Evaluation of HPV type-replacement in unvaccinated and vaccinated adolescent females-Post-hoc analysis of a community-randomized clinical trial (II)
Evaluation of HPV type-replacement in unvaccinated and vaccinated adolescent females-Post-hoc analysis of a community-randomized clinical trial (II)
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DOI：
10.1002/ijc.31281
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发表时间：
2018-06-15
影响因子：
6.4
通讯作者：
Lehtinen, Matti
中科院分区：
文献类型：
--
作者：
Gray, Penelope;Palmroth, Johanna;Lehtinen, Matti
人乳头瘤病毒（HPV）疫苗的有效性有望控制HPV感染。然而，HPV疫苗接种计划可能会暴露出非疫苗HPV类型的生态位。我们在一项在HPV疫苗接种初治人群中进行的社区随机试验中评估了HPV类型和疫苗接种策略的类型替代。33个社区被随机分配至性别中立的AS 04佐剂HPV 16/18疫苗接种组（A组）、女孩HPV疫苗接种组和男孩乙型肝炎病毒（HBV）疫苗接种组（B组）以及性别中立的HBV疫苗接种组（C组）。1992-95年出生的男孩（40 852人）和女孩（39 420人）被邀请。11 662名男孩和20 513名女孩接种了疫苗，覆盖率分别为20-30%和45-48%。采用高通量PCR对11,396例宫颈阴道标本进行HPV分型。计算两组间的患病率（PR）、HPV类型的排序以及HPV 16或18/45阳性个体中具有多种HPV类型的比值比（OR）。HPV类型的排序在两组或出生队列之间没有显著差异。对于未接种HPV疫苗的1992-1993年出生队列，观察到HPV 39（PRA 1.84，95% CI 1.12-3.02）和HPV 51（PRA 1.56，95% CI 1.11-2.19）的性别中性干预组与对照组之间的PR增加。在性别中立组中，在1994-1995年未接种HPV疫苗的出生队列中观察到HPV 39和疫苗覆盖的HPV 16或18/45型（ORA 16 = 5.1，ORA 18/45 = 11.4）之间的聚集性增加。在仅女孩组中，HPV 51与HPV 16或HPV 18/45之间的聚集性相当（ORB 16 = 4.7，ORB 18/45 = 4.3）。总之，未观察到明确一致的接种后HPV类型替换模式。HPV 39和HPV 51的未来发生值得研究。
Efficacy of human papillomavirus (HPV) vaccines promises to control HPV infections. However, HPV vaccination programs may lay bare an ecological niche for non-vaccine HPV types. We evaluated type-replacement by HPV type and vaccination strategy in a community-randomized trial executed in HPV vaccination naive population. Thirty-three communities were randomized to gender-neutral vaccination with AS04-adjuvanted HPV16/18 vaccine (Arm A), HPV vaccination of girls and hepatitis B-virus (HBV) vaccination of boys (Arm B) and gender-neutral HBV vaccination (Arm C). Resident 1992-95 born boys (40,852) and girls (39,420) were invited. 11,662 boys and 20,513 girls were vaccinated with 20-30% and 45-48% coverage, respectively. HPV typing of 11,396 cervicovaginal samples was performed by high throughput PCR. Prevalence ratios (PR) between arms and ranked order of HPV types and odds ratio (OR) for having multiple HPV types in HPV16 or 18/45 positive individuals were calculated. The ranked order of HPV types did not significantly differ between arms or birth cohorts. For the non-HPV vaccinated 1992-1993 birth cohorts increased PR, between the gender-neutral intervention versus control arms for HPV39 (PRA 1.84, 95% CI 1.12-3.02) and HPV51 (PRA 1.56, 95% CI 1.11-2.19) were observed. In the gender-neutral arm, increased clustering between HPV39 and the vaccine-covered HPV types 16 or 18/45 (ORA16 = 5.1, ORA18/45 = 11.4) was observed in the non-HPV vaccinated 1994-1995 birth cohorts. Comparable clustering was seen between HPV51 and HPV16 or HPV18/45 (ORB16 = 4.7, ORB18/45 = 4.3), in the girls-only arm. In conclusion, definitively consistent postvaccination patterns of HPV type-replacement were not observed. Future occurrence of HPV39 and HPV51 warrant investigation.