人类乳头瘤病毒疫苗接种计划引入后的人口层面影响和群体影响:更新的系统审查和元分析
Mélanie Drolet1, Élodie Bénard2, Norma Pérez1
1Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada.
Lancet (London, England)
|July 1, 2019
概括
人类乳头瘤病毒 (HPV) 疫苗在女孩和妇女中显著减少了HPV感染,阴道和宫内皮瘤 (CIN2+). 疫苗接种也显示出群体效应,未接种疫苗的个体和男性的诊断率下降.
科学领域:
- 公共卫生
- 疫苗学
- 流行病学
背景情况:
- 十多年来,人类乳头瘤病毒 (HPV) 疫苗的实施需要对其在现实世界的人口水平的影响提供最新证据.
- 之前的系统审查强调了HPV疫苗接种的重要性,但需要更多关于多队列疫苗接种效应的数据.
研究的目的:
- 对HPV疫苗接种影响的人口级数据进行系统审查和元分析.
- 总结HPV疫苗对HPV感染,阴道和2级宫内皮瘤 (CIN2+) 的有效性证据.
- 量化多队列HPV疫苗接种策略的影响.
主要方法:
- 使用MEDLINE和Embase数据库进行系统审查和元分析 (2014年2月至2018年10月).
- 包括在一般人群中比较疫苗接种前和接种后的HPV相关终点 (感染,,CIN2+).
- 按性别,年龄和疫苗接种以来的年份分层分析;用于汇总相对风险的随机效应模型.
主要成果:
- 观察到HPV 16/18流行率 (83%在13-19岁的女孩中,66%在20-24岁的女性中) 和HPV 31/33/45流行率 (54%在13-19岁的女孩中) 的显著降低.
- 在女孩 (15-19岁) 和女性 (20-24岁) 中,阴道的诊断减少了67%,在男性中也出现了减少.
- 接种疫苗5-9年后,CIN2+的发病率在女孩 (15-19) 和女性 (20-24) 中降低了51%.
结论:
- 疫苗接种计划对HPV感染,阴道和CIN2+具有显著的影响.
- 高疫苗覆盖率和多队列疫苗接种策略增强了直接效应和群体免疫力.
- 证据支持全球继续实施和扩大HPV疫苗接种计划.
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