Impact of HPV vaccination with Gardasil® in Switzerland

BMC Infectious Diseases

Research Article

Gilbert Greub¹  Roland Sahli²  Massimo Bongiovanni³  Jérôme Pasquier⁴  Chahin Achtari⁵  Martine Jacot-Guillarmod⁵ 

[1] Institute of Microbiology, Lausanne University Hospital, Bugnon 48, 1011, Lausanne, Switzerland;Institute of Microbiology, Lausanne University Hospital, Bugnon 48, 1011, Lausanne, Switzerland;WHO HPV Regional Reference Laboratory for Europe, Bugnon 48, 1011, Lausanne, Switzerland;Institute of Pathology, Lausanne University Hospital, Bugnon 25, 1011, Lausanne, Switzerland;Institute of Social and Preventive Medicine, Lausanne University Hospital and University of Lausanne, Corniche 10, 1010, Lausanne, Switzerland;Service of Gynecology and Obstetrics, Lausanne University Hospital, Pierre-Decker 2, 1011, Lausanne, Switzerland;

关键词: Human papillomavirus;    HPV genotyping;    HPV vaccine;    Gardasil®;    Chlamydia trachomatis;    Real-time PCR;    PGMY-CHUV;    Anyplex II™ HPV28;    Segmented logistic regression;    Cervical cancer screening;   

DOI  :  10.1186/s12879-017-2867-x

 received in 2017-01-17, accepted in 2017-11-28,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundGardasil®, a quadrivalent vaccine targeting low-risk (6, 11) and high-risk (16, 18) human papillomaviruses (HPV), has been offered to 11–14 year-old schoolgirls in Switzerland since 2008. To evaluate its success and its potential impact on cervical cancer screening, HPV genotypes were examined in 18-year-old girls five years later (sub-study 1) and in outpatients participating to cervical cancer screening before and after vaccine implementation (sub-study 2).MethodsFor sub-study 1, 3726 females aged 18 in 2013 were invited to fill a questionnaire on personal demographics and HPV risk factors and to provide a self-collected cervicovaginal sample for HPV genotyping and Chlamydia trachomatis PCR. Personal data were evaluated by univariable and multivariable statistics. In sub-study 2, the proportion of the vaccine-type HPV among anogenital HPV was examined with archived genotyping data of 8039 outpatients participating to cervical cancer screening from 1999 till 2015. The yearly evolution of this proportion was evaluated by segmented logistic regression.Results690 (18.5%) women participated to sub-study 1 and 327 (8.8%) provided a self-collected sample. Prevalence of Chlamydia trachomatis (4.6%) and demographics confirmed that the subjects were representative of sexually-active Swiss young women. Vaccine (five-year coverage: 77.5%) was preferentially accepted by contraceptive-pill users (P = 0.001) and samples were mainly provided by sexually-active subjects (P < 0.001). The proportion (4%) of the vaccine-type HPV in this population was lower than in sub-study 2 outpatients (n = 849, <26 years old) in the pre-vaccine era (25.7%). The proportion of the high-risk vaccine-type HPV decreased significantly (59%, P = 0.0048) in the outpatients during the post-vaccine era, yet this decrease was restricted to those aged less than 26 years (n = 673, P < 0.0001).ConclusionsThe low proportion of vaccine-type HPV in 18-year-old females and its rapid decrease in young women participating to cervical cancer screening extend the success of HPV vaccination to Switzerland. Our data suggest that cervical cancer screening is now entering a stage of reduced proportion of HPV16 and/or 18 in samples reported positive by cytology. In view of the high likelihood of reduced clinical specificity of cytology, primary screening modalities involving HPV testing and cytology should now be re-evaluated in Switzerland.

【 授权许可】

CC BY   
© The Author(s). 2017