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HPV vaccination decreased diagnoses of CIN grade 3 or worse by 89%

Clinical Question

What is the effect of human papillomavirus vaccination on the prevalence of cervical disease by age 20 years?

Bottom line

During the initial years of human papillomavirus (HPV) vaccination during which only half of eligible female adolescents in Scotland received all 3 doses, vaccination decreased the likelihood of an histological diagnosis of cervical intraepithelial neoplasia (CIN) grade 3 or worse by 89% at the time of first screening. With the current uptake of vaccination of 90% or greater, the vaccination of boys, and coverage of 7 additional strains of virus, the benefit is likely even higher. 2b

Reference

Palmer T, Wallace L, Pollock KG, et al. Prevalence of cervical disease at age 20 after immunisation with bivalent HPV vaccine at age 12-13 in Scotland: retrospective population study. BMJ 2019;365:l1161.

Study design: Cohort (retrospective)

Funding: Self-funded or unfunded

Setting: Population-based

Synopsis

Using the Scottish cervical screening program, a system that includes approximately 70% of eligible women, the authors enrolled 138,693 women who had cervical screening at age 20 years who were invited to receive HPV vaccination using the bivalent version (we're now up to 9 strains with Gardasil 9) between the ages of 12 and 13 years or sometime before age 18. Of these, 46% were unvaccinated and 49% received all 3 doses. Compared with unvaccinated women, at first screening only 0.06% of vaccinated women had CIN grade 3 or worse as compared with 0.59% of unvaccinated women. In other words, one CIN 3 diagnosis is avoided for every 189 women who are vaccinated 2 to 8 years before the first screening (number needed to vaccinate = 189; 95% CI 166 - 227).

Reviewer

Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA


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