Data from Scotland: Less Cervical Lesions After HPV Vaccination

    

    

Doctors newspaper online, 15.07.2019

    

        
        
        

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Data from Scotland

HPV vaccination with a bivalent vaccine not only reduces the prevalence of pre-invasive cervical lesions, it may also provide protection for the non-vaccinated.

By Peter Leiner

HPV protection is recommended for girls between the ages of 9 and 14.

© Gorilla / Fotolia

Important news

• Question: What effect does vaccination with a bivalent HPV vaccine on infants have on the prevalence of preinvasive cervical lesions?
• Answer: In the retrospective Scottish study of nearly 140,000 participants, the rate of cervical intraepithelial neoplasia (CIN) at least grade 3 was reduced by 89 percent from the time before immunization to the age of 20.
• Meaning: Routine vaccination with the bivalent HPV vaccine is highly effective and may help reduce the incidence of cervical cancer.

EDINBURGH. In a retrospective study of data from the National Vaccine and Cervical Screening Program in Scotland, scientists Tim Palmer from the University of Edinburgh reviewed the effect of HPV vaccination in girls aged 12-13 years on the development of cervical intraepithelial neoplasia (CIN) ( BMJ 2019; 365: 1161 ).

The more than 138,000 women were born between January 1988 and June 1996. At the age of 20 (at the earliest in 2010) they were treated with a cervical smear and, if necessary, a colposcopy.

A total of 64,026 study participants had not been vaccinated against HPV. 68,480 girls received all three vaccine doses, 4,135 only two, and in 2051 only one dose of the bivalent vaccine. Overall, the rate of high-grade CIN lesions was significantly reduced by the vaccine, as reported by Palmer and his colleagues.

For women of the preimmune cohort born 1988, the rate of CIN3 or higher was 0.59 percent; in women born 1995 or 1996, the rate was only 0.06 percent. That is, the incidence of high-grade CIN lesions has been reduced by 89 percent.

The rate of at least grade 2 CIN lesions was reduced by 88 percent through the HPV vaccine, from 1.44 to 0.17 percent. The CIN1 rate fell by just under 79 percent from 0.69 to 0.15 percent.

When the calculation only included women who received all three doses of vaccine, the researchers found a vaccination efficiency of 78 percent for CIN1, 89 percent for CIN2, and 86 percent for CIN at least. The results in women with only one dose or with two doses were not significant.

Herd protection is possible

Finally, the researchers also consider a herd protection in the group of women in the 1995/1996 cohort by the HPV vaccine possible. In the unvaccinated women of this cohort, the probability of a CIN1 lesion was 63 percent, that of CIN2 lesions was reduced by 67 percent and for CIN3 lesions by 100 percent. The comparison group were unvaccinated women born between 1988 and 1990.

The researchers point out that only women with cervical screening at the age of 20 participated in the study. Among the fully vaccinated women of this age, one out of every two women is screened in Scotland, but only about 23 percent of the unvaccinated, and the effect of the HPV vaccine may be overestimated. Nevertheless, they consider it legitimate to be able to generalize the results, inter alia because of herd protection.

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