Is one dose of human papillomavirus vaccine as effective as three?: A national cohort analysis
Is one dose of human papillomavirus vaccine as effective as three?: A national cohort analysis
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DOI：
10.1016/j.pvr.2019.100177
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发表时间：
2019-12-01
影响因子：
3.2
通讯作者：
Saville, Marion
中科院分区：
文献类型：
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作者：
Brotherton, Julia M. L.;Budd, Alison;Saville, Marion
目的：预防性人乳头瘤病毒（HPV）疫苗在预防宫颈癌前病变方面非常有效，当以三剂时间表给予时。一些事后试验数据表明，一剂预防HPV感染。如果一剂就能预防癌前宫颈病变，那么全球宫颈癌预防工作将大大便利。我们评估了四价HPV疫苗在澳大利亚接种后7年内对宫颈上皮内瘤变（CIN）2或3/原位腺癌（AIS）/癌症的有效性。方法：我们将所有8个管辖区宫颈筛查登记处的登记数据与国家HPV疫苗接种登记处的数据相关联，在2007年4月（开始接种疫苗时）至2014年12月31日期间进行筛查的所有15岁或15岁以下有资格接种疫苗的澳大利亚妇女的死亡指数和癌症登记。我们进行了考克斯比例风险回归，对年龄、社会经济地位和居住地区进行了先验调整，以估计组织学确诊的CIN 2/CIN 3/AIS/癌症的风险比。结果：我们纳入了250,648名女性：48，845人（19.5%）未接种疫苗，174，995人（69.8%）接种了三剂疫苗，18，190人（7.3%）接种了两剂疫苗，8，618人（3.4%）接种了一剂疫苗。与未接种疫苗的女性相比，所有剂量组的校正风险比均显著较低（1剂0.65（95%CI 0.52-0.81），2剂0.61（0.52-0.72）和3剂0.59（0.54-0.65））。在疫苗接种组中调整疫苗接种时的年龄后，一剂和两剂接种者的调整后风险比与三剂接种者相当（一剂1.01（95%CI 0.81-1.26），两剂1.00（0.85-1.17））。多项敏感性分析（包括使用不同的剂量分配方法）产生了一致的结果。与历史队列的年龄相匹配的妇女的比较表明，结果是不是由于畜群protection alternatives.Conclusions：一个剂量有相当的有效性，两个或三个剂量在预防高级别的疾病，在高覆盖率的设置。这些发现支持了一种假设，即在全球消除宫颈癌时，一剂疫苗接种可能是一种可行的策略。
Aim: Prophylactic human papillomavirus (HPV) vaccines are highly effective at preventing pre-cancerous cervical lesions when given in a three-dose schedule. Some post-hoc trial data suggest that one dose prevents HPV infection. If one dose could prevent pre-cancerous cervical lesions, then global cervical cancer prevention would be greatly facilitated. We assessed the effectiveness of quadrivalent HPV vaccine by number of doses against cervical intraepithelial neoplasia (CIN) 2 or 3/adenocarcinoma-in-situ (AIS)/cancer in Australia up to seven years post vaccination.Methods: We linked registry data from all 8 jurisdictional cervical screening registers, with the national HPV vaccination register, death index and cancer registers for all Australian women aged 15 or under when eligible for vaccine who screened between April 2007 (when vaccination commenced) and 31 December 2014. We performed Cox proportional hazard regression, adjusted a priori for age, socioeconomic status, and area of residence, to estimate hazard ratios of histologically confirmed CIN2/CIN3/AIS/cancer.Results: We included 250,648 women: 48,845 (19.5%) unvaccinated, 174,995 (69.8%) had received three doses, 18,190 (7.3%) two doses and 8,618 (3.4%) one dose. The adjusted hazard ratio was significantly lower for all dose groups compared to unvaccinated women (1 dose 0.65 (95%CI 0.52-0.81), 2 doses 0.61 (0.52-0.72) and 3 doses 0.59 (0.54-0.65).) With adjustment for age at vaccination amongst the vaccinated group, the adjusted hazard ratios for one dose and two dose recipients were comparable to three dose recipients (one dose 1.01 (95%CI 0.81-1.26), two doses 1.00 (0.85-1.17).) Multiple sensitivity analyses, including use of different dose assignment methods, produced consistent findings. Comparison with a historical cohort of age matched women showed that the result was not due to herd protection alone.Conclusions: One dose had comparable effectiveness as two or three doses in preventing high-grade disease in a high coverage setting. These findings support the hypothesis that one dose vaccination may be a viable strategy when working towards the global elimination of cervical cancer.