HPV vaccine, can be said to be the first human vaccine that can effectively prevent cancer, not only can effectively prevent cervical cancer caused by high-risk HPV infection, but also can prevent anal cancer caused by similar causes , penile cancer and other cancers.
In other words, both men and women can benefit from HPV vaccination (but 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 it? How good is the effect?
As of this year, 15 years have passed since the first HPV vaccine in humans (2006). Scientists have really found a large number of people who have been vaccinated during these 15 years, and after studying their conditions, they have come to conclusions that are worthy of our reference.
In this article, we will talk about it in detail by combining the three latest and most authoritative world heavyweight studies.
(If you want to save some time and go straight to the conclusion, you can go directly to the bold font in the text.)
Image source: Zhanku Hailuo
Almost all cervical cancers (99.7%) are related to HPV infection. Vaccination to prevent HPV infection can effectively prevent cervical cancer.
So how does the HPV vaccine prevent in the real world?
In October 2021, the New England Journal of Medicine (NEJM), the world’s leading medical journal, published a study by Swedish scientists.
This study includes the tracking results of more than 1.6 million women in Sweden for more than ten years. It has a long time span and a large sample size. It can be said to be a “milestone study” [1].
(Paper titled “Association between HPV Vaccination and Risk of Invasive Cervical Cancer,” Screenshot from nejm.org)
Researchers tracked approximately 1.673 million women aged 10-30 in Sweden over 11 years from 2006 to 2017, screening and evaluating them for cervical cancer until they reached the age of 30. 31 years old.
Look at the chart below, and you will definitely find it easy to find: HPV vaccination can significantly reduce the incidence of cervical cancer, and the earlier the better.
More specifically:
Over 500,000 of 1.67 million women were vaccinated against HPV during the 11 years they were followed;
In the vaccinated population, 19 were diagnosed with cervical cancer, and the cumulative incidence was equivalent to 47 cases/100,000 women. Among the unvaccinated population, 538 were diagnosed with cervical cancer. The incidence is equivalent to 94 cases/100,000 women[1];
After adjusting for factors such as age, place of residence, education, family status and related medical history, overall, women who received the HPV vaccine had a significantly lower risk of cervical cancer by 63% [1]!
If vaccinated before age 17, the incidence drops by as much as 88%[1]!
Image source: Zhanku Hailuo
In the study above, almost all Swedish women were vaccinated with the quadrivalent HPV vaccine (protection against HPV6, HPV11, HPV16 and HPV18high-risk HPV infection), is that a “high-priced” vaccine that will have such a good effect?
Another UK study sheds light on this question.
The UK launched a bivalent HPV vaccination program in 2008 to provide routine vaccinations for girls aged 12-13 and supplementary vaccinations for girls aged 14-18.
Just in November 2021, the Lancet, a leading international medical journal, published the results of a British researcher, the largest and longest-running study on cervical cancer to date. Real-world data on vaccines [2].
(Paper titled “The impact of the UK HPV vaccination programme on the incidence of cervical cancer and grade 3 cervical intraepithelial neoplasia: a registry-based observational study”, screenshot source : the Lancet)
The research team assessed the diagnostic data of cervical cancer and cervical precancer in women aged 20 to 64 living in England during the 13 years from 2006 to 2019, and set up seven groups for Analysis, found:
The most basic bivalent vaccine, if vaccinated at the age of 16-18, is 34% effective in preventing cervical cancer, and effective in preventing severe cervical intraepithelial neoplasia (CIN3). 39%; if vaccinated at 12-13 years old, these two figures are as high as 87% and 97% respectively[2];
However, even if the nine-valent HPV vaccine is vaccinated after the age of 30, it will still be effective, but it is far less effective than the bivalent HPV vaccine administered at a young age [2] .
To sum up in one sentence: HPV vaccine, “early vaccination” is more important than “higher price”.
In fact, the World Health Organization clearly stated as early as 2017:
Existing evidence demonstrates the efficacy of bivalent, quadrivalent and 9valent vaccines in the immunogenicity, prevention of HPV 16 and 18 (high-risk) types of cervical cancer from a public health perspective With no difference in efficacy, all three vaccines protect against most relevant cancers [3].
This is also instructive for our practical actions:
If you have a daughter who is over 9 years old, you can let her get the bivalent and quadrivalent vaccine first. There is really no need to wait for the nine-valent vaccine after the age of 16.
After all, it’s better to get vaccinated earlier than “probably better” protection in the future, right?
Image source: Zhanku Hailuo
How long will the protective effect of the HPV vaccine last? Will it hit early and fail early?
In response to this issue, a study from Finland was published in The Lancet Infection, a subsidiary of The Lancet.
This study followed up to 12 years and found that women who received the bivalent HPV vaccine still had detectable HPV vaccine-induced antibody titers at 12 years. degree [4].
(Paper titled “Sustainability of Neutralizing Antibodies Induced by Bivalent or Quadrivalent HPV Vaccines and Their Correlation with Efficacy: Two Randomized, Double-Blind, Multicenter , Joint Follow-up Analysis of Phase 3 Trial Data”, screenshot source: The Lancet Infectious Disease)
The HPV vaccine has been on the market for 15 years now, and we have no way of knowing how protective it will be over a longer period of time. But at least for now, the protective effect is satisfactory, and there is no need for a booster shot.
However, there is still chaos here.The HPV vaccine does not mean that “you don’t have to worry about cervical cancer anymore”, you still need to do regular screening [5].
Cervical Cancer Screening Recommendations:
(1) Sexually active women aged 21-29: Cytology screening every 3 years;
(2) Females aged 30-65 years: If conditions permit, it is recommended to perform cytological examination and HPV/DNA combined detection every 5 years. Perform a cytology test;
(3) Women over 65 years old: If the results of multiple previous screenings are negative, screening should be selected according to individual differences or according to the doctor’s advice.
Image source: Zhanku Hailuo
You may also want to ask: these are all foreign cases, what about our own country?
Currently my country’s domestic HPV vaccine (currently only 2-valent HPV vaccine) has also shown good safety and efficacy in Phase III clinical trials. Protection results [6].
The clinical trial, which began in November 2012, included more than 7,000 female volunteers who were randomly assigned to either a vaccine group (vaccinated against domestic bivalent HPV vaccine) or a control group ( Inoculated with hepatitis E vaccine as a control), received one dose of vaccine at 0, 1, and 6 months, respectively.
After 42 months of follow-up, it was found that the domestic bivalent HPV vaccine[6]:
The effective rate of preventing precancerous lesions was 100.0% (0/3306 in the vaccine group and 10/3296 in the control group);
The effective rate of preventing HPV16/18 persistent infection was 97.8% (1/3240 in the vaccine group and 45/3246 in the control group).
That is, 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 my country!
Image source: Zhanku Hailuo
In many regions in China, such as Guangdong Province, Chengdu, Sichuan, etc., free HPV vaccination has been started for girls of appropriate age. I believe that in the future, more cities and regions will join this ranks.
City and district and local vaccination policies
Wuxi, Jiangsu, Lianyungang, Jiangsu: The free HPV vaccination program will be launched in December 2021, providing 2 doses of domestic bivalent HPV vaccine for girls in the second grade of junior high school free full vaccination.
Guangdong: From 2022, girls under the age of 14 who have a student status in Guangdong Province, who have entered the first grade of junior high school from September and have not been vaccinated against HPV vaccine can receive free vaccination .
Chengdu, Sichuan: For 13-14 year old female students in school, a subsidy of 600 yuan/person for vaccination will be given by financial funds. Independent choice between 2-valent and imported 4-valent HPV vaccines. The difference between the vaccine fee and the vaccination service fee (2 yuan/dose) after the subsidy shall be borne by the parents (guardians) of the recipients.
Ordos City, Inner Mongolia: Females aged 13-18 are vaccinated with three doses of HPV vaccine free of charge (the vaccination cycle is 0, 1, and 6 months), and the public only needs to pay Vaccination service fee.
Jinan, Shandong: Seventh grade girls aged ≤14 years (before 15 years old) and without a history of HPV vaccination can receive free vaccinations.
Wenchuan County and Malkang City, Aba, Sichuan Province: Girls aged 9-14 will be vaccinated free of charge in the next 3 years.
Just in 2020, the WHO released the Global Strategy to Accelerate Cervical Cancer Elimination, setting 90% HPV vaccination coverage and 70% screening coverage by 2030 As well as cervical precancerous lesions and cervical cancer treatment accessibility of 90%.
Here, “HPV vaccine coverage” means that by 2030, 90 percent of girls in all countries will be vaccinated against HPV before reaching the age of 15 [7].
In other words, if you are vaccinated against HPV, you are not only protecting yourself, but also contributing to a better future for humanity to eliminate cervical cancer.
If you have a girl of school age around you, you can also forward this article to her or her family so that effective vaccines can help more girls.
Let’s hope that one day in the future, cervical cancer can really be eliminated by human beings, and I wish you who have been vaccinated with HPV vaccine to witness the arrival of this day!
Contributing Writers: Johnny John
Master of Neuroscience, Hokkaido University, Japan
Reviewers:
Lu Xuexin
Assistant Researcher, Doctor of Immunology, Institute of Viral Disease Prevention and Control, Chinese Center for Disease Control and Prevention
bangs
Deputy Chief Physician, Department of Obstetrics and Gynecology, Huashan Hospital Affiliated to Fudan University
References
[1]Lei J, Ploner A, Elfstr m K M, et al. HPV vaccination and the risk of invasive cervical cancer[J]. New England Journal of Medicine, 2020, 383(14 ): 1340-1348.
[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.
[3]Wang Zhenxing, Zou Li, Xu Bing. WHO’s position paper on human papillomavirus vaccine[J] . International Journal of Biological Products, 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.
[5] 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
[7] Wei Lihui. Facing the challenge of accelerating the elimination of cervical cancer [J]. Chinese Journal of Obstetrics and Gynecology, 2021, 22(1): 1-2.
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