Cervical Intraepithelial Neoplasia Rates in British Columbia Women: A Population-Level Data Linkage Evaluation of the School-Based HPV Immunization Program
Cervical Intraepithelial Neoplasia Rates in British Columbia Women: A Population-Level Data Linkage Evaluation of the School-Based HPV Immunization Program
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DOI：
10.1093/infdis/jiz422
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发表时间：
2020-01-01
影响因子：
6.4
通讯作者：
Ogilvie, Gina
中科院分区：
文献类型：
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作者：
Racey, C. Sarai;Albert, Arianne;Ogilvie, Gina
背景。为了了解真实世界的人乳头瘤病毒（HPV）疫苗的影响，使用基于人群的数据进行持续评估至关重要。我们评估了以学校为基础的HPV免疫计划对加拿大不列颠哥伦比亚省妇女宫颈发育不良的早期影响。使用省级子宫颈筛查和免疫登记的记录进行数据链接。比较了1994-2005年出生的未接种hpv疫苗和接种hpv疫苗的妇女的癌前预后。采用未调整和调整的细胞学（HSIL）和组织病理学（CIN2、CIN3和CIN2+）泊松回归，比较不同接种状态组的发病率、相对率（RR）和疫苗有效性（VE）。与未接种疫苗的妇女相比，在9至14岁期间接受完整系列疫苗的妇女在7年随访期间CIN2+的调整RR = 0.42(95%可信区间[CI]， 0.31-0.57)，导致VE为57.9% （95% CI, 43.2%-69.0%）。HSIL的校正RR为0.53 (95% CI, 0.43 - 0.64)， VE为47.1% （95% CI, 35.6%-56.7%）。接种HPV疫苗的妇女与未接种疫苗的妇女相比，宫颈发育不良的发生率较低。应鼓励9至14岁的儿童进行免疫接种。持续的项目评估对于衡量长期的人口影响非常重要。
Background. To understand real-world human papillomavirus (HPV) vaccine impact, continuous evaluation using populationbased data is critical. We evaluated the early impact of the school-based HPV immunization program on cervical dysplasia in women in British Columbia, Canada.Methods. Data linkage was performed using records from provincial cervical screening and immunization registries. Precancerous outcomes were compared between unvaccinated and HPV-vaccinated women born 1994-2005. Incidence rate, relative rate (RR), and vaccine effectiveness (VE), using unadjusted and adjusted Poisson regression of cytology (HSIL) and histopathology (CIN2, CIN3, and CIN2+) outcomes, were compared across vaccination status groups.Results. Women who received a complete series of vaccine on schedule between age 9 and 14 years had an adjusted RR = 0.42 (95% confidence interval [CI], 0.31-0.57) for CIN2+ over 7 years of follow-up compared to unvaccinated women, resulting in a VE of 57.9% (95% CI, 43.2%-69.0%). Adjusted RR for HSIL was 0.53 (95% CI, .43-.64), resulting in a VE of 47.1% (95% CI, 35.6%-56.7%).Conclusion. Women vaccinated against HPV have a lower incidence of cervical dysplasia compared to unvaccinated women. Immunization between 9 and 14 years of age should be encouraged. Continued program evaluation is important for measuring long-term population impact.