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

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

Research output: Contribution to journalArticle

11 Citations (Scopus)

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.

LanguageEnglish
Number of pages10
JournalBritish Medical Journal
Volume365
DOIs
Publication statusPublished - 3 Apr 2019

Fingerprint

Papillomavirus Vaccines
Immunization
Vaccine
Scotland
Retrospective Studies
Cervical Intraepithelial Neoplasia
Vaccination
Population
Screening
Vaccines
Cancer
Uterine Cervical Neoplasms
Logistic Regression
Confidence interval
Human
Incidence
Quantify
Cell Biology
Logistic Models
Outcome Assessment (Health Care)

Keywords

  • HPV
  • human papillomavirus
  • cervical disease
  • Scotland

Cite this

@article{03f61773bf164ada96e3923d52e220a2,
title = "Prevalence of cervical disease at age 20 after immunisation with bivalent HPV vaccine at age 12-13 in Scotland: retrospective population study",
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.",
keywords = "HPV, human papillomavirus, cervical disease, Scotland",
author = "Tim Palmer and Lynne Wallace and Pollock, {Kevin G} and Kate Cuschieri and Chris Robertson and Kim Kavanagh and Margaret Cruickshank",
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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, Lynne; Pollock, Kevin G; Cuschieri, Kate; Robertson, Chris; Kavanagh, Kim; Cruickshank, Margaret.

In: British Medical Journal, 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

T2 - BMJ

AU - Palmer, Tim

AU - Wallace, Lynne

AU - Pollock, Kevin G

AU - Cuschieri, Kate

AU - Robertson, Chris

AU - Kavanagh, Kim

AU - Cruickshank, Margaret

PY - 2019/4/3

Y1 - 2019/4/3

N2 - 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.

AB - 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.

KW - HPV

KW - human papillomavirus

KW - cervical disease

KW - Scotland

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DO - 10.1136/bmj.l1161

M3 - Article

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JO - BMJ

JF - BMJ

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