澳大利亚全国实施 HPV 通用型疫苗接种项目对女性和异性恋男性人群生殖器疣的影响：2004-2018 年全国哨点监测数据分析
Effect on genital warts in Australian female and heterosexual male individuals after introduction of the national human papillomavirus gender-neutral vaccination programme: an analysis of national sentinel surveillance data from 2004-18.
机构信息
Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia; Simon Fraser University, Burnaby, BC, Canada.
出版信息
Lancet Infect Dis. 2021 Dec;21(12):1747-1756. doi: 10.1016/S1473-3099(21)00071-2. Epub 2021 Jul 30.
BACKGROUND
In Australia, the government-funded human papillomavirus (HPV) vaccination programme was introduced in April, 2007, for girls and young women, and in February, 2013, for boys. As of Dec 31, 2018, all Australian-born female individuals younger than 38 years and male individuals younger than 21 years have been eligible for the free quadrivalent or nonavalent HPV vaccine. We aimed to examine the trends in genital wart diagnoses among Australian-born female and heterosexual male individuals who attended sexual health clinics throughout Australia before and after the introduction of the gender-neutral HPV vaccination programme in February, 2013.
METHODS
We did a serial cross-sectional analysis of genital wart diagnoses among Australian-born female and heterosexual male individuals attending a national surveillance network of 35 clinics between Jan 1, 2004, and Dec 31, 2018. We calculated prevalence ratios of genital warts, using log-binomial regression models, for the female-only vaccination period (July 1, 2007, to Feb 28, 2013), gender-neutral vaccination period (March 1, 2013, to Dec 31, 2018), and the whole vaccination period (July 1, 2007, to Dec 31, 2018) compared with the pre-vaccination period (Jan 1, 2004, to June 30, 2007).
FINDINGS
We included 121 038 men and 116 341 women in the analysis. Overall, we observed a 58% reduction (prevalence ratio 0·42, 95% CI 0·40-0·44) in genital wart diagnoses in female individuals and a 45% reduction (0·55, 0·53-0·57) in genital wart diagnoses in heterosexual male individuals after the introduction of the vaccination programme in 2007. The largest reduction in genital warts was observed in younger individuals, and there was a decreasing magnitude of reduction with increasing age (80%, 72%, 61%, 41%, and 16% reductions in female individuals aged 15-20 years, 21-25 years, 26-30 years, 31-35 years, and ≥36 years, respectively; 70%, 61%, 49%, 37%, and 29% reductions in male individuals aged 15-20 years, 21-25 years, 26-30 years, 31-35 years, and ≥36 years, respectively). Significant reductions observed in female individuals (0·32, 0·28-0·36) and male individuals (0·51, 0·43-0·61) aged 15-20 years in the female-only vaccination period were followed by a more substantial reduction in female individuals (0·07, 0·06-0·09) and male individuals (0·11, 0·08-0·15) aged 15-20 years in the gender-neutral vaccination period.
INTERPRETATION
The national gender-neutral HPV vaccination programme has led to substantial and ongoing reduction in genital warts among Australian female and heterosexual male individuals, with a marked reduction in young individuals who received the vaccine at school.
FUNDING
Seqirus Australia and the Australian Government Department of Health.
背景
在澳大利亚，政府资助的人乳头瘤病毒（HPV）疫苗接种计划于 2007 年 4 月开始为女孩和年轻女性接种，于 2013 年 2 月开始为男孩接种。截至 2018 年 12 月 31 日，所有澳大利亚出生的年龄在 38 岁以下的女性和 21 岁以下的男性都有资格免费接种四价或九价 HPV 疫苗。我们旨在研究自 2013 年 2 月实施性别中立 HPV 疫苗接种计划以来，在澳大利亚出生的女性和异性恋男性个体在参加澳大利亚全国性性健康诊所时，生殖器疣诊断的趋势。
方法
我们对 2004 年 1 月 1 日至 2018 年 12 月 31 日期间，参加全国性监测网络的 35 家诊所的澳大利亚出生的女性和异性恋男性个体的生殖器疣诊断情况进行了连续的横断面分析。我们使用对数二项式回归模型计算了女性专用疫苗接种期（2007 年 7 月 1 日至 2013 年 2 月 28 日）、性别中立疫苗接种期（2013 年 3 月 1 日至 2018 年 12 月 31 日）和整个疫苗接种期（2007 年 7 月 1 日至 2018 年 12 月 31 日）与疫苗接种前（2004 年 1 月 1 日至 2007 年 6 月 30 日）相比，生殖器疣的患病率比。
结果
我们纳入了 121038 名男性和 116341 名女性进行分析。总体而言，我们观察到女性生殖器疣诊断减少了 58%（患病率比 0.42，95%CI 0.40-0.44），异性恋男性生殖器疣诊断减少了 45%（0.55，0.53-0.57），自 2007 年疫苗接种计划推出后。在年轻人中观察到生殖器疣的最大减少，随着年龄的增加，减少的幅度也在减小（15-20 岁、21-25 岁、26-30 岁、31-35 岁和≥36 岁的女性个体分别减少 80%、72%、61%、41%和 16%；15-20 岁、21-25 岁、26-30 岁、31-35 岁和≥36 岁的男性个体分别减少 70%、61%、49%、37%和 29%）。在女性专用疫苗接种期（0.32，0.28-0.36）和 15-20 岁的男性个体（0.51，0.43-0.61）中观察到的显著减少，随后在性别中立疫苗接种期（0.07，0.06-0.09）和 15-20 岁的女性个体（0.11，0.08-0.15）和男性个体中观察到更大的减少。
解释
全国性的性别中立 HPV 疫苗接种计划导致澳大利亚女性和异性恋男性生殖器疣的发病率大幅持续下降，在学校接种疫苗的年轻人群中发病率明显下降。
资金
Seqirus Australia 和澳大利亚政府卫生部。
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