HPV vaccine can be said to be the first vaccine in humans that can effectively prevent cancer, which can not only effectively prevent cervical cancer caused by high-risk HPV infection, but also prevent anal cancer, penile cancer and other cancers caused by similar causes.
In other words, both men and women can benefit from HPV vaccination (although most countries in the world, including China, are still "ladies first").
With the popularization of popular science, many people want to know these two questions: Is the HPV vaccine worth playing? How good is the effect?
By this year, 15 years have passed since the first HPV vaccine for humans came to market (2006). Scientists have really found a large number of people who have been vaccinated in these 15 years, and after studying their situation, they have come to a conclusion that is worth referring to.
In this article, we will combine the 3 latest and most authoritative world blockbuster studies to talk in detail.
(If you want to save some time and go straight to the conclusion, you can directly look at the bold font in the text.) ）
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Almost all cervical cancer (99.7%) is associated with HPV infection, and cervical cancer can be effectively prevented by vaccination, which can prevent HPV infection.
So in the real world, how effective is the HPV vaccine?
In October 2021, the world's leading medical journal, the New England Journal of Medicine (NEJM), published a study by Swedish scientists.
The study, which included more than 1.6 million women in Sweden for more than a decade, was a "landmark study" with a long time span and a large sample size[1].
(The paper is titled "The Relationship between HPV Vaccination and The Risk of Invasive Cervical Cancer", screenshot source: nejm.org)
In the 11 years from 2006 to 2017, the researchers tracked about 1.673 million women aged 10 to 30 in Sweden, screened and evaluated them for cervical cancer until they turned 31.
Looking at the chart below, it is certainly not difficult to find that HPV vaccination can significantly reduce the incidence of cervical cancer, and the sooner you fight, the better.
More specifically:
Over the 11 years that were tracked, more than 500,000 of the 1.67 million women were vaccinated against HPV;
Of the vaccinated population, 19 people were diagnosed with cervical cancer, with a cumulative incidence equivalent to 47 cases per 100,000 women, respectively, and among the unoccupied population, 538 people were diagnosed with cervical cancer, with a cumulative incidence equivalent to 94 cases per 100,000 women[1];
After adjusting for factors such as age factors, place of residence, education level, family status and related medical history, overall, the risk of cervical cancer in women vaccinated with HPV was significantly reduced by 63%[1]!
If vaccinated before the age of 17, the incidence drops by up to 88%[1]!
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In the above study, Swedish women were almost all vaccinated with quadrivalent HPV vaccine (to prevent HPV6, HPV11, HPV16 and HPV18, these four high-risk HPV infections), is it a "high-priced" vaccine that will have such a good effect?
This is another British study that made it clear.
The UK launched a bivalent HPV vaccination programme in 2008, providing routine vaccination for girls aged 12 to 13 years and supplementary vaccination for adolescent girls aged 14 to 18 years.
Just in November 2021, The Lancet published the work of a British researcher, the largest and longest real-world data on cervical cancer vaccines to date [2].
(The paper is titled "Effect of HPV Vaccination Programmes in the UK on the Incidence of Cervical Cancer and Grade 3 Cervical Intraepithelial Neoplasia: An Observational Study Based on Registration Data", Screenshot Source: the Lancet)
The research team evaluated the diagnostic data of cervical cancer and precancerous lesions of the 20-64-year-old women living in England in the 13-year period from 2006 to 2019, and set up 7 groups for analysis, and found that:
The most basic bivalent vaccine, if given at 16 to 18 years of age, is 34% effective against cervical cancer and 39% effective against severe cervical intraepithelial neoplasia (CIN3); if vaccinated at 12 to 13 years of age, these two figures are as high as 87% and 97% respectively [2];
However, even the nine-valent HPV vaccine, if given after the age of 30, will still be effective, but it is far less effective than the bivalent HPV vaccine received at a young age [2].
To sum up: HPV vaccine, "early vaccination" is more important than "high price".
In fact, as early as 2017, the World Health Organization clearly pointed out:
Available evidence suggests that, from a public health perspective, bivalent, quadrivalent, and nine-valent vaccines do not differ in immunogenicity, efficacy and efficacy in preventing HPV-related cervical cancers type 16 and type 18 (high-risk), and all three vaccines prevent most associated cancers [3].
This is also very instructive for our practical actions:
If you have a daughter over the age of 9, you can let her get bivalent and quadrivalent vaccines first, and you really don't have to wait for the nine-valent vaccine after the age of 16.
After all, it's better to have "probably better" protection than in the future, or early vaccination can benefit early, right?
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Since you have to fight early, how long can the protective effect of the HPV vaccine be maintained? Will it be played early and invalidated early?
In response to this problem, a study from Finland was published in the Lancet's sub-journal Lancet Infection.
The study, which followed up for 12 years, found that women who received the divalent HPV vaccine could still detect HPV vaccine-induced antibody titers at 12 years of vaccination [4].
(The paper is titled "Sustainability of Neutralizing Antibodies Induced by Bivalent or Quadrivalent HPV Vaccines and Their Correlation with Efficacy: A Combined Follow-Up Analysis of Data from Two Randomized, Double-Blind, Multicenter, Phase 3 Trials", Screenshot Source: The Lancet Infectious Disease)
It's only been 15 years since the HPV vaccine hit the market, and we don't know much longer on the protection range. But at least for now, the protection is satisfactory and there is no need for booster vaccination.
However, there is also a long sentence here: hpvic vaccination does not mean that "no longer have to worry about cervical cancer", or to do regular screening [5].
Cervical cancer screening recommendations:
(1) Women who have sex and are 21 to 29 years old: cytology screening every 3 years;
(2) Women aged 30 to 65 years: if possible, it is recommended to have a cytology examination and HPV every 5 years. DNA combination testing, under insufficient conditions, can be performed every 3 years cytology test;
(3) Women over 65 years old: If the results of multiple screenings are negative in the past, choose whether to screen according to individual differences or follow the doctor's instructions.
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You may also want to ask: these are all foreign cases, what about our country's own?
At present, the hpvic vaccine produced in Mainland China (currently only the 2-valent HPV vaccine) has also shown good safety and protective results in phase III clinical trials [6].
The clinical trial, which began in November 2012, included more than 7,000 female volunteers who were randomly assigned to the vaccine group (for domestic bivalent HPV vaccine) or control group (for hepatitis E vaccine as a control) for one dose at months 0, 1, and 6, respectively.
After 42 months of follow-up, it was found that the domestic bivalent HPV vaccine [6]:
The effectiveness rate for preventing precancerous lesions is 100.0% (vaccine group 0/3306, control group 10/3296);
The effectiveness rate in preventing persistent infection of HPV16/18 was 97.8% (1/3240 in the vaccine group and 45/3246 in the control group).
That is to say, after 17 years of research and development, our researchers have brought a highly effective and safe HPV vaccine to Chinese women. This is good news for the popularization of HPV vaccination in the mainland!
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In many parts of the country, such as Guangdong Province, Chengdu, Sichuan and other places, free HPV vaccination has begun for girls of appropriate age. I believe that in the future, more cities and regions will join this rank.
Cities and districts, as well as local vaccination policies
Wuxi, Jiangsu, Lianyungang, Jiangsu: Since December 2021, the free HPV vaccination program has been launched, providing 2 doses of free domestic bivalent HPV vaccine for girls in the second grade of junior high school.
Guangdong: From 2022, girls under the age of 14 who have a guangdong provincial school registration, have entered the first grade of junior high school since September and have not been vaccinated against HPV can be vaccinated free of charge.
Chengdu, Sichuan: For female students aged 13 to 14 years old, a vaccination subsidy of 600 yuan / person will be given by financial funds, and the vaccinators can choose between domestic/imported 2-valent and imported 4-valent HPV vaccines. The difference in vaccine fees after subsidies and vaccination service fees (2 yuan / dose) shall be borne by the parents (guardians) of the recipients.
Ordos City, Inner Mongolia: Women aged 13 to 18 are given three free doses of HPV vaccine (the vaccination cycle is October, January, and June), and people only need to pay the vaccination service fee.
Jinan, Shandong: Girls in the seventh grade who are ≤ 14 years old (before the age of 15) and have no history of HPV vaccination can be vaccinated free of charge.
Wenchuan County, Aba, Sichuan Province, and Malkang City: Girls of the right age 9 to 14 will be vaccinated free of charge for the next three years.
Just in 2020, the WHO released the Global Strategy to Accelerate the Elimination of Cervical Cancer, which sets HPV vaccination coverage at 90%, screening coverage at 70%, and cervical precancerous lesions and cervical cancer treatment access to 90% by 2030.
"HPV vaccination coverage" here refers to the fact that by 2030, 90% of girls in all countries will be vaccinated against HPV by the age of 15 [7].
That is to say, if you are vaccinated against HPV, then you not only protect yourself, but also contribute to the bright future of cervical cancer elimination for human beings.
If you have a girl of the right age around you, you can also forward this article to her or her family to get an effective vaccine to help more girls.
Let us look forward to the day in the future, cervical cancer can really be eliminated by humans, and I also wish that you who have been vaccinated with HPV can witness the arrival of this day!
Contributing Author: Zhuang Shilihe
Master of Neuroscience, Hokkaido University, Japan
Reviewers:
Lu Xuexin
Assistant researcher and doctor of immunology at the Institute of Viral Disease Prevention and Control, Chinese Center for Disease Control and Prevention
Liu Haiphong
Deputy Chief Physician of the Department of Obstetrics and Gynecology, Huashan Hospital, Fudan University
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[2] Falcaro M, Casta on A, Ndlela B, et al. The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study[J]. The Lancet, 2021, 398(10316): 2084-2092.
Wang Zhenxing, Zou Li, Xu Bing. WHO Opinion Paper on HPV Vaccine [J] . International Journal of Biologics,2017,40(6): 303-309. DOI: 10.3760/cma.j.issn.1673-4211.2017.06.010
[4] Mariz F C, Gray P, Bender N, et al. Sustainability of neutralising antibodies induced by bivalent or quadrivalent HPV vaccines and correlation with efficacy: a combined follow-up analysis of data from two randomised, double-blind, multicentre, phase 3 trials[J]. The Lancet Infectious Diseases, 2021.
Qiao Youlin,Zhao Yuqian. Epidemiological status and prevention of cervical cancer[J].Chinese Journal of Clinical Medicine for Women and Children (Electronic Edition), 2015,11(02):1-6.
[6] Wei L,Xie X,Liu J,et al. Efficacy of quadrivalent human papillomavirus vaccine against persistent infection and genital disease in Chinese women: A randomized, placebo-controlled trial with 78-month follow-up[J]. Vaccine,2018,364:401-411
Wei Lihui. Challenges to accelerate the elimination of cervical cancer[J]. Chinese Clinical Journal of Obstetrics and Gynecology, 2021, 22(1): 1-2.
*The content of this article is a popularization of health knowledge and cannot be used as a specific diagnosis and treatment recommendation, nor is it a substitute for face-to-face consultation by a practicing physician, for reference only.
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