Real-world effectiveness of Human Papillomavirus vaccination against vulvovaginal high-grade precancerous lesions and cancers
Menée à partir de données de registres portant sur 514 537 jeunes femmes vivant au Danemark entre 2006 et 2019 (âge : 17-26 ans ; durée médiane de suivi : 6,9 ans), cette étude évalue l'effet du vaccin anti-papillomavirus humain sur l'incidence des lésions vulvo-vaginales de haut grade
Vaccination against human papillomavirus (HPV) has proven to be effective against severe cervical lesions and genital warts, whereas no previous study has provided real-world data on the HPV vaccine effectiveness against high-grade vulvovaginal lesions.A cohort of all women aged 17–26 years, living in Denmark during 2006–2019 was followed in nationwide registers for individual-level information about HPV vaccination and first diagnoses of vulvar and vaginal high-grade intraepithelial lesions or worse (HSIL+). The cumulative incidence of vulvar and vaginal HSIL+, respectively, was estimated with the Aalen-Johansen estimator and Cox proportional hazards regression was used to estimate hazard ratios (HRs) for vulvar and vaginal lesions separately comparing women vaccinated at age <16 years and at age 17–26 years with unvaccinated women.The cohort consisted of 514,537 women, of which 50.6% were vaccinated at baseline (<16 years), 31.8% were vaccinated during follow-up (17–26 years) and 17.6% remained unvaccinated. The cumulative incidence was less than 0.6‰ for vulvar HSIL+ and less than 0.2‰ for vaginal HSIL+. Adjusted analyses showed reduced hazard rates for both vulvar (HR = 0.22, 95% CI = 0.13 to 0.38) and vaginal HSIL + (HR = 0.16, 95% CI = 0.04 to 0.55) for women vaccinated at age ≤16 years compared to unvaccinated women. For women vaccinated at 17–26 years, the reductions in hazard rates were smaller for vaginal HSIL+ and close to zero for vulvar HSIL+.HPV vaccination before 17 years of age reduces the risk of vulvar and vaginal HSIL+ based on real-world data.