基于美国营养与健康调查数据的HPV疫苗上市后人群HPV感染率变化分析

目的 通过分析美国营养与健康调查数据库,了解美国HPV疫苗上市后18~59岁女性HPV感染率的变化,为合理制定我国HPV疫苗接种策略提供借鉴。方法 选取美国营养与健康调查2009—2010、2011—2012、2013—2014年共3轮调查数据,提取人口学、性行为特征、女性宫颈拭子HPV DNA分型等数据。分别计算不同年度、人口学特征、性行为特征的任意HPV亚型感染率、疫苗可预防HPV感染率、非疫苗可预防高危HPV感染率等指标。结果 2009—2014年,美国18~59岁女性任意HPV感染率从42.8%(95%CI: 39.7~45.9)降到39.9%(95%CI: 36.7~43.1);疫苗可预防HPV感染率在6年间下降相对迅速,从7.9%(95%CI: 6.5~9.3)降到5.5%(95%CI: 3.8~7.2);非疫苗可预防高危HPV感染率从20.3%(95%CI: 18.0~22.7)降到17.8%(95%CI: 15.7~20.0)。年龄在30岁以下、收入低于贫困线、过去1年内有1个以上性伴为疫苗可预防HPV感染的危险因素(所有P<0.05)。结论 虽然HPV疫苗接种可降低疫苗可预防HPV感染率,但要重视对于弱势人群及性活跃人群的HPV疫苗接种。我国应借鉴美国HPV接种的历史经验,加强对HPV疫苗的宣传教育,实现HPV疫苗的早期接种和人群覆盖。

HPV infection rate of HPV vaccine in post-marking period based on National Health and Nutrition Examination Survey in United States

Objective To assess the changes in human papillomavirus (HPV) infection rate in women aged 18-59 years after HPV vaccine marketing by analyzing the database of National Health and Nutrition Examination Survey (NHANES) in United States and provide reference for the strategy of HPV vaccination in China. Methods Data were downloaded from the NHANES database(2009-2010, 2011-2012, 2013-2014). Information about demographic features, sexual behaviors and HPV DNA test results of the cervical swabs were exacted from the database. Prevalence of any HPV infection, vaccine-type HPV infection, no vaccine-type HPV infection of different years, demographic features, sexual behaviors, were estimated. Results The prevalence of any HPV infection was dropped from 42.8%(95%CI: 39.7,45.9) to 39.9%(95%CI: 36.7,43.1) in the females aged 18-59 from the NHANES from 2009 to 2014. The rate of vaccine preventable HPV infection decreased relatively rapidly within 6 years, from 7.9%(95CI: 6.5,9.3) to 5.5%(95%CI: 3.8,7.2). The non-vaccine preventable high-risk HPV infection rate was decreased from 20.3%(95%CI: 18.0,22.7) to 17.8%(95%CI: 15.7,20.0). Risk factors for vaccine-preventable HPV infection were under the age of 30, income below poverty line, and having more than one sexual partner in the past year(all P<0.05). Conclusion s Although the HPV vaccination can reduce the rate of HPV infection that can be prevented by the vaccine, it is important to pay attention to the HPV vaccination of vulnerable and sexually active people. China should learn from the historical experience of HPV vaccination in the United States, strengthen the publicity and education of HPV vaccine, and realize the early vaccination and population coverage of HPV vaccine.