN2（40.8%-29.9%，<0.001）和 CIN2/3（61.8%-46.2%，<0.001）；非西班牙裔白人（59.5%-47.9%，<0.001）和非西班牙裔黑人（40.7%-26.5%，<0.001）。
结论
2008-2014 年期间，HPV16/18 阳性 CIN2+的比例下降，接种疫苗的女性中降幅最大；未接种疫苗的女性的下降表明存在群体保护效应。
意义
HPV16/18 阳性 CIN2+比例的下降为美国的疫苗效果提供了额外的证据。
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