疫苗问世后 6 年，美国中西部都会区青年男性中疫苗型人乳头瘤病毒流行率下降。
Decline in vaccine-type human papillomavirus prevalence in young men from a Midwest metropolitan area of the United States over the six years after vaccine introduction.
机构信息
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, USA.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, USA.
出版信息
Vaccine. 2019 Oct 23;37(45):6832-6841. doi: 10.1016/j.vaccine.2019.08.052. Epub 2019 Sep 30.
PURPOSE
The aim of this study was to determine changes in human papillomavirus (HPV) prevalence among young men from a Midwest metropolitan area over the six years after vaccine introduction, including HPV prevalence in men overall, in vaccinated men to examine vaccine impact and in unvaccinated men to examine herd protection. An exploratory aim was to examine associations between number of vaccine doses and HPV prevalence.
METHODS
Men aged 14-26 years reporting male-female and/or male-male sexual contact were recruited from a primary care clinic, sexually transmitted disease clinic, and community setting during two waves of data collection: 2013-2014 (N = 400) and 2016-2017 (N = 347). Participants completed a questionnaire and were tested for penile, scrotal and anal HPV. Changes in prevalence of any (≥1 type) and vaccine-type HPV (HPV6, 11, 16, and/or 18) were examined using propensity score weighted logistic regression. Associations between number of doses and HPV infection were determined using chi-square tests and logistic regression.
RESULTS
The proportion of men with a history of ≥1 HPV vaccine doses increased from 23% to 44% (p < 0.001) from waves 1 to 2. After propensity score weighting, infection with ≥1 vaccine-type HPV significantly decreased among all men (29% to 20%; 31% decrease; odds ratio [OR] = 0.62, 95% confidence interval [CI] = 0.44-0.88) and unvaccinated men (32% to 21%; 36% decrease; OR = 0.56, 95%CI = 0.34-0.86); there was a non-significant decrease (21%) among vaccinated men. Associations between number of doses and HPV prevalence were not statistically significant.
CONCLUSIONS
Prevalence of vaccine-type HPV decreased among all, vaccinated, and unvaccinated men six years after HPV vaccine recommendation, supporting vaccine impact and herd protection. Decreases in vaccine-type HPV in all men appear to be due to decreases in unvaccinated men, suggesting that the full impact of vaccination has yet to be realized. Continued monitoring and efforts to vaccinate men prior to sexual initiation are warranted.
目的
本研究旨在确定在疫苗引入后的六年中，中西部都会区年轻男性的人乳头瘤病毒（HPV）流行率的变化，包括总体男性中的 HPV 流行率、接种疫苗的男性中以检查疫苗的影响以及未接种疫苗的男性中以检查群体保护。一个探索性目标是检查疫苗剂量与 HPV 流行率之间的关联。
方法
从一家初级保健诊所、性传播疾病诊所和社区环境中招募了年龄在 14-26 岁之间、报告有男性-女性和/或男性-男性性接触的男性。在两个数据收集阶段（2013-2014 年（N=400）和 2016-2017 年（N=347）），参与者完成了一份问卷并接受了阴茎、阴囊和肛门 HPV 检测。使用倾向评分加权逻辑回归来检查任何（≥1 种）和疫苗型 HPV（HPV6、11、16 和/或 18）流行率的变化。使用卡方检验和逻辑回归确定疫苗剂量与 HPV 感染之间的关联。
结果
从第 1 波到第 2 波，有≥1 次 HPV 疫苗接种史的男性比例从 23%增加到 44%（p<0.001）。在进行倾向评分加权后，所有男性（29%降至 20%；下降 31%；比值比[OR] = 0.62，95%置信区间[CI] = 0.44-0.88）和未接种疫苗的男性（32%降至 21%；下降 36%；OR = 0.56，95%CI = 0.34-0.86）中，≥1 种疫苗型 HPV 的感染显著减少；而接种疫苗的男性中（21%）的感染减少则不具有统计学意义。疫苗剂量与 HPV 流行率之间的关联没有统计学意义。
结论
HPV 疫苗推荐六年后，所有、接种疫苗和未接种疫苗的男性中疫苗型 HPV 的流行率均下降，支持疫苗的影响和群体保护。所有男性中疫苗型 HPV 的减少似乎是由于未接种疫苗的男性减少所致，这表明疫苗接种的全部影响尚未实现。需要继续监测并努力在开始性行为之前为男性接种疫苗。
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