Reduction in HPV16/18 prevalence among young women with high-grade cervical lesions following the Japanese HPV vaccination program
Reduction in HPV16/18 prevalence among young women with high-grade cervical lesions following the Japanese HPV vaccination program
复制标题
DOI：
10.1111/cas.14212
复制
发表时间：
2019-11-04
期刊：
影响因子：
5.7
通讯作者：
Yoshikawa, Hiroyuki
中科院分区：
文献类型：
--
作者：
Matsumoto, Koji;Yaegashi, Nobuo;Yoshikawa, Hiroyuki
日本政府于2010年开始为12-16岁的女孩接种人类乳头瘤病毒（HPV）疫苗，但由于潜在的不良反应，于2013年撤回了该建议，导致疫苗接种率大幅下降。为了评估人群水平的HPV疫苗接种效果，自2012年以来，每年在21个参与研究的机构登记新诊断为宫颈上皮内瘤变1-3级（CIN1-3）、原位腺癌（AIS）或浸润性宫颈癌（ICC）的40岁以下女性。2012-2017年共登记了7709名妇女，其中5045名为HPV基因型。在6年期间，仅在25岁以下女性中，CIN1 （50.0% ~ 0.0%， p趋势< 0.0001）和CIN2-3/AIS （83.3% ~ 45.0%， p趋势= 0.07）疫苗型HPV16和HPV18的流行率呈下降趋势。总体而言，HPV疫苗接种将hpv16 /18归因于CIN2-3/AIS的比例从47.7%降低到33.0% (P = 0.003)；常规疫苗接种从43.5%降低到12.5% (P = 0.08)，补种疫苗接种从47.8%降低到36.7% （P = 0.04）。在20岁或以下首次接种疫苗的女性中，CIN2-3/AIS病例中HPV16/18的流行率显著降低（P = 0.02）。由于25岁以下女性的ICC发病率较低，我们无法评估疫苗接种对ICC的影响。我们发现HPV疫苗在日本对hpv16 /18阳性CIN/AIS有有效的保护作用；然而，我们的数据不支持20岁以上女性的补种疫苗。由于政府暂停疫苗推荐而错过常规疫苗接种的年龄较大的青少年可以在20岁之前接受补充疫苗接种。
The Japanese government began a human papillomavirus (HPV) vaccination program for girls aged 12-16 years in 2010 but withdrew its recommendation in 2013 because of potential adverse effects, leading to drastically reduced vaccination uptake. To evaluate population-level effects of HPV vaccination, women younger than 40 years of age newly diagnosed with cervical intraepithelial neoplasia grade 1-3 (CIN1-3), adenocarcinoma in situ (AIS), or invasive cervical cancer (ICC) have been registered at 21 participating institutes each year since 2012. A total of 7709 women were registered during 2012-2017, of which 5045 were HPV genotyped. Declining trends in prevalence of vaccine types HPV16 and HPV18 during a 6-year period were observed in CIN1 (50.0% to 0.0%, P-trend < .0001) and CIN2-3/AIS (83.3% to 45.0%, P-trend = .07) only among women younger than 25 years of age. Overall, HPV vaccination reduced the proportion of HPV16/18-attributable CIN2-3/AIS from 47.7% to 33.0% (P = .003): from 43.5% to 12.5% as routine vaccination (P = .08) and from 47.8% to 36.7% as catch-up vaccination (P = .04). The HPV16/18 prevalence in CIN2-3/AIS cases was significantly reduced among female individuals who received their first vaccination at age 20 years or younger (P = .02). We could not evaluate vaccination effects on ICC owing to low incidence of ICC among women aged less than 25 years. We found HPV vaccination to be effective in protecting against HPV16/18-positive CIN/AIS in Japan; however, our data did not support catch-up vaccination for women older than 20 years. Older adolescents who skipped routine vaccination due to the government's suspension of its vaccine recommendation could benefit from receiving catch-up vaccination before age 20 years.