Ji Mengdi, Huang Zhuoying, Yan Han, Ren Jia, Wagner Abram L, Sun Xiaodong, Boulton Matthew L
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
Department of Immunization Program, Shanghai Municipal Centers for Disease Control & Prevention, Shanghai, China.
Hum Vaccin Immunother. 2025 Dec;21(1):2513707. doi: 10.1080/21645515.2025.2513707. Epub 2025 Jun 9.
Cervical cancer is the fourth most common cancer among women globally and a significant public health challenge in China, which accounts for nearly 18% of global cervical cancer cases. The HPV vaccine is a proven intervention for preventing high-risk HPV infections and associated cancers. This serial cross-sectional study conducted in Shanghai, China, in 2019 and 2024 analyzed changes in HPV vaccination rates and vaccine hesitancy. Multivariable logistic regression was used to assess the associations between HPV vaccination, general vaccine hesitancy, and HPV-specific vaccine hesitancy, adjusting for sociodemographic factors. The Population Attributable Fraction (PAF) quantified the proportion of non-vaccination attributable to these factors. In 2019 and 2024, two waves of data were collected from 1,037 and 1,450 parents, respectively. Results showed an increase in HPV vaccination from 6% to 30% during the study period, primarily among women aged 18 and older, while coverage among the WHO target group (girls aged 9-14) remained low at 8%. Parents with HPV-specific vaccine hesitancy were 75% less likely to vaccinate their daughters (OR = 0.25, 95% CI: 0.11-0.56), while general vaccine hesitancy reduced vaccination likelihood by 94% (OR = 0.06, 95% CI: 0.00-0.89). PAF analysis indicated that HPV-specific vaccine hesitancy contributed to 24% of non-vaccination cases, higher than general vaccine hesitancy (10%). These findings highlight the critical need for targeted interventions addressing HPV-specific barriers, improving education about vaccination timing and options, and reducing logistical obstacles to align with global cervical cancer elimination goals.
宫颈癌是全球女性中第四大常见癌症，在中国也是一项重大的公共卫生挑战，中国的宫颈癌病例占全球近18%。人乳头瘤病毒（HPV）疫苗是预防高危HPV感染及相关癌症的一种经证实有效的干预措施。这项于2019年和2024年在中国上海进行的系列横断面研究分析了HPV疫苗接种率和疫苗犹豫情况的变化。采用多变量逻辑回归评估HPV疫苗接种、一般疫苗犹豫和HPV特异性疫苗犹豫之间的关联，并对社会人口学因素进行了调整。人群归因分数（PAF）量化了可归因于这些因素的未接种疫苗的比例。2019年和2024年分别从1037名和1450名家长中收集了两波数据。结果显示，在研究期间，HPV疫苗接种率从6%上升到30%，主要是18岁及以上女性，而世界卫生组织目标群体（9至14岁女孩）的接种率仍较低，为8%。有HPV特异性疫苗犹豫的家长为女儿接种疫苗的可能性降低75%（比值比[OR]=0.25，95%置信区间[CI]：0.11 - 0.56），而一般疫苗犹豫使接种可能性降低94%（OR=0.06，95% CI：0.00 - 0.89）。PAF分析表明，HPV特异性疫苗犹豫导致24%的未接种病例，高于一般疫苗犹豫（10%）。这些发现凸显了针对HPV特异性障碍进行有针对性干预、改善疫苗接种时间和选择方面的教育以及减少后勤障碍以实现全球消除宫颈癌目标的迫切需求。
