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期刊来源：BMJ

原文链接：https://doi.org/10.1136/bmj-2023-077341

摘要内容如下：

目标

通过额外12个月的随访，重复先前关于英国人乳头瘤病毒（HPV）疫苗接种计划对宫颈癌和3级宫颈上皮内瘤变（CIN3）发病率的有效性的分析，并调查不同社会经济贫困水平的有效性。

设计

观察研究。

设置

英格兰，英国。

参与者

2006年1月至2020年6月期间居住在英格兰的20-64岁妇女，包括诊断为宫颈癌的29968人和诊断为CIN3的335228人。在英格兰，2008年在全国范围内引入了HPV疫苗接种，并定期向12-13岁的女孩提供疫苗接种，2008-10年期间针对19岁以下的青少年开展了补种活动。

主要结果指标

浸润性宫颈癌和CIN3的发病率。

结果

在英格兰，2006年1月1日至2020年6月30日期间，29968名20-64岁的妇女被诊断为宫颈癌，335228名妇女被诊断为CIN3。在12-13岁接受常规疫苗接种的妇女的出生队列中，在额外12个月的随访期间（2019年7月1日至2020年6月30日），宫颈癌和CIN3的校正年龄标准化发病率分别为:83.9%（95%置信区间（CI）63.8%至92.8%）和94.3%（92.6%至95.7%）低于从未接种HPV疫苗的妇女的参考队列。到2020年中期，HPV疫苗接种预防了约687例（95%CI 556至819）宫颈癌和23192例（22163至24220）CIN3。生活在最贫困地区的妇女的发病率仍然最高，但HPV疫苗接种计划在所有五个贫困水平上都有很大的影响。在提供补种疫苗的妇女中，来自最贫困地区的妇女的CIN3率比来自最贫困地区的妇女下降得更多（16-18岁和14-16岁接受疫苗接种的妇女分别下降了40.6%和29.6%以及72.8%和67.7%）。在参考的未接种疫苗组中，宫颈癌发病率从高到低的强烈下降梯度在提供疫苗的人群中不再存在。

结论

在接下来的12个月的随访中，先前在英格兰看到的国家HPV疫苗接种计划的高效性得以延续。HPV疫苗接种与所有五个剥夺组的宫颈癌和CIN3发病率显著降低相关，尤其是在接受常规疫苗接种的妇女中。

英文原文如下：

Abstracts

OBJECTIVES  To replicate previous analyses on the effectiveness of the English human papillomavirus (HPV) vaccination programme on incidence of cervical cancer and grade 3 cervical intraepithelial neoplasia (CIN3) using 12 additional months of follow-up, and to investigate effectiveness across levels of socioeconomic deprivation.

DESIGN  Observational study.

SETTING  England, UK.

PARTICIPANTS  Women aged 20-64 years resident in England between January 2006 and June 2020 including 29 968 with a diagnosis of cervical cancer and 335 228 with a diagnosis of CIN3. In England, HPV vaccination was introduced nationally in 2008 and was offered routinely to girls aged 12-13 years, with catch-up campaigns during 2008-10 targeting older teenagers aged <19 years.

MAIN OUTCOME MEASURES  Incidence of invasive cervical cancer and CIN3.

RESULTS  In England, 29 968 women aged 20-64 years received a diagnosis of cervical cancer and 335 228 a diagnosis of CIN3 between 1 January 2006 and 30 June 2020. In the birth cohort of women offered vaccination routinely at age 12-13 years, adjusted age standardised incidence rates of cervical cancer and CIN3 in the additional 12 months of follow-up (1 July 2019 to 30 June 2020) were, respectively, 83.9% (95% confidence interval (CI) 63.8% to 92.8%) and 94.3% (92.6% to 95.7%) lower than in the reference cohort of women who were never offered HPV vaccination. By mid-2020, HPV vaccination had prevented an estimated 687 (95% CI 556 to 819) cervical cancers and 23 192 (22 163 to 24 220) CIN3s. The highest rates remained among women living in the most deprived areas, but the HPV vaccination programme had a large effect in all five levels of deprivation. In women offered catch-up vaccination, CIN3 rates decreased more in those from the least deprived areas than from the most deprived areas (reductions of 40.6% v 29.6% and 72.8% v 67.7% for women offered vaccination at age 16-18 and 14-16, respectively). The strong downward gradient in cervical cancer incidence from high to low deprivation in the reference unvaccinated group was no longer present among those offered the vaccine.

CONCLUSIONS  The high effectiveness of the national HPV vaccination programme previously seen in England continued during the additional 12 months of follow-up. HPV vaccination was associated with a substantially reduced incidence of cervical cancer and CIN3 across all five deprivation groups, especially in women offered routine vaccination.

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