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Grand Rounds

Bivalent HPV Vaccination: Dramatic Reduction in Prevalence of Cervical Disease at Age 20

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BACKGROUND AND PURPOSE:

  • In 2008 Scotland initiated a national immunization program against HPV
    • Bivalent vaccine | girls ages 12-13
  • Palmer et al. (The BMJ, 2019) aimed to quantify the effect of this program on cervical disease at age 20

METHODS:

  • Retrospective population study
  • Participants
    • Women born between January 1st, 1988 and June 5th, 1996 who had liquid-based cytology with image assisted screening) result recorded at age 20
  • Primary outcome measures
    • Effect of vaccination on cytology results and associated histological CIN diagnoses at age 20
  • Classification based on British Association for Cytopathology and NHS cervical screening program (Table 1 provides an easy comparison to Bethesda system)  
  • Researchers also investigated herd protection
    • Compared the disease rates among unvaccinated women in the 1991-92, 1993-4, and 1995-96 cohorts with unvaccinated women in the 1989-90 cohort (control group prior to national vaccine program)
  • Statistical analysis: Logistic regression

RESULTS:

  • 138,692 women included
  • When compared to unvaccinated women, vaccinated women
    • CIN grade 3 or worse: 89% reduction (95% CI, 81% to 94%)
      • From 0.59% to 0.06%
    • CIN grade 2 or worse: 88% reduction (95% CI, 83-92%)
      • From 1.44% to 0.17%
    • CIN grade 1: 79% reduction (95% CI, 69% to 86%) 
      • From 0.69% to 0.15%
  • Younger age at immunization was associated with an increase in vaccine effectiveness for CIN grade 3 or worse
    • Vaccinated age 12-13: 86% reduction (95% CI, 75% to 92%)
    • Vaccinated age 17: 51% reduction (95% CI, 28% to 66%)
  • Found evidence for herd protection against high-grade cervical disease in unvaccinated girls in the 1995 and 1996 cohort
    • Even in unvaccinated women in the 1995-96 cohort, there was a reduction in CIN compared with unvaccinated women in 1988-90.

CONCLUSION:

  • Bivalent HPV vaccine is highly effective
    • Should result in decreased cervical cancer rates
    • Study demonstrated herd protection in unvaccinated women
  • Study results consistent with reduced prevalence of high-risk HPV in Scotland

Learn More – Primary Sources:

Prevalence of cervical disease at age 20 after immunisation with bivalent HPV vaccine at age 12-13 in Scotland: retrospective population study

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Related ObG Topics:

HPV Vaccines: Cochrane Reviews Looks at the Evidence with Multi-Year Follow-Up
HPV Testing vs PAP Smear: Results of the HPV FOCAL Trial
How has HPV Prevalence Changed Since Introduction of Vaccine?

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