Prevalence of cervical disease at age 20 after immunisation with bivalent HPV vaccine at age 12-13 in Scotland: retrospective population study

Tim Palmer, Lynn Wallace, Kevin G Pollock, Kate Cuschieri, Chris Robertson, Kim Kavanagh, Margaret Cruickshank

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Abstract

Objective
To quantify the effect on cervical disease at age 20 years of immunisation with bivalent human papillomavirus (HPV) vaccine at age 12-13 years.

Design
Retrospective population study, 1988-96.

Setting
National vaccination and cervical screening programmes in Scotland.

Participants
138¿692 women born between 1 January 1988 and 5 June 1996 and who had a smear test result recorded at age 20.

Main outcome measures
Effect of vaccination on cytology results and associated histological diagnoses from first year of screening (while aged 20), calculated using logistic regression.

Results
138¿692 records were retrieved. Compared with unvaccinated women born in 1988, vaccinated women born in 1995 and 1996 showed an 89% reduction (95% confidence interval 81% to 94%) in prevalent cervical intraepithelial neoplasia (CIN) grade 3 or worse (from 0.59% (0.48% to 0.71%) to 0.06% (0.04% to 0.11%)), an 88% reduction (83% to 92%) in CIN grade 2 or worse (from 1.44% (1.28% to 1.63%) to 0.17% (0.12% to 0.24%)), and a 79% reduction (69% to 86%) in CIN grade 1 (from 0.69% (0.58% to 0.63%) to 0.15% (0.10% to 0.21%)). Younger age at immunisation was associated with increasing vaccine effectiveness: 86% (75% to 92%) for CIN grade 3 or worse for women vaccinated at age 12-13 compared with 51% (28% to 66%) for women vaccinated at age 17. Evidence of herd protection against high grade cervical disease was found in unvaccinated girls in the 1995 and 1996 cohorts.

Conclusions
Routine vaccination of girls aged 12-13 years with the bivalent HPV vaccine in Scotland has led to a dramatic reduction in preinvasive cervical disease. Evidence of clinically relevant herd protection is apparent in unvaccinated women. These data are consistent with the reduced prevalence of high risk HPV in Scotland. The bivalent vaccine is confirmed as being highly effective vaccine and should greatly reduce the incidence of cervical cancer. The findings will need to be considered by cervical cancer prevention programmes worldwide.
Original languageEnglish
Number of pages10
JournalBMJ
Volume365
DOIs
Publication statusPublished - 3 Apr 2019

Fingerprint

Papillomavirus Vaccines
Scotland
Immunization
Retrospective Studies
Cervical Intraepithelial Neoplasia
Population
Vaccination
Vaccines
Uterine Cervical Neoplasms
Cell Biology
Logistic Models
Confidence Intervals
Incidence

Keywords

  • cervical disease
  • immunisation
  • retrospective population study
  • HPV vaccine
  • vaccination

Cite this

Palmer, Tim ; Wallace, Lynn ; Pollock, Kevin G ; Cuschieri, Kate ; Robertson, Chris ; Kavanagh, Kim ; Cruickshank, Margaret. / Prevalence of cervical disease at age 20 after immunisation with bivalent HPV vaccine at age 12-13 in Scotland: retrospective population study. In: BMJ. 2019 ; Vol. 365.
@article{55d5b85e77524d1a9dcb95671d6a935b,
title = "Prevalence of cervical disease at age 20 after immunisation with bivalent HPV vaccine at age 12-13 in Scotland: retrospective population study",
abstract = "ObjectiveTo quantify the effect on cervical disease at age 20 years of immunisation with bivalent human papillomavirus (HPV) vaccine at age 12-13 years.DesignRetrospective population study, 1988-96.SettingNational vaccination and cervical screening programmes in Scotland.Participants138¿692 women born between 1 January 1988 and 5 June 1996 and who had a smear test result recorded at age 20.Main outcome measuresEffect of vaccination on cytology results and associated histological diagnoses from first year of screening (while aged 20), calculated using logistic regression.Results138¿692 records were retrieved. Compared with unvaccinated women born in 1988, vaccinated women born in 1995 and 1996 showed an 89{\%} reduction (95{\%} confidence interval 81{\%} to 94{\%}) in prevalent cervical intraepithelial neoplasia (CIN) grade 3 or worse (from 0.59{\%} (0.48{\%} to 0.71{\%}) to 0.06{\%} (0.04{\%} to 0.11{\%})), an 88{\%} reduction (83{\%} to 92{\%}) in CIN grade 2 or worse (from 1.44{\%} (1.28{\%} to 1.63{\%}) to 0.17{\%} (0.12{\%} to 0.24{\%})), and a 79{\%} reduction (69{\%} to 86{\%}) in CIN grade 1 (from 0.69{\%} (0.58{\%} to 0.63{\%}) to 0.15{\%} (0.10{\%} to 0.21{\%})). Younger age at immunisation was associated with increasing vaccine effectiveness: 86{\%} (75{\%} to 92{\%}) for CIN grade 3 or worse for women vaccinated at age 12-13 compared with 51{\%} (28{\%} to 66{\%}) for women vaccinated at age 17. Evidence of herd protection against high grade cervical disease was found in unvaccinated girls in the 1995 and 1996 cohorts.ConclusionsRoutine vaccination of girls aged 12-13 years with the bivalent HPV vaccine in Scotland has led to a dramatic reduction in preinvasive cervical disease. Evidence of clinically relevant herd protection is apparent in unvaccinated women. These data are consistent with the reduced prevalence of high risk HPV in Scotland. The bivalent vaccine is confirmed as being highly effective vaccine and should greatly reduce the incidence of cervical cancer. The findings will need to be considered by cervical cancer prevention programmes worldwide.",
keywords = "cervical disease, immunisation, retrospective population study, HPV vaccine, vaccination",
author = "Tim Palmer and Lynn Wallace and Pollock, {Kevin G} and Kate Cuschieri and Chris Robertson and Kim Kavanagh and Margaret Cruickshank",
note = "Acceptance from webpage",
year = "2019",
month = "4",
day = "3",
doi = "10.1136/bmj.l1161",
language = "English",
volume = "365",
journal = "British Medical Journal",
issn = "0959-8138",
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Prevalence of cervical disease at age 20 after immunisation with bivalent HPV vaccine at age 12-13 in Scotland: retrospective population study. / Palmer, Tim; Wallace, Lynn; Pollock, Kevin G; Cuschieri, Kate; Robertson, Chris; Kavanagh, Kim; Cruickshank, Margaret.

In: BMJ, Vol. 365, 03.04.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prevalence of cervical disease at age 20 after immunisation with bivalent HPV vaccine at age 12-13 in Scotland: retrospective population study

AU - Palmer, Tim

AU - Wallace, Lynn

AU - Pollock, Kevin G

AU - Cuschieri, Kate

AU - Robertson, Chris

AU - Kavanagh, Kim

AU - Cruickshank, Margaret

N1 - Acceptance from webpage

PY - 2019/4/3

Y1 - 2019/4/3

N2 - ObjectiveTo quantify the effect on cervical disease at age 20 years of immunisation with bivalent human papillomavirus (HPV) vaccine at age 12-13 years.DesignRetrospective population study, 1988-96.SettingNational vaccination and cervical screening programmes in Scotland.Participants138¿692 women born between 1 January 1988 and 5 June 1996 and who had a smear test result recorded at age 20.Main outcome measuresEffect of vaccination on cytology results and associated histological diagnoses from first year of screening (while aged 20), calculated using logistic regression.Results138¿692 records were retrieved. Compared with unvaccinated women born in 1988, vaccinated women born in 1995 and 1996 showed an 89% reduction (95% confidence interval 81% to 94%) in prevalent cervical intraepithelial neoplasia (CIN) grade 3 or worse (from 0.59% (0.48% to 0.71%) to 0.06% (0.04% to 0.11%)), an 88% reduction (83% to 92%) in CIN grade 2 or worse (from 1.44% (1.28% to 1.63%) to 0.17% (0.12% to 0.24%)), and a 79% reduction (69% to 86%) in CIN grade 1 (from 0.69% (0.58% to 0.63%) to 0.15% (0.10% to 0.21%)). Younger age at immunisation was associated with increasing vaccine effectiveness: 86% (75% to 92%) for CIN grade 3 or worse for women vaccinated at age 12-13 compared with 51% (28% to 66%) for women vaccinated at age 17. Evidence of herd protection against high grade cervical disease was found in unvaccinated girls in the 1995 and 1996 cohorts.ConclusionsRoutine vaccination of girls aged 12-13 years with the bivalent HPV vaccine in Scotland has led to a dramatic reduction in preinvasive cervical disease. Evidence of clinically relevant herd protection is apparent in unvaccinated women. These data are consistent with the reduced prevalence of high risk HPV in Scotland. The bivalent vaccine is confirmed as being highly effective vaccine and should greatly reduce the incidence of cervical cancer. The findings will need to be considered by cervical cancer prevention programmes worldwide.

AB - ObjectiveTo quantify the effect on cervical disease at age 20 years of immunisation with bivalent human papillomavirus (HPV) vaccine at age 12-13 years.DesignRetrospective population study, 1988-96.SettingNational vaccination and cervical screening programmes in Scotland.Participants138¿692 women born between 1 January 1988 and 5 June 1996 and who had a smear test result recorded at age 20.Main outcome measuresEffect of vaccination on cytology results and associated histological diagnoses from first year of screening (while aged 20), calculated using logistic regression.Results138¿692 records were retrieved. Compared with unvaccinated women born in 1988, vaccinated women born in 1995 and 1996 showed an 89% reduction (95% confidence interval 81% to 94%) in prevalent cervical intraepithelial neoplasia (CIN) grade 3 or worse (from 0.59% (0.48% to 0.71%) to 0.06% (0.04% to 0.11%)), an 88% reduction (83% to 92%) in CIN grade 2 or worse (from 1.44% (1.28% to 1.63%) to 0.17% (0.12% to 0.24%)), and a 79% reduction (69% to 86%) in CIN grade 1 (from 0.69% (0.58% to 0.63%) to 0.15% (0.10% to 0.21%)). Younger age at immunisation was associated with increasing vaccine effectiveness: 86% (75% to 92%) for CIN grade 3 or worse for women vaccinated at age 12-13 compared with 51% (28% to 66%) for women vaccinated at age 17. Evidence of herd protection against high grade cervical disease was found in unvaccinated girls in the 1995 and 1996 cohorts.ConclusionsRoutine vaccination of girls aged 12-13 years with the bivalent HPV vaccine in Scotland has led to a dramatic reduction in preinvasive cervical disease. Evidence of clinically relevant herd protection is apparent in unvaccinated women. These data are consistent with the reduced prevalence of high risk HPV in Scotland. The bivalent vaccine is confirmed as being highly effective vaccine and should greatly reduce the incidence of cervical cancer. The findings will need to be considered by cervical cancer prevention programmes worldwide.

KW - cervical disease

KW - immunisation

KW - retrospective population study

KW - HPV vaccine

KW - vaccination

U2 - 10.1136/bmj.l1161

DO - 10.1136/bmj.l1161

M3 - Article

VL - 365

JO - British Medical Journal

JF - British Medical Journal

SN - 0959-8138

ER -