Wu Shiqiang, Ploner Alexander, Astorga Alsina Ana Martina, Deng Yunyang, Ask Schollin Lina, Lei Jiayao
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Unit for Vaccination Programmes, Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden.
Lancet Reg Health Eur. 2025 Jan 5;49:101178. doi: 10.1016/j.lanepe.2024.101178. eCollection 2025 Feb.
One or two-dose schedule for human papillomavirus (HPV) vaccination has been recommended by the World Health Organization and used in many vaccination programs. We aimed to comprehensively evaluate the effectiveness of quadrivalent HPV vaccine against high-grade cervical lesions by age at vaccination and number of doses received.
This cohort study included 2,200,495 females aged 10-35 years old who were residents of Sweden between 2006 and 2022, with 584,676 (26.6%) receiving at least one dose of quadrivalent HPV vaccine. We used Poisson regression models to estimate the incidence rate ratios (IRR) comparing the incidence rate of high-grade cervical lesions in relation to age at vaccination and doses.
In girls initiating vaccination before age 15, we observed IRRs of 0.42 (95% CI 0.33-0.52) after one-dose, 0.54 (0.47-0.63) after two-dose, and 0.50 (0.47-0.53) after three-dose. The IRRs were 0.60 (95% CI 0.52-0.70), 0.55 (0.49-0.62), and 0.54 (0.52-0.56) after one, two or three doses for girls who initiated vaccination age 15-17. For women who initiated vaccination after age 20, higher doses may be needed to achieve a statistically significant risk reduction.
Receiving one or two doses of HPV vaccines prior to age 17, especially for those initiating before age 15, has comparable effectiveness against high-grade cervical lesions with those who received three doses.
Swedish Research Council, Swedish Research Council for Health, Working Life and Welfare, and Karolinska Institutet.
世界卫生组织已推荐人乳头瘤病毒（HPV）疫苗采用一剂或两剂接种方案，并在许多疫苗接种计划中使用。我们旨在按接种年龄和接种剂量全面评估四价HPV疫苗预防高级别宫颈病变的有效性。
这项队列研究纳入了2006年至2022年间居住在瑞典的2200495名10至35岁的女性，其中584676名（26.6%）接受了至少一剂四价HPV疫苗。我们使用泊松回归模型来估计发病率比（IRR），以比较高级别宫颈病变的发病率与接种年龄和剂量的关系。
在15岁之前开始接种疫苗的女孩中，我们观察到一剂接种后的IRR为0.42（95%CI 0.33 - 0.52），两剂接种后为0.54（0.47 - 0.63），三剂接种后为0.50（0.47 - 0.53）。对于15至17岁开始接种疫苗的女孩，一剂、两剂或三剂接种后的IRR分别为0.60（95%CI 0.52 - 0.70）、0.55（0.49 - 0.62）和0.54（0.52 - 0.56）。对于20岁之后开始接种疫苗的女性，可能需要更高剂量才能在统计学上显著降低风险。
在17岁之前接种一剂或两剂HPV疫苗，特别是对于15岁之前开始接种的人，预防高级别宫颈病变的有效性与接种三剂的人相当。
瑞典研究委员会、瑞典健康、工作生活与福利研究委员会以及卡罗林斯卡学院。
