Assessment of herd effects among women and heterosexual men after girls-only HPV16/18 vaccination in the Netherlands: A repeated cross-sectional study
Assessment of herd effects among women and heterosexual men after girls-only HPV16/18 vaccination in the Netherlands: A repeated cross-sectional study
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DOI：
10.1002/ijc.31989
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发表时间：
2019-06-01
影响因子：
6.4
通讯作者：
Pelgrim, M.
中科院分区：
文献类型：
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作者：
Woestenberg, Petra J.;Bogaards, Johannes A.;Pelgrim, M.
关于人乳头瘤病毒（HPV）疫苗接种对人群HPV患病率影响的数据主要来自女性。我们使用PASSYON研究的数据，评估了2009年开始的荷兰女孩HPV 16/18疫苗接种计划对女性和异性恋男性HPV患病率趋势的影响。在这项横断面研究中，在2009年，2011年，2013年和2015年评估了16至24岁的性传播感染诊所访客中的HPV患病率。我们使用Poisson GEE模型比较了生殖器接种后HPV感染率与接种前HPV感染率（2009年）。总共有4，996名女性和1，901名异性恋男性。报告接种疫苗的妇女比例从2009年的2.3%增加到2015年的37%。在所有女性中，HPV 16/18的患病率从接种前的23%下降到2015年的15%（调整后的患病率[aPR] 0.62，p（趋势）< 0.01）。在异性恋男性中，HPV 16/18的患病率从接种前的17%下降到2015年的11%（aPR 0.52，p（趋势）< 0.01）。在有固定伴侣的异性恋男性中，HPV 16/18的患病率在那些固定伴侣在国家免疫规划中符合疫苗接种条件的人中较低（aPR 0.13）。在未接种疫苗的女性中，2015年HPV 16/18的患病率与接种前没有差异。异性恋男性中HPV 16/18患病率的下降以及具有符合接种条件的稳定伴侣的异性恋男性中HPV 16/18患病率的下降强烈表明仅女孩接种疫苗的群体保护。未接种疫苗的妇女在接种疫苗6年后没有出现明显的群体效应，这可能是由于荷兰女孩的疫苗接种量适中。人乳头瘤病毒（HPV）是一种性传播病毒，在男性和女性的肛门生殖器癌和口咽癌的发展中起着因果作用。然而，HPV疫苗接种计划对HPV患病率的人群水平影响主要在女性中进行研究。这项研究显示，在荷兰引入仅针对女孩的HPV 16/18疫苗接种计划后，女性和异性恋男性中HPV 16和HPV 18的患病率呈下降趋势。这些发现为男性群体保护提供了令人信服的证据。由于HPV 16/18是最致癌的类型，因此在仅女孩接种HPV疫苗后，HPV相关癌症预计将在两性中下降。
Data on the impact of human papillomavirus (HPV) vaccination on the population HPV prevalence are largely obtained from women. We assessed the impact of the girls-only HPV16/18 vaccination program in the Netherlands that started in 2009, on trends in HPV prevalence among women and heterosexual men, using data from the PASSYON study. In this cross-sectional study, the HPV prevalence among 16- to 24-year-old visitors to sexually transmitted infection clinics was assessed in 2009, 2011, 2013, and 2015. We compared the genital postvaccination HPV prevalence with the prevaccination prevalence (2009) using Poisson GEE models. In total, we included 4,996 women and 1,901 heterosexual men. The percentage of women who reported to be vaccinated increased from 2.3% in 2009 to 37% in 2015. Among all women, the HPV16/18 prevalence decreased from 23% prevaccination to 15% in 2015 (adjusted prevalence ratio [aPR] 0.62, p(trend) < 0.01). Among heterosexual men, the HPV16/18 prevalence decreased from 17% prevaccination to 11% in 2015 (aPR 0.52, p(trend) < 0.01). Of the heterosexual men with a steady partner, HPV16/18 prevalence was lower among those whose steady partner had been vaccine-eligible in the national immunization program (aPR 0.13). Among unvaccinated women, the HPV16/18 prevalence in 2015 was not different from prevaccination. The decreasing HPV16/18 prevalence among heterosexual men and the reduced HPV16/18 prevalence among heterosexual men with a vaccine-eligible steady partner strongly suggests herd protection from girls-only vaccination. Absence of notable herd effects among unvaccinated women 6 years postvaccination may be due to the moderate vaccine uptake among girls in the Netherlands.What's new? Human papillomavirus (HPV) is a sexually transmitted virus that plays a causal role in the development of anogenital and oropharyngeal cancers in both men and women. The population-level impact of HPV vaccination programs on the HPV prevalence has however mainly been studied in women. This study shows decreasing trends in the HPV16 and HPV18 prevalence among both women and heterosexual men after the introduction of a girls-only HPV16/18 vaccination program in the Netherlands. The findings provide compelling evidence for herd protection in men. Because HPV16/18 are the most oncogenic types, HPV-related cancers are expected to decline in both sexes after girls-only HPV vaccination.