2020年HPV疫苗接种ACOG专家委员会意见NO.809（取代2017年6月原704号）：

王继东，袁冰，等 

山东省妇幼保健院 妇科肿瘤综合诊治中心

摘要

建议和结论

•作为青少年免疫计划的一部分，建议在11-12岁目标年龄（但可从9岁起）为女童和男童进行常规HPV疫苗接种。

•强烈建议符合条件的患者接种HPV疫苗，并强调HPV疫苗的益处和安全性。

•对于13-26岁年龄段的少女和年轻女性，如果未在11-12岁目标年龄阶段接种HPV疫苗，无论是否有性生活、是否曾有HPV感染，以及性取向如何，都应对她们进行评估并予以HPV疫苗接种。

•妇产科医生和其他保健专业人员应教育孩子父母在为子女接种疫苗方面作出决策。

•27-45岁年龄段以前未接种过HPV疫苗的妇女，在接种HPV疫苗前可采用共享的临床决策，评估患者获得新的HPV型别感染的风险并考虑接种HPV疫苗是否获益。

•不建议已经接种四价HPV疫苗后重新接种九价疫苗。

•鼓励妇产科医生在条件允许时储存和管理HPV疫苗。

•建议26岁以下女性接种HPV疫苗，即使接种前HPVDNA检测阳性。

•不建议在接种疫苗前进行HPV DNA检测。

•妊娠期间不建议接种HPV疫苗；在接种前不必常规进行妊娠试验。

•既往未接种过HPV疫苗的26岁及以下哺乳期妇女，可以接种HPV疫苗。

•对于有性虐待或性攻击史的儿童，应尽早接种HPV疫苗，从9岁开始。

背景资料

HPV疫苗

HPV疫苗接种时间和剂量

疫苗安全性

疫苗效力

患者教育

参考文献

1. de Villiers EM. Cross-roads in theclassification of papillomaviruses. Virology 2013;445:2–10.

2. American Cancer Society. Cancer facts& figures 2020. Atlanta, GA: ACS; 2020. Available at: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-andstatistics/annual-cancer-facts-and-figures/2020/cancerfacts-and-figures-2020.pdf.Retrieved April 3, 2020.

3. FDA licensure of bivalent humanpapillomavirus vaccine (HPV2, Cervarix) for use in females and updated HPVvaccination recommendations from the Advisory Committee on ImmunizationPractices (ACIP). Centers for Disease Control and Prevention (CDC). [publishederratum appears in MMWR Morb Mortal Wkly Rep 2010;59:1184]. MMWR Morb MortalWkly Rep 2010;59:626–9.

4. Van Dyne EA, Henley SJ, Saraiya M,Thomas CC,Markowitz LE, Benard VB. Trends in human papilloavirus-associatedcancers—United States, 1999-2015. MMWR Morb Mortal Wkly Rep 2018;67:918–24.

5. Walker TY, Elam-Evans LD, Yankey D,Markowitz LE, Williams CL, Fredua B, et al. National, regional, state, andselected local area vaccination coverage among adolescents aged 13-17 years -United States, 2018. MMWR Morb Mortal Wkly Rep 2019;68:718–3.

6. Human papillomavirus vaccinationcoverage among adolescent girls, 2007-2012, and postlicensure vaccine safetymonitoring, 2006-2013—United States. Centers for Disease Control and Prevention(CDC). MMWR Morb Mortal Wkly Rep 2013;62:591–5.

7. Meites E, Szilagyi PG, Chesson HW, UngerER, Romero JR, Markowitz LE. Human papillomavirus vaccination for adults:updated recommendations of the Advisory Committee on Immunization Practices.MMWR Morb Mortal Wkly Rep 2019;68:698–702.

8. Meites E, Kempe A, Markowitz LE. Use ofa 2-dose schedule for human papillomavirus vaccination—updated recommendationsof the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep2016;65:1405–8.

9. Partnering with patients to improvesafety. Committee Opinion No. 490. American College of Obstetricians andGynecologists. Obstet Gynecol 2011;117:1247–9.

10. Effective patient–physiciancommunication. Committee Opinion No. 587. American College of Obstetricians andGynecologists. Obstet Gynecol 2014;123:389–93.

11. World Health Organization. Evidencebased recommendations on human papilloma virus (HPV) vaccines schedules.Background paper for SAGE discussions. Geneva: WHO; 2014. Available at:https://www.who.int/immunization/sage/meetings/2014/april/1_HPV_Evidence_based_recommendationsWHO_with_Appendices2_3.pdf?ua51.Retrieved April 3, 2020.

12. Schiller JT, Castellsague X, GarlandSM. A review of clinical trials of human papillomavirus prophylactic vaccines.Vaccine 2012;30(suppl 5):F123–38.

13. Kann L, McManus T, Harris WA, ShanklinSL, Flint KH, Queen B, et al. Youth Risk Behavior Surveillance—United States,2017. MMWR Surveill Summ. 2018;67:1–114.

14. Leval A, Herweijer E, Ploner A,Eloranta S, Fridman Simard J, Dillner J, et al. Quadrivalent humanpapillomavirus vaccine effectiveness: a Swedish national cohort study. J NatlCancer Inst 2013;105:469–74.

15. Bednarczyk RA, Davis R, Ault K,Orenstein W, Omer SB. Sexual activity-related outcomes after humanpapillomavirus vaccination of 11- to 12-year-olds. Pediatrics 2012;130:798–805.

16. Cook E, Venkataramani AS, Kim JJ, TamimiRM, Holmes MD. Legislation to increase uptake of HPV vaccination and adolescentsexual behaviors. Pediatrics 2018;142:e20180458.

17. Munoz N, Kjaer SK, Sigurdsson K,Iversen OE, HernandezAvila M, Wheeler CM, et al. Impact of human papillomavirus(HPV)-6/11/16/18 vaccine on all HPV- associated genital diseases in youngwomen. J Natl Cancer Inst 2010;102:325–39.

18. Paavonen J, Naud P, Salmeron J, WheelerCM, Chow SN, Apter D, et al. Efficacy of human papillomavirus (HPV)- 16/18AS04-adjuvanted vaccine against cervical infection and precancer caused byoncogenic HPV types (PATRICIA): final analysis of a double-blind, randomisedstudy in young women. HPV PATRICIA Study Group [published erratum appears inLancet 2010;376:1054]. Lancet 2009; 374:301–14.

19. Garland SM, Ault KA, Gall SA, PaavonenJ, Sings HL, Ciprero KL, et al. Pregnancy and infant outcomes in the clinicaltrials of a human papillomavirus type 6/11/16/18 vaccine: a combined analysisof five randomized controlled trials. Quadrivalent Human Papillomavirus VaccinePhase III Investigators. Obstet Gynecol 2009;114:1179–88.

20. Roteli-Martins CM, Naud P, De Borba P,Teixeira JC, De Carvalho NS, Zahaf T, et al. Sustained immunogenicity andefficacy of the HPV-16/18 AS04-adjuvanted vaccine: up to 8.4 years offollow-up. Hum Vaccin Immunother 2012;8:390–7.

21. Scheller NM, Pasternak B,Mølgaard-Nielsen D, Svanström H, Hviid A. Quadrivalent HPV Vaccination and therisk of adverse pregnancy outcomes. N Engl J Med 2017;376: 1223– 33.

22. Markowitz LE, Dunne EF, Saraiya M,Chesson HW, Curtis CR, Gee J, et al. Human papillomavirus vaccination:recommendations of the Advisory Committee on Immunization Practices (ACIP).Centers for Disease Control and Prevention (CDC) [published erratum appears inMMWR Morb Mortal Wkly Rep 2014;63:1182]. MMWR Recomm Rep 2014;63: 1–30.

23. Levin MJ, Moscicki AB, Song LY, FentonT, Meyer WA  III, Read JS, et al. Safetyand immunogenicity of a quadrivalent human papillomavirus (types 6, 11, 16, and18) vaccine in HIV-infected children 7 to 12 years old. IMPAACTP1047 ProtocolTeam. J Acquir Immune Defic Syndr 2010; 55:197– 204.

24. Rowhani-Rahbar A, Alvarez FB, Bryan JT,Hughes JP, Hawes SE, Weiss NS, et al. Evidence of immune memory 8.5 yearsfollowing administration of a prophylactic human papillomavirus type 16vaccine. J Clin Virol 2012;53:239– 43.

25. Kjaer SK, Nygard M, Dillner J, BrookeMarshall J, Radley D, Li M, et al. A 12-year follow-up on the long-termeffectiveness of the quadrivalent human papillomavirus vaccine in 4 Nordiccountries. Clin Infect Dis 2018;66:339–45.

26. Petrosky E, Bocchini JA Jr, Hariri S,Chesson H, Curtis CR, Saraiya M, et al. Use of 9-valent human papillomavirus(HPV) vaccine: updated HPV vaccination recommendations of the advisorycommittee on immunization practices. Centers for Disease Control and Prevention(CDC). MMWR Morb Mortal Wkly Rep 2015;64:300–4.

27. American Cancer Society. HPV vaccinefacts. Atlanta, GA: ACS; 2018. Available at: https://www.cancer.org/cancer/ cancer-causes/infectious-agents/hpv/hpv-vaccine-factsand-fears.html.Retrieved April 3, 2020.

28. Shimabukuro TT, Su JR, Marquez PL,Mba-Jonas A, Arana JE, Cano MV. Safety of the 9-valent human papillomavirusvaccine. Pediatrics 2019;144:e20191791.

29. Garland SM, Cheung TH, McNeill S,Petersen LK, Romaguera J, Vazquez-Narvaez J, et al. Safety and immunogenicityof a 9-valent HPV vaccine in females 12–26 years of age who previously receivedthe quadrivalent HPV vaccine. Vaccine 2015;33:6855–64.

30. Moreira ED Jr, Block SL, Ferris D,Giuliano AR, Iversen OE, Joura EA, et al. Safety profile of the 9-valent HPVvaccine: a combined analysis of 7 phase III clinical trials. Pediatrics2016;138:e20154387.

31. Markowitz LE, Gee J, Chesson H, StokleyS. Ten years of human papillomavirus vaccination in the United States. AcadPediatr 2018;18:S3–10.

32. Drolet M, Benard E, Perez N, Brisson M.Population-level impact and herd effects following the introduction of humanpapillomavirus vaccination programmes: updated systematic review andmeta-analysis. HPV Vaccination Impact Study Group. Lancet 2019;394:497–509.

33. Donovan B, Franklin N, Guy R, GrulichAE, Regan DG, Ali H, et al. Quadrivalent human papillomavirus vaccination andtrends in genital warts in Australia: analysis of national sentinelsurveillance data. Lancet Infect Dis 2011;11:39–44.

34. Chabeda A, Yanez RJ, Lamprecht R,Meyers AE, Rybicki EP, Hitzeroth II. Therapeutic vaccines for high-riskHPVassociated diseases. Papillomavirus Res 2018;5:46–58.

35. Zimet GD, Mays RM, Winston Y, Kee R,Dickes J, Su L. Acceptability of human papillomavirus immunization. J WomensHealth Gend Based Med 2000;9:47–50.