Effectiveness of the Quadrivalent Human Papillomavirus Vaccine Against Cervical Dysplasia in Manitoba, Canada
Effectiveness of the Quadrivalent Human Papillomavirus Vaccine Against Cervical Dysplasia in Manitoba, Canada
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DOI：
10.1200/jco.2013.52.4645
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发表时间：
2014-02-10
影响因子：
45.3
通讯作者：
Demers, Alain A.
中科院分区：
文献类型：
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作者：
Mahmud, Salaheddin M.;Kliewer, Erich V.;Demers, Alain A.
目的：尚未使用基于人群的个体水平数据评估四价人乳头瘤病毒（QHPV）疫苗预防宫颈发育不良的有效性。我们评估了疫苗的有效性（VE）的QHPV疫苗对宫颈发育不良使用常规收集的数据在马尼托巴。方法女性15岁谁收到了QHPV疫苗在马尼托巴之间的2006年9月和2010年4月私人（n = 3,541）的年龄匹配到三个未接种疫苗的女性（n = 9,594）。我们使用考克斯回归模型来估计三种结局的风险比：结果在15- 17岁的青少年中，校正后的VE估计值为35%，针对HSIL、LSIL和ASCUS的检测，分别为95% CI（-19%至65%）、21%（-10%至43%）和-1%（-44%至29%）。在入组后进行一次巴氏涂片检查的患者中，相应的估计值较高（46% [0%至71%]，35% [10%至54%]和23% [-8%至45%]）。QHPV疫苗与23%的（-17%至48%）在没有异常细胞学史的18名患者中，HSIL风险降低，但没有证据表明有这种病史的人会受到保护（-8% [-59%至27%]）。结论很大比例的接种疫苗的妇女可能无法预防HSIL和轻度发育不良，特别是如果她们在年龄较大时接种疫苗（18）或接种前有细胞学异常。这些发现证实了在任何重大HPV暴露发生之前接种疫苗的重要性，并强调了覆盖所有性活跃女性的筛查计划的必要性，即使她们接种了疫苗。(C)2014年美国临床肿瘤学会
Purpose Effectiveness of the quadrivalent human papillomavirus (QHPV) vaccine against cervical dysplasia has not been estimated using population-based individual level data. We assessed the vaccine effectiveness (VE) of the QHPV vaccine against cervical dysplasia using data collected routinely in Manitoba.Methods Females 15 years old who received the QHPV vaccine in Manitoba between September 2006 and April 2010 privately (n = 3,541) were matched on age to up to three nonvaccinated females (n = 9,594). We used Cox regression models to estimate the hazard ratios for three outcomes: atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesions (LSILs), and high-grade SILs (HSILs).Results Among the 15- to 17-year-olds, the adjusted VE estimates were 35% (95% CI, -19% to 65%), 21% (-10% to 43%), and -1% (-44% to 29%) against the detection of HSILs, LSILs, and ASCUS, respectively. The corresponding estimates were higher (46% [0% to 71%], 35% [10% to 54%], and 23% [-8% to 45%]) among those who had one Pap smear after enrollment. The QHPV vaccine was associated with 23% (-17% to 48%) reduction in HSIL risk among those 18 with no history of abnormal cytology, but there was no evidence of protection among those with such a history (-8% [-59% to 27%]).Conclusion A significant percentage of vaccinated women may not be protected against HSIL and lesser dysplasia especially if they were vaccinated at older age ( 18) or had abnormal cytology before vaccination. These findings affirm the importance of vaccination before any significant exposure to HPV occurs and underscore the need for screening programs that cover all sexually active women, even if they were vaccinated. (C) 2014 by American Society of Clinical Oncology