Dong Li, Nygård Mari, Støer Nathalie C, Klungsøyr Ole, Hansen Bo T
Department of Research, Cancer Registry of Norway, Oslo, Norway.
Institutes of Biomedical Sciences, Shanxi University, Taiyuan, China.
Int J Cancer. 2023 Jul 15;153(2):399-406. doi: 10.1002/ijc.34489. Epub 2023 Mar 9.
Human papillomavirus (HPV) vaccine effectiveness may differ between settings. Here we present the first real-world effectiveness study of HPV vaccination on high-grade cervical lesions from Norway, among women who received HPV vaccine outside the routine program. We performed an observational study of all Norwegian women born 1975 to 1996 and retrieved individual data from nationwide registries on HPV vaccination status and incidence of histologically verified high-grade cervical neoplasia during 2006 to 2016. We estimated the incidence rate ratio (IRR) and 95% confidence intervals (CI) for vaccination vs no vaccination by Poisson regression stratified by age at vaccination <20 years and ≥20 years. The cohort consisted of 832 732 women, of which 46 381 (5.6%) received at least one dose of HPV vaccine by the end of 2016. The incidence rate of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) increased with age regardless of vaccination status and was highest at age 25 to 29, at 637/100 000 among unvaccinated women, 487/100 000 among women vaccinated before age 20 and 831/100 000 among women vaccinated at age 20 or older. The adjusted IRR of CIN2+ between vaccinated and unvaccinated women was 0.62 (95% CI: 0.46-0.84) for women vaccinated below age 20, and 1.22 (95% CI: 1.03-1.43) for women vaccinated at age 20 or older. These findings indicate that HPV vaccination among women too old to be eligible for routine HPV vaccination is effective among women who are vaccinated below age 20 but may not have the desired impact among women who are vaccinated at age 20 or older.
人乳头瘤病毒（HPV）疫苗的有效性在不同环境下可能存在差异。在此，我们展示了挪威针对非按常规计划接种HPV疫苗的女性进行的、关于HPV疫苗对高级别宫颈病变的首次真实世界有效性研究。我们对所有1975年至1996年出生的挪威女性进行了一项观察性研究，并从全国性登记处获取了关于HPV疫苗接种状况以及2006年至2016年期间经组织学证实的高级别宫颈肿瘤发生率的个体数据。我们通过按接种时年龄<20岁和≥20岁分层的泊松回归估计了接种疫苗与未接种疫苗的发病率比（IRR）及95%置信区间（CI）。该队列由832732名女性组成，其中46381名（5.6%）在2016年底前接种了至少一剂HPV疫苗。无论接种状况如何，宫颈上皮内瘤变2级或更严重病变（CIN2+）的发病率均随年龄增长而上升，在25至29岁时最高，未接种疫苗的女性中为637/100000，20岁之前接种疫苗的女性中为487/100000，20岁及以上接种疫苗的女性中为831/100000。20岁以下接种疫苗的女性与未接种疫苗的女性相比，CIN2+的调整后IRR为0.62（95%CI：0.46 - 0.84），20岁及以上接种疫苗的女性为1.22（95%CI：1.03 - 1.43）。这些发现表明，对于年龄太大而不符合常规HPV疫苗接种资格的女性，HPV疫苗接种在20岁以下接种的女性中是有效的，但在20岁及以上接种的女性中可能没有预期效果。
