Investigating the impact of Britain's HPV vaccination program to inform national public health interventions in the next decade

大多数宫颈癌病例是由高危人乳头瘤病毒(HPV)感染引起的，特别是HPV16型和18型。英国每年约有3200例新的宫颈癌病例。然而，与HPV相关的癌症，如宫颈癌，可以通过接种疫苗来预防。宫颈癌还可以通过常规宫颈癌筛查(向25岁及以上的所有妇女提供)及早发现和治疗异常细胞来预防。在英国，自2008年以来，HPV疫苗(二价Cervarx至2012年9月，四价Gardasil于2012-2021年，9价Gardasil于2021/2022年)已向所有12或13岁的女孩提供。2018年7月，该计划扩大到包括相同年龄段的男孩，以及2018年4月与男性发生性行为的男性(MSM)。英国和全球的早期证据表明，疫苗接种计划在降低接种人群中HPV感染率方面取得了巨大成功，从而预防了HPV相关癌症，尽管尚不清楚这些影响和感染在不同人群中是否一致。还不清楚是否会发生疫苗可预防的HPV类型(例如高危HPV16/18型)与非疫苗类型的“类型替换”，或非疫苗类型的交叉保护。《十年一度的全国性态度和生活方式调查》(Natsal)研究是英国一项具有代表性的性健康人口调查。Natsal-2(1999-2001年)提供了用于指导疫苗接种计划设计的特定类型HPV的基线流行率，最近的Natsal研究(Natsal-3；2010-12)捕捉到了最初追赶HPV疫苗接种计划的早期影响和宫颈癌筛查吸收方面的不平等。来自Natsal-4(2022-23年)的数据将对确定这些HPV干预措施在人口水平上的效果至关重要。该项目将使用Natsal-4研究的数据以及常规监测数据来分析特定类型的HPV流行率以及HPV疫苗接种和宫颈癌筛查的情况，这些筛查与一系列人口和行为因素有独特联系，以评估对不平等的影响和有针对性的干预机会。在接下来的十年里，这些数据将对国家公共卫生政策和估计一系列干预措施的数学模型至关重要，包括适应疫苗时间表(例如单剂)、宫颈癌筛查以及向年轻群体推广。

Most cervical cancer cases are caused by infection with high-risk human papillomavirus (HPV), particularly HPV types 16 and 18. Annually, there are approximately 3,200 new cases of cervical cancer in the UK. However, HPV-related cancers, such as cervical cancer, can be prevented through vaccination. Cervical cancer can also be prevented through early detection and treatment of abnormal cells through routine cervical cancer screening (offered to all women aged 25 and over). In the UK, the HPV vaccine (bivalent Cervarix until September 2012, quadrivalent Gardasil from 2012-2021, and 9-valent Gardasil 9 in 2021/2022) has been offered to all girls aged 12 or 13 years since 2008. The program was expanded to include boys in the same age bracket in July 2018, as well as men who have sex with men (MSM) in April 2018. Early evidence, both in the UK and globally, suggests that the vaccination program has been highly successful at reducing HPV prevalence among vaccinated individuals and therefore preventing HPV-related cancers, though it is unclear whether the effects and uptake are consistent across population groups. It is also unclear whether 'type replacement' of the vaccine-preventable HPV types (e.g. high-risk HPV types 16/18) with non-vaccine types, or cross-protection of non-vaccine types, will occur. The decennial National Survey of Sexual Attitudes and Lifestyles (Natsal) study is a representative population survey on sexual health in Britain. Natsal-2 (1999-2001) provided baseline type-specific HPV prevalence used to inform the design of the vaccination program, and the most recent Natsal study (Natsal-3; 2010-12) captured the early effects of the initial catch-up HPV vaccination program and inequalities in cervical cancer screening uptake. Data from Natsal-4 (2022-23) will be crucial to determine the effect of these HPV interventions at a population level. This project will use data from the Natsal-4 study, as well as routine surveillance data, to analyse type-specific HPV prevalence and uptake of HPV vaccination and cervical cancer screening uniquely linked to a range of demographic and behavioural factors to assess impact on inequalities and opportunities for targeted interventions. Over the next ten years, these data will be critical to inform national public health policy and mathematical models estimating a range of interventions, including adaptations to vaccine schedule (e.g. to single dose), cervical cancer screening, and roll out to younger age groups.