Montroy Joshua, Salvadori Marina I, Forbes Nicole, Dubey Vinita, Almasri Sarah, Jirovec Anna, Yan Cathy, Gusic Katarina, Stevens Adrienne, Young Kelsey, Tunis Matthew
Centre for Immunization Programs, Public Health Agency of Canada, Ottawa, ON.
Toronto Public Health and University of Toronto Dalla Lana School of Public Health, Toronto, ON.
Can Commun Dis Rep. 2024 Jun 28;50(6):166-178. doi: 10.14745/ccdr.v50i06a01.
Current National Advisory Committee on Immunization (NACI) guidance recommends human papillomavirus (HPV) vaccines be administered as a two or three-dose schedule. Recently, several large clinical trials have reported the clinical benefit of a single HPV vaccine dose. As a result, the World Health Organization released updated guidance on HPV vaccines in 2022, recommending a two-dose schedule for individuals aged 9-20 years, and acknowledging the use of an alternative off-label single dose schedule.
The objective of this overview is to provide a detailed account of the available evidence comparing HPV vaccination schedules, which was considered by NACI when updating recommendations on HPV vaccines.
To identify relevant evidence, existing systematic reviews were leveraged where possible. Individual studies were critically appraised, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence.
Available evidence suggests that a one, two, or three-dose HPV vaccine schedule may provide similar protection from HPV infection. While antibody levels against HPV vaccine types were statistically significantly lower with a single dose schedule compared to two or three doses, titres were sustained for up to 16 years. The clinical significance of lower antibody titres is unknown, as there is no established immunologic correlate of protection.
While the available evidence on single-dose HPV vaccination schedules shows a one-dose schedule is highly effective, continued follow-up of single-dose cohorts will be critical to understanding the relative duration of protection for reduced dose schedules and informing future NACI guidance on HPV vaccines.
当前国家免疫咨询委员会（NACI）指南建议人乳头瘤病毒（HPV）疫苗按两剂或三剂程序接种。最近，多项大型临床试验报告了单剂HPV疫苗的临床益处。因此，世界卫生组织于2022年发布了关于HPV疫苗的更新指南，建议9至20岁的个体采用两剂程序，并认可使用替代的未标明的单剂程序。
本综述的目的是详细介绍比较HPV疫苗接种程序的现有证据，NACI在更新HPV疫苗建议时考虑了这些证据。
为了识别相关证据，尽可能利用现有的系统评价。对个体研究进行严格评估，并使用推荐分级评估、制定和评价（GRADE）方法来评估证据的确定性。
现有证据表明，一剂、两剂或三剂HPV疫苗接种程序可能提供相似的HPV感染防护。虽然与两剂或三剂相比，单剂程序的HPV疫苗类型抗体水平在统计学上显著较低，但抗体滴度可持续长达16年。较低抗体滴度的临床意义尚不清楚，因为尚未确立免疫保护相关指标。
虽然关于单剂HPV疫苗接种程序的现有证据表明单剂程序非常有效，但对单剂队列的持续随访对于了解减少剂量程序的相对保护持续时间以及为NACI未来的HPV疫苗指南提供信息至关重要。
