Effectiveness of quadrivalent human papillomavirus vaccine for the prevention of cervical abnormalities: case-control study nested within a population based screening programme in Australia.
Effectiveness of quadrivalent human papillomavirus vaccine for the prevention of cervical abnormalities: case-control study nested within a population based screening programme in Australia.
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DOI：
10.1136/bmj.g1458
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发表时间：
2014-03-04
期刊：
影响因子：
--
通讯作者：
Whiteman DC
中科院分区：
文献类型：
--
作者：
Crowe E;Pandeya N;Brotherton JM;Dobson AJ;Kisely S;Lambert SB;Whiteman DC
目的评估澳大利亚昆士兰州实施国家资助的疫苗接种计划4年后，四价人乳头瘤病毒（HPV）疫苗对宫颈异常的有效性。设计关联管理健康数据集的病例对照分析。背景是澳大利亚的昆士兰州。2007年4月至2011年3月期间有资格免费接种疫苗（2007年为12-26岁）并参加首次宫颈涂片检查的妇女。高级别病例是组织学证实的高级别宫颈异常的女性（n=1062），“其他病例”是细胞学或组织学检查有任何其他异常的女性（n=10 887）。对照组为细胞学正常的女性（n=96 404）。主要结局指标暴露比值比（病例与对照组相比，既往接种疫苗（1剂、2剂或3剂疫苗与未接种疫苗相比）的比值）、疫苗有效性（（1-校正比值比）×100）和在第一轮筛查时预防一种宫颈异常所需的疫苗接种人数。我们根据随访时间、出生年份、社会经济地位和偏远程度的衡量标准，按四个年龄组进行分层。主要分析涉及首次涂片检查确定其状态为病例或对照的妇女。结果与细胞学正常的对照组相比，高级别病例暴露于三剂HPV疫苗与未接种疫苗相比的调整后比值比为0.54（95%置信区间0.43至0.67），其他病例为0.66（0.62至0.70），相当于疫苗有效性分别为46%和34%。需要接种疫苗的调整数量分别为125（95%置信区间97 - 174）和22（19 - 25）。两种疫苗剂量的校正暴露比值比对于高级别病例为0.79（95%置信区间0.64至0.98），对于其他病例为0.79（0.74至0.85），相当于疫苗有效性为21%。结论在澳大利亚昆士兰州实施疫苗接种计划之前，四价HPV疫苗对未开始筛查的年轻女性的宫颈异常具有统计学意义的保护作用。
Objective To measure the effectiveness of the quadrivalent human papillomavirus (HPV) vaccine against cervical abnormalities four years after implementation of a nationally funded vaccination programme in Queensland, Australia. Design Case-control analysis of linked administrative health datasets. Setting Queensland, Australia. Participants Women eligible for free vaccination (aged 12-26 years in 2007) and attending for their first cervical smear test between April 2007 and March 2011. High grade cases were women with histologically confirmed high grade cervical abnormalities (n=1062) and “other cases” were women with any other abnormality at cytology or histology (n=10 887). Controls were women with normal cytology (n=96 404). Main outcome measures Exposure odds ratio (ratio of odds of antecedent vaccination (one, two, or three vaccine doses compared with no doses) among cases compared with controls), vaccine effectiveness ((1−adjusted odds ratio)×100), and number needed to vaccinate to prevent one cervical abnormality at first screening round. We stratified by four age groups adjusted for follow-up time, year of birth, and measures of socioeconomic status and remoteness. The primary analysis concerned women whose first ever smear test defined their status as a case or a control. Results The adjusted odds ratio for exposure to three doses of HPV vaccine compared with no vaccine was 0.54 (95% confidence interval 0.43 to 0.67) for high grade cases and 0.66 (0.62 to 0.70) for other cases compared with controls with normal cytology, equating to vaccine effectiveness of 46% and 34%, respectively. The adjusted numbers needed to vaccinate were 125 (95% confidence interval 97 to 174) and 22 (19 to 25), respectively. The adjusted exposure odds ratios for two vaccine doses were 0.79 (95% confidence interval 0.64 to 0.98) for high grade cases and 0.79 (0.74 to 0.85) for other cases, equating to vaccine effectiveness of 21%. Conclusion The quadrivalent HPV vaccine conferred statistically significant protection against cervical abnormalities in young women who had not started screening before the implementation of the vaccination programme in Queensland, Australia.
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DOI：
10.1136/bmj.e1401
发表时间：
2012-03-27
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Joura EA;Garland SM;Paavonen J;Ferris DG;Perez G;Ault KA;Huh WK;Sings HL;James MK;Haupt RM;FUTURE I and II Study Group
通讯作者：
FUTURE I and II Study Group
影响因子：
10.3
作者：
Munoz, Nubia;Kjaer, Susanne K.;Haupt, Richard M.
通讯作者：
Haupt, Richard M.
影响因子：
5.5
作者：
Bonanni, Paolo;Boccalini, Sara;Bechini, Angela
通讯作者：
Bechini, Angela
影响因子：
7.2
作者：
Bender, R;Blettner, M
通讯作者：
Blettner, M
影响因子：
158.5
作者：
Garland, Suzanne M.;Hernandez-Avila, Mauricio;Koutsky, Laura A.
通讯作者：
Koutsky, Laura A.