PMID- 30944092
DCOM- 20190415
LR  - 20190418
IS  - 1756-1833 (Electronic)
IS  - 0959-8138 (Linking)
VI  - 365
DP  - 2019 Apr 3
TI  - Prevalence of cervical disease at age 20 after immunisation with bivalent HPV
      vaccine at age 12-13 in Scotland: retrospective population study.
PG  - l1161
LID - 10.1136/bmj.l1161 [doi]
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.
CI  - Published by the BMJ Publishing Group Limited. For permission to use (where not
      already granted under a licence) please go to
FAU - Palmer, Tim
AU  - Palmer T
AD  - Department of Pathology, University of Edinburgh, Edinburgh, UK
FAU - Wallace, Lynn
AU  - Wallace L
AD  - Information Services Division, NHS Scotland, Glasgow, UK.
FAU - Pollock, Kevin G
AU  - Pollock KG
AD  - Health Protection Scotland, Glasgow, UK.
AD  - School of Health and Life Science, Glasgow Caledonian University, Glasgow, UK.
FAU - Cuschieri, Kate
AU  - Cuschieri K
AD  - Scottish Human Papillomavirus Reference Laboratory, Royal Infirmary of Edinburgh,
      Edinburgh, UK.
FAU - Robertson, Chris
AU  - Robertson C
AD  - Health Protection Scotland, Glasgow, UK.
AD  - International Prevention Research Institute, Lyon, France.
AD  - Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK.
FAU - Kavanagh, Kim
AU  - Kavanagh K
AD  - Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK.
FAU - Cruickshank, Margaret
AU  - Cruickshank M
AD  - Institute of Applied Health Services, University of Aberdeen, Aberdeen, UK.
LA  - eng
PT  - Journal Article
DEP - 20190403
PL  - England
JT  - BMJ (Clinical research ed.)
JID - 8900488
RN  - 0 (Papillomavirus Vaccines)
SB  - IM
MH  - Cervical Intraepithelial Neoplasia/*epidemiology/pathology/*prevention & control
MH  - Early Diagnosis
MH  - Female
MH  - Humans
MH  - Papillomavirus Infections/epidemiology/pathology/prevention & control
MH  - Papillomavirus Vaccines/*administration & dosage
MH  - Prevalence
MH  - Retrospective Studies
MH  - Scotland/epidemiology
MH  - Treatment Outcome
MH  - Uterine Cervical Neoplasms/*epidemiology/pathology/*prevention & control
MH  - *Vaccination
MH  - Young Adult
PMC - PMC6446188
COIS- Competing interests: All authors have completed the ICMJE uniform disclosure form
      at and declare: KP has received travel monies
      from both Merck and GSK to attend conferences. KC's institution has received
      monies to deliver research, or associated consumables to support research, from: 
      Qiagen, Hologic, Selfscreen, GeneFirst, Euroimmun, Cepheid, Genomica, and
      LifeRiver. No personal conflicts of interest are declared.
EDAT- 2019/04/05 06:00
MHDA- 2019/04/16 06:00
CRDT- 2019/04/05 06:00
PHST- 2019/04/05 06:00 [entrez]
PHST- 2019/04/05 06:00 [pubmed]
PHST- 2019/04/16 06:00 [medline]
AID - 10.1136/bmj.l1161 [doi]
PST - epublish
SO  - BMJ. 2019 Apr 3;365:l1161. doi: 10.1136/bmj.l1161.