澳大利亚女性在疫苗接种计划引入 9-12 年后的人乳头瘤病毒流行率和危险因素。
Human papillomavirus prevalence and risk factors among Australian women 9-12 years after vaccine program introduction.
机构信息
Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia; Molecular Microbiology Group, Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Australia.
Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia; Molecular Microbiology Group, Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.
出版信息
Vaccine. 2021 Aug 9;39(34):4856-4863. doi: 10.1016/j.vaccine.2021.07.005. Epub 2021 Jul 17.
BACKGROUND
In Australia, high and widespread uptake of the quadrivalent human papillomavirus (HPV) vaccine has led to substantial population-level reductions in the prevalence of quadrivalent vaccine targeted HPV genotypes 6/11/16/18 in women aged ≤ 35 years. We assessed risk factors for HPV detection among 18-35 year old women, 9-12 years after vaccine program introduction.
METHODS
Women attending health services between 2015 and 2018 provided a self-collected vaginal specimen for HPV genotyping (Roche Linear Array) and completed a questionnaire. HPV vaccination status was validated against the National Register. Adjusted odds ratios (aORs) and 95% confidence intervals (CI) were calculated for factors associated with HPV detection.
RESULTS
Among 1564 women (median age 24 years; IQR 21-27 years), Register-confirmed ≥ 1-dose vaccine coverage was highest at 69.3% and 68.1% among women aged 18-21 and 22-24 years respectively, decreasing to 42.9% among those aged 30-35 years. Overall prevalence of quadrivalent vaccine-targeted HPV types was very low (2.0%; 95% CI: 1.4-2.8%) and influenced only by vaccination status (5.5% among unvaccinated compared with 0.7% among vaccinated women; aOR = 0.13 (95% CI: 0.05-0.30)). Prevalence of remaining HPV types, at 40.4% (95% CI: 38.0-42.9%), was influenced by established risk factors for HPV infection; younger age-group (p-trend < 0.001), more recent (p < 0.001) and lifetime sexual partners (p-trend < 0.001), but not vaccination status. Prevalence of HPV31/33/45, which shared risk factors with that of non-vaccine targeted HPV types, was also lower among vaccinated (4%) compared with unvaccinated (7%) women (aOR = 0.51; 95% CI: 0.29-0.89), indicative of cross-protection.
CONCLUSION
Vaccination has changed the epidemiology of HPV infection in Australian women, having markedly reduced the prevalence of vaccine-targeted types, including amongst women with known risk factors for infection. Vaccinated women appear to be benefiting from modest cross-protection against types 31/33/45 afforded by the quadrivalent HPV vaccine. These results reinforce the importance of HPV vaccination.
背景
在澳大利亚，四价人乳头瘤病毒（HPV）疫苗的高接种率和广泛接种率导致了女性中四价疫苗针对的 HPV 基因型 6/11/16/18 的流行率显著降低，年龄在 35 岁以下。我们评估了在疫苗计划引入 9-12 年后，18-35 岁女性中 HPV 检测的危险因素。
方法
2015 年至 2018 年间，在卫生服务机构就诊的女性提供了自我采集的阴道标本进行 HPV 基因分型（罗氏线性阵列）并完成了问卷调查。HPV 疫苗接种状况通过国家登记处进行了验证。计算了与 HPV 检测相关的因素的调整优势比（aOR）和 95%置信区间（CI）。
结果
在 1564 名女性（中位年龄 24 岁；IQR 21-27 岁）中，登记确认的≥1 剂疫苗覆盖率最高，分别为 69.3%和 68.1%，年龄在 18-21 岁和 22-24 岁的女性中，年龄在 30-35 岁的女性中降至 42.9%。四价疫苗针对的 HPV 类型的总体流行率非常低（2.0%；95%CI：1.4-2.8%），仅受疫苗接种状况影响（未接种疫苗的女性为 5.5%，接种疫苗的女性为 0.7%；aOR=0.13（95%CI：0.05-0.30））。剩余 HPV 类型的流行率为 40.4%（95%CI：38.0-42.9%），受 HPV 感染的既定危险因素影响；年龄较小（p 趋势 <0.001）、最近（p<0.001）和终身性伴侣（p 趋势 <0.001），但与疫苗接种状况无关。与非疫苗针对的 HPV 类型具有共同危险因素的 HPV31/33/45 的流行率也较低，接种疫苗的女性（4%）低于未接种疫苗的女性（7%）（aOR=0.51；95%CI：0.29-0.89），表明存在交叉保护作用。
结论
疫苗接种改变了澳大利亚女性 HPV 感染的流行病学，显著降低了疫苗针对的 HPV 类型的流行率，包括具有已知感染危险因素的女性。接种疫苗的女性似乎从四价 HPV 疫苗提供的对 31/33/45 型的适度交叉保护中受益。这些结果强调了 HPV 疫苗接种的重要性。
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