Early Impact of Human Papillomavirus Vaccination on Cervical NeoplasiauNationwide Follow-up of Young Danish Women
Early Impact of Human Papillomavirus Vaccination on Cervical NeoplasiauNationwide Follow-up of Young Danish Women
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DOI：
10.1093/jnci/djt460
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发表时间：
2014-03-01
影响因子：
10.3
通讯作者：
Kjaer, Susanne K.
中科院分区：
文献类型：
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作者：
Baldur-Felskov, Birgitte;Dehlendorff, Christian;Kjaer, Susanne K.
在临床试验中，针对人乳头瘤病毒 (HPV) 的疫苗对于预防 HPV16 或 HPV18 相关的宫颈病变非常有效。四价HPV疫苗于2006年获得许可，随后在丹麦疫苗接种计划中实施。该研究的目的是利用有关HPV疫苗接种状况的个人信息来评估随后发生宫颈病变的风险。采用队列研究设计，我们识别了1989年至1999年期间在丹麦出生的所有女孩和妇女，并从全国登记处获得了2006年至2012年期间个人HPV疫苗接种状况的信息。通过与全国病理数据库的连接来识别宫颈病变的事件病例。我们比较了 Cox 比例风险模型中按出生队列分层的已接种疫苗和未接种疫苗的女孩和妇女。1991 年至 1994 年出生队列中接种疫苗的妇女中，异型性或更严重（异型性）和宫颈上皮内瘤变 2 级或 3 级 (CIN2/3) 的风险在统计学上显着降低（19911992（异型性）：风险比 [HR] 0.46， 双边 95% 置信区间 [CI] 0.39 至 0.56； 19911992(CIN2/3)：HR 0.56，95% CI 0.37 至 0.84； 19931994（异型性）：HR 0.40，95% CI 0.29 至 0.56； 19931994 (CIN2/3)：HR 0.27，95% CI 0.10 至 0.67）。 1989年至1990年出生队列的异型性风险在统计学上显着降低（HR 0.75；95% CI 0.65至0.86）； CIN2/3 的风险也有所降低，但没有统计学意义。 1997年至1999年出生队列中的女孩中没有发生任何事件，而1995年至1996年出生队列中的风险比只能计算异型性。四价HPV疫苗在丹麦获得许可六年后，在人群水平上观察到宫颈病变的风险降低。
In clinical trials, vaccines against human papillomavirus (HPV) have been highly effective against HPV16- or HPV18-associated cervical lesions. The quadrivalent HPV vaccine was licensed in 2006 and subsequently implemented in the Danish vaccination program. The study aim was to use individual information on HPV vaccination status to assess subsequent risk of cervical lesions.Using a cohort study design, we identified all girls and women born in Denmark in the period from 1989 to 1999 and obtained information on individual HPV vaccination status in the period from 2006 to 2012 from nationwide registries. Incident cases of cervical lesions were identified by linkage to the nationwide Pathology Data Bank. We compared vaccinated and unvaccinated girls and women stratified by birth cohort in Cox proportional hazards models.Risk of atypia or worse (atypia) and of cervical intraepithelial neoplasia grade 2 or 3 (CIN2/3) were statistically significantly reduced among vaccinated women in birth cohorts 1991 to 1994 (19911992(atypia): hazard ratio [HR] 0.46, two-sided 95% confidence interval [CI] 0.39 to 0.56; 19911992(CIN2/3): HR 0.56, 95% CI 0.37 to 0.84; 19931994(atypia): HR 0.40, 95% CI 0.29 to 0.56; 19931994 (CIN2/3): HR 0.27, 95% CI 0.10 to 0.67). The birth cohort 1989 to 1990 had a statistically significantly reduced risk of atypia (HR 0.75; 95% CI 0.65 to 0.86); the risk of CIN2/3 was also decreased but not statistically significant. No events occurred among girls in the birth cohort 1997 to 1999, whereas for the birth cohort 1995 to 1996 a hazard ratio could be calculated only for atypia.Six years after licensure of the quadrivalent HPV vaccine in Denmark, a reduced risk of cervical lesions is observed at the population level.