Influence of Pre-Vaccination HPV Status on Vaccine Effectiveness Among Chinese Women: A Multicenter Cross-Sectional Study

IF 1.9 Q4 ONCOLOGY

Cancer reports Pub Date : 2025-08-28 DOI:10.1002/cnr2.70294

Lucia Li, Haiyue Wu, Yibo Chen, Zhanjun Shen, Kun Fu, Minghui Qiu, Yingzhen Liu, Yufei Shen, Yingnan Lu, Xinxin Wen, Siyu Yang, Kehan Zou, Hui Zhang, Yangzong Gesang, Haojie Huang, Chao Zhao, Pengming Sun, Lisha Wu, Yu Zhang

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Abstract

Background and Aims

Human papillomavirus (HPV) vaccines have been available in China for only 8 years, and routine HPV testing is not recommended prior to vaccination. Therefore, evaluation of HPV vaccine effectiveness and the impact of pre-vaccination HPV infection status on vaccine protective effect in Chinese women is warranted.

Methods

From June 2022 to June 2023, women aged 18 to 50 years without a history of cervical or uterine excision were recruited from three medical institutions. Baseline characteristics were compared between vaccinated and unvaccinated participants, with inverse probability treatment weighting (IPTW) applied to adjust for confounding factors. HPV infection rates and vaccine effectiveness (VE) were calculated. Additionally, a sub-group analysis was conducted among vaccinated women to explore the impact of pre-vaccination HPV infection status.

Results

After adjusting for group differences, the vaccine effectiveness against new HPV16/18 infections was 76.1% (95% CI: 58.7%–86.2%) among 2285 participants. Older age and possession of a master's degree or higher were identified as protective factors, whereas increased parity and exclusive use of oral contraceptives were determined to be risk factors for HPV16/18 infection. Women with unknown pre-vaccination HPV status exhibited significantly higher post-vaccination rates of high-risk HPV infections (RR 4.278, 95% CI: 2.537–7.215) compared to those who were HPV-negative prior to vaccination. However, no significant difference in new high-risk HPV infection rates was observed between pre-vaccination HPV-negative and HPV-positive women.

Conclusion

In addition to HPV vaccination, factors such as age, parity, exclusive use of oral contraceptives, and higher education attainment were independently associated with HPV16/18 infection rates. Pre-vaccination HPV infection status did not significantly influence the protective efficacy of the HPV vaccine against previously unencountered HPV types.

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中国妇女接种HPV疫苗前状态对疫苗有效性的影响：一项多中心横断面研究

背景与目的人乳头瘤病毒（HPV）疫苗在中国问世仅8年，不建议在接种前进行常规HPV检测。因此，有必要评估HPV疫苗的有效性以及接种前HPV感染状况对疫苗保护效果的影响。方法于2022年6月至2023年6月在三家医疗机构招募年龄在18 ~ 50岁，无宫颈或子宫切除术史的女性。比较接种疫苗和未接种疫苗的参与者的基线特征，应用逆概率处理加权（IPTW）来调整混杂因素。计算HPV感染率和疫苗有效性（VE）。此外，在接种疫苗的妇女中进行了亚组分析，以探讨接种前HPV感染状况的影响。结果在调整组间差异后，在2285名参与者中，疫苗对HPV16/18新发感染的有效性为76.1% （95% CI: 58.7% ~ 86.2%）。年龄较大和拥有硕士或更高学位被确定为保护因素，而增加的胎次和独家使用口服避孕药被确定为HPV16/18感染的危险因素。与接种前HPV阴性的妇女相比，接种前HPV状态未知的妇女接种后高危HPV感染率显着更高（RR 4.278, 95% CI: 2.537-7.215）。然而，在疫苗接种前HPV阴性和HPV阳性妇女之间，新的高危HPV感染率没有显著差异。结论除HPV疫苗接种外，年龄、胎次、独家使用口服避孕药、高等教育程度等因素与HPV16/18感染率独立相关。接种前HPV感染状态对HPV疫苗对以前未遇到的HPV类型的保护效果没有显著影响。

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