女性中疫苗型人乳头瘤病毒流行率的下降：来自全国性调查的数据。
Declines in Vaccine-Type Human Papillomavirus Prevalence in Females Across Racial/Ethnic Groups: Data From a National Survey.
机构信息
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; Synergy America, Inc., Duluth, Georgia.
出版信息
J Adolesc Health. 2019 Dec;65(6):715-722. doi: 10.1016/j.jadohealth.2019.07.003. Epub 2019 Sep 9.
PURPOSE
To monitor human papillomavirus (HPV) vaccine impact in the U.S., we evaluated quadrivalent vaccine (4vHPV)-type prevalence among females aged 14-34 years in the prevaccine (2003-2006) and vaccine (2013-2016) eras overall and by race/ethnicity in the National Health and Nutrition Examination Survey.
METHODS
We analyzed HPV DNA prevalence in self-collected cervicovaginal specimens, demographic characteristics, sexual behavior, and self-reported/parent-reported vaccination status. We compared prevaccine to vaccine era 4vHPV-type prevalence, using unadjusted and adjusted prevalence ratios (PR and aPR) and 95% confidence intervals (CIs). PRs were calculated by race/ethnicity (non-Hispanic white [NHW], non-Hispanic black [NHB], and Mexican American [MA]). Overall aPRs were adjusted for race/ethnicity, lifetime sex partners, and poverty.
RESULTS
Overall, 4,674 females had HPV typing results; 3,915 reported NHW, NHB, or MA race/ethnicity. Vaccination coverage of ≥1 dose was 53.9% among 14- to 19-year-olds (NHW 52.6%, NHB 58.1%, and MA 59.5%) and 51.5% among 20- to 24-year-olds (NHW 58.8%, NHB 45.0%, MA 33.8%). Among 14- to 19-year-olds, 4vHPV-type prevalence decreased overall (11.5% to 1.8%; aPR = .14 [CI: .08-.24]) and in NHW (PR = .14 [CI: .06-.29]), NHB (PR = .26 [CI: .12-.54]), and MA (PR = .13 [CI: .03-.53]). In 20- to 24-year-olds, 4vHPV-type prevalence decreased overall (18.5% to 5.3%; aPR = .29 [CI: .15-.56]) and in NHW (PR = .27 [CI: .11-.67]) and NHB (PR = .38 [CI: .18-.80]). No significant declines were observed in older age groups.
CONCLUSIONS
Within 10 years of vaccine introduction, 4vHPV-type prevalence declined 86% among 14- to 19-year-olds, with declines observed in NHW, NHB, and MA females, and 71% among 20- to 24-year-olds, with declines in NHW and NHB females. These extraordinary declines should lead to substantial reductions in HPV-associated cancers.
目的
为了监测人乳头瘤病毒（HPV）疫苗在美国的影响，我们评估了在疫苗前（2003-2006 年）和疫苗后（2013-2016 年）时代，14-34 岁女性中四价疫苗（4vHPV）型别在全国健康和营养检查调查中的流行率，按种族/民族进行了分层。
方法
我们分析了自我采集的宫颈阴道标本中的 HPV DNA 流行率、人口统计学特征、性行为以及自我报告/父母报告的疫苗接种情况。我们比较了疫苗前和疫苗后时代的 4vHPV 型别流行率，使用未经调整和调整后的患病率比（PR 和 aPR）及其 95%置信区间（CI）。PR 按种族/民族（非西班牙裔白人[NHW]、非西班牙裔黑人[NHB]和墨西哥裔美国人[MA]）进行分层。总体而言，aPR 按种族/民族、终生性伴侣和贫困状况进行了调整。
结果
总体而言，有 4674 名女性进行了 HPV 分型检测；3915 名女性报告了 NHW、NHB 或 MA 种族/民族。14-19 岁女性中≥1 剂疫苗接种率为 53.9%（NHW 为 52.6%，NHB 为 58.1%，MA 为 59.5%），20-24 岁女性中为 51.5%（NHW 为 58.8%，NHB 为 45.0%，MA 为 33.8%）。在 14-19 岁女性中，4vHPV 型别总体流行率下降（11.5%降至 1.8%；aPR=0.14 [CI：0.08-0.24]），在 NHW（PR=0.14 [CI：0.06-0.29]）、NHB（PR=0.26 [CI：0.12-0.54]）和 MA（PR=0.13 [CI：0.03-0.53]）中也观察到下降。在 20-24 岁女性中，4vHPV 型别总体流行率下降（18.5%降至 5.3%；aPR=0.29 [CI：0.15-0.56]），在 NHW（PR=0.27 [CI：0.11-0.67]）和 NHB（PR=0.38 [CI：0.18-0.80]）中也观察到下降。在年龄较大的女性中，没有观察到明显的下降。
结论
在疫苗引入后的 10 年内，14-19 岁女性中 4vHPV 型别流行率下降了 86%，NHW、NHB 和 MA 女性中均观察到下降，20-24 岁女性中下降了 71%，NHW 和 NHB 女性中也观察到下降。这些显著的下降应该会导致 HPV 相关癌症的大量减少。
Zotero 插件