Abyan Irzaldy, Tine Jerman, Inge M C M de Kok, Jan A C Hontelez, Harry J de Koning, Erik E L Jansen, Urška Ivanuš
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We compared the incidence of high-grade lesions (CIN2 or worse) between women in the first vaccine-targeted birth cohort (1998-2001) and in the latest non-vaccine-targeted birth cohort (1994-1997). We calculated the Incidence Rate Ratio (IRR) of CIN2+ using Poisson regression. To identify a possible shift in the harms-benefits ratio of screening, we compared the following screening performance indicators using chi-square tests: colposcopy referral rate (CRR), positive predictive value (PPV) of low-grade and high-grade results, and CIN2+ detection rate.</p><p><strong>Findings: </strong>The annual quadrivalent vaccine coverage in vaccine-targeted cohort was between 48.7% and 55.2%. The CIN2+ incidence was substantially lower in vaccine-targeted cohort (IRR 0.58 95% CI 0.49-0.69). Screening indicators were significantly lower for the vaccine-targeted cohort: direct CRR (0.47% [118/25,185] vs. 0.68% [206/30,181]), PPV (26.8% [30/112] vs. 39.0% [76/195]), and CIN2+ detection rate (0.31% [79/25,185] vs. 0.55% [165/30,181]) (p < 0.05).</p><p><strong>Interpretation: </strong>Even under imperfect vaccination coverage of around 50%, CIN2+ incidence in the vaccine-targeted cohort was observed to be 42% lower. Furthermore, the harms-benefits ratio of cervical screening deteriorates, marked by lower PPV and detection rate. 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To identify a possible shift in the harms-benefits ratio of screening, we compared the following screening performance indicators using chi-square tests: colposcopy referral rate (CRR), positive predictive value (PPV) of low-grade and high-grade results, and CIN2+ detection rate.</p><p><strong>Findings: </strong>The annual quadrivalent vaccine coverage in vaccine-targeted cohort was between 48.7% and 55.2%. The CIN2+ incidence was substantially lower in vaccine-targeted cohort (IRR 0.58 95% CI 0.49-0.69). Screening indicators were significantly lower for the vaccine-targeted cohort: direct CRR (0.47% [118/25,185] vs. 0.68% [206/30,181]), PPV (26.8% [30/112] vs. 39.0% [76/195]), and CIN2+ detection rate (0.31% [79/25,185] vs. 0.55% [165/30,181]) (p < 0.05).</p><p><strong>Interpretation: </strong>Even under imperfect vaccination coverage of around 50%, CIN2+ incidence in the vaccine-targeted cohort was observed to be 42% lower. 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引用次数: 0
摘要
背景：在青春期前接种HPV疫苗对预防宫颈癌及其前体最有效。由于斯洛文尼亚女性从20岁起就被邀请进行细胞学筛查，因此自2018年以来，针对青春期前HPV疫苗接种的女性一直符合筛查条件。我们的目的是评估青春期前HPV疫苗接种计划对细胞学筛查表现和CIN2+发病率的影响。方法：这是一项队列研究，使用斯洛文尼亚宫颈筛查登记处的数据。我们比较了1998-2001年第一个接种疫苗的出生队列和1994-1997年最新的非接种疫苗的出生队列中女性高级别病变（CIN2或更严重）的发生率。我们用泊松回归计算CIN2+的发病率比（IRR）。为了确定筛查的利弊比可能发生的变化，我们使用卡方检验比较了以下筛查绩效指标：阴道镜转诊率（CRR）、低分级和高分级结果的阳性预测值（PPV）以及CIN2+检出率。研究结果：疫苗靶向队列的年四价疫苗覆盖率在48.7%至55.2%之间。在疫苗靶向队列中，CIN2+发生率显著降低（IRR 0.58, 95% CI 0.49-0.69）。疫苗靶向队列的筛查指标明显较低：直接CRR（0.47%[118/25,185]对0.68%[206/30,181]）、PPV（26.8%[30/112]对39.0%[76/195]）和CIN2+检出率（0.31%[79/25,185]对0.55% [165/30,181]）(p解释：即使在疫苗接种覆盖率约为50%的不完善情况下，疫苗靶向队列的CIN2+发病率也低42%。此外，子宫颈筛查的危害效益比恶化，表现为PPV和检出率降低。这就需要在接种疫苗的队列中调整筛选算法。资助：欧盟地平线2020。
Impact of a national HPV vaccination programme for preadolescent girls on cytology screening performance and CIN2+ incidence: five-year population-based cervical screening results from Slovenia.
Background: HPV vaccination is most efficacious in preventing cervical cancer and its precursors when administered during preadolescence. Because in Slovenia women are invited for cytology screening from age 20, women targeted for preadolescent HPV vaccination have been screening-eligible since 2018. We aim to assess the impact of preadolescent HPV vaccination programme on cytology screening performance and CIN2+ incidence.
Methods: This is a cohort study using data from Slovenia's cervical screening registry. We compared the incidence of high-grade lesions (CIN2 or worse) between women in the first vaccine-targeted birth cohort (1998-2001) and in the latest non-vaccine-targeted birth cohort (1994-1997). We calculated the Incidence Rate Ratio (IRR) of CIN2+ using Poisson regression. To identify a possible shift in the harms-benefits ratio of screening, we compared the following screening performance indicators using chi-square tests: colposcopy referral rate (CRR), positive predictive value (PPV) of low-grade and high-grade results, and CIN2+ detection rate.
Findings: The annual quadrivalent vaccine coverage in vaccine-targeted cohort was between 48.7% and 55.2%. The CIN2+ incidence was substantially lower in vaccine-targeted cohort (IRR 0.58 95% CI 0.49-0.69). Screening indicators were significantly lower for the vaccine-targeted cohort: direct CRR (0.47% [118/25,185] vs. 0.68% [206/30,181]), PPV (26.8% [30/112] vs. 39.0% [76/195]), and CIN2+ detection rate (0.31% [79/25,185] vs. 0.55% [165/30,181]) (p < 0.05).
Interpretation: Even under imperfect vaccination coverage of around 50%, CIN2+ incidence in the vaccine-targeted cohort was observed to be 42% lower. Furthermore, the harms-benefits ratio of cervical screening deteriorates, marked by lower PPV and detection rate. This warrants an adaptation in screening algorithms in vaccinated cohorts.
期刊介绍：
The Lancet Regional Health – Europe, a gold open access journal, is part of The Lancet's global effort to promote healthcare quality and accessibility worldwide. It focuses on advancing clinical practice and health policy in the European region to enhance health outcomes. The journal publishes high-quality original research advocating changes in clinical practice and health policy. It also includes reviews, commentaries, and opinion pieces on regional health topics, such as infection and disease prevention, healthy aging, and reducing health disparities.
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