加拿大魁北克大学研究中心-拉瓦尔大学Marc Brisson研究小组对人类乳头瘤病毒（HPV）疫苗接种计划实施后的人口影响和群体效应进行了最新的系统回顾和荟萃分析。 该分析报告发表在2019年8月10日出版的国际学术期刊《柳叶刀》上。

研究人员沿袭之前的检索方法，在MEDLINE和Embase上检索了2014年2月1日至2018年10月11日之间发表的论文。最终确定了1702篇符合要求的文章，包括14个高收入国家的65篇文章：23篇HPV感染，29篇肛门生殖器疣，13篇CIN2+。

经统计，接种疫苗5-8年后，13-19岁女孩中HPV 16和18的患病率显著下降83%，20-24岁妇女显著下降66%；13-19岁女孩中HPV 31、33和45的患病率显著下降54%。15-19岁女孩中肛门生殖器疣的患病率显著下降67%，20-24岁妇女显著下降54%， 25-29岁妇女显著下降31%；15-19岁男孩中肛门生殖器疣的患病率显著下降48%，20-24岁男性显著下降32%。接种疫苗5-9年后，经筛查15-19岁女孩中CIN2+显著下降51%，20-24岁妇女显著下降31%。

这一最新的荟萃分析涵盖了6000万人，接种疫苗后进行了长达8年的随访。统计结果充分证明HPV疫苗接种计划大大降低了女孩和妇女HPV感染和CIN2+，以及女孩、妇女、男孩和男性肛门生殖器疣的发病率。此外，多队列疫苗接种计划和疫苗接种的高覆盖率将会造成更大更积极的人口影响和群体效应。

据悉，人类乳头瘤病毒(HPV)疫苗接种实施已逾10年。

附：英文原文

Title: Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis

Author: Mélanie Drolet, PhD, Élodie Bénard, MSc, Norma Pérez, MSc, Prof Marc Brisson, PhD, on behalf of the HPV Vaccination Impact Study Group

Issue&Volume: VOLUME 394, ISSUE 10197, P497-509, AUGUST 10, 2019

Summary:

Background

More than 10 years have elapsed since human papillomavirus (HPV) vaccination was implemented. We did a systematic review and meta-analysis of the population-level impact of vaccinating girls and women against human papillomavirus on HPV infections, anogenital wart diagnoses, and cervical intraepithelial neoplasia grade 2+ (CIN2+) to summarise the most recent evidence about the effectiveness of HPV vaccines in real-world settings and to quantify the impact of multiple age-cohort vaccination.

Methods

In this updated systematic review and meta-analysis, we used the same search strategy as in our previous paper. We searched MEDLINE and Embase for studies published between Feb 1, 2014, and Oct 11, 2018. Studies were eligible if they compared the frequency (prevalence or incidence) of at least one HPV-related endpoint (genital HPV infections, anogenital wart diagnoses, or histologically confirmed CIN2+) between pre-vaccination and post-vaccination periods among the general population and if they used the same population sources and recruitment methods before and after vaccination. Our primary assessment was the relative risk (RR) comparing the frequency (prevalence or incidence) of HPV-related endpoints between the pre-vaccination and post-vaccination periods. We stratified all analyses by sex, age, and years since introduction of HPV vaccination. We used random-effects models to estimate pooled relative risks.

Findings

We identified 1702 potentially eligible articles for this systematic review and meta-analysis, and included 65 articles in 14 high-income countries: 23 for HPV infection, 29 for anogenital warts, and 13 for CIN2+. After 5–8 years of vaccination, the prevalence of HPV 16 and 18 decreased significantly by 83% (RR 0·17, 95% CI 0·11–0·25) among girls aged 13–19 years, and decreased significantly by 66% (RR 0·34, 95% CI 0·23–0·49) among women aged 20–24 years. The prevalence of HPV 31, 33, and 45 decreased significantly by 54% (RR 0·46, 95% CI 0·33–0·66) among girls aged 13–19 years. Anogenital wart diagnoses decreased significantly by 67% (RR 0·33, 95% CI 0·24–0·46) among girls aged 15–19 years, decreased significantly by 54% (RR 0·46, 95% CI 0.36–0.60) among women aged 20–24 years, and decreased significantly by 31% (RR 0·69, 95% CI 0·53–0·89) among women aged 25–29 years. Among boys aged 15–19 years anogenital wart diagnoses decreased significantly by 48% (RR 0·52, 95% CI 0·37–0·75) and among men aged 20–24 years they decreased significantly by 32% (RR 0·68, 95% CI 0·47–0·98). After 5–9 years of vaccination, CIN2+ decreased significantly by 51% (RR 0·49, 95% CI 0·42–0·58) among screened girls aged 15–19 years and decreased significantly by 31% (RR 0·69, 95% CI 0·57–0·84) among women aged 20–24 years.

Interpretation

This updated systematic review and meta-analysis includes data from 60 million individuals and up to 8 years of post-vaccination follow-up. Our results show compelling evidence of the substantial impact of HPV vaccination programmes on HPV infections and CIN2+ among girls and women, and on anogenital warts diagnoses among girls, women, boys, and men. Additionally, programmes with multi-cohort vaccination and high vaccination coverage had a greater direct impact and herd effects.

DOI: https://doi.org/10.1016/S0140-6736(19)30298-3

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30298-3/fulltext#