Real-world Effectiveness of Human Papillomavirus Vaccination Against Cervical Cancer
Menée au Danemark à partir de données 2006-2019 de registres portant sur 867 689 femmes âgées de 17 à 30 ans, cette étude estime l'efficacité de la vaccination anti-papillomavirus humain sur l'incidence du cancer du col de l'utérus, selon l'âge au moment du vaccin
Résumé en anglais
The primary goal of human papillomavirus (HPV) vaccination is to reduce morbidity and mortality from HPV-associated disease, especially cervical cancer. We determined the real-world effectiveness of HPV vaccination against cervical cancer.The study included women 17–30 years living in Denmark October 2006–December 2019. From nationwide registries, information on HPV vaccination and cervical cancer diagnoses were retrieved. Incidence rate ratios (IRRs) with 95% confidence intervals (CI) for cervical cancer according to vaccination status were estimated using Poisson regression with HPV vaccination treated as a time-varying variable and stratified by age at vaccination. We adjusted for attained age, education, and ethnicity. To address the effect of prevalent disease, different buffer periods were used, with one-year buffer period as primary analysis.The cohort comprised 867,689 women. At baseline, 36.3% were vaccinated at ≤ 16 years, and during follow-up, 19.3% and 2.3% were vaccinated at 17–19 and 20–30 years, respectively. For women vaccinated at ≤ 16 or 17–19 years, the IRRs of cervical cancer were 0.14 (95% CI:0. 04–0.53) and 0.32 (95% CI: 0.08–1.28), respectively, compared to unvaccinated women. In women 20–30 years at vaccination, the IR was higher than among unvaccinated women (IRR=1.19, 95% CI: 0.80–1.79), but slightly decreased with increasing buffer period (IRR=0.85 (95% CI: 0.55–1.32) with four-year buffer period).HPV vaccine effectiveness against cervical cancer at the population-level is high among girls vaccinated before age 20 years. The lack of immediate effect in women vaccinated at age 20–30 years points to the importance of early age at vaccination.
