Lancet Oncol:为打疫苗去三次香港?单剂接种效果如何?

2021-11-08 MedSci原创 MedSci原创

实际上,单剂疫苗的效果与观察到的两剂或一剂四价疫苗三剂相同疫苗的效果没有什么不同。

据世卫组织估计,2019年HPV疫苗的全球覆盖率仅为15%,原因是很多低收入和中等收入国家的卫生系统没有做好充分准备,无法应对向适龄女性提供两剂疫苗的艰巨挑战。那么,这些国家能否通过HPV单剂量疫苗接种计划来解决这个问题呢?因为单剂接种在后勤上更简单、更具弹性,也可能有助于解决供应危机。

于是,有研究者提出了问题:单剂量接种的效果怎么样?本研究的目的就是描述单剂四价HPV疫苗与两剂或三剂疫苗在预防接种后10年内的偶发性和持续性宫颈HPV感染方面的效果。

在随机试验中,从印度九个中心招募10-18岁的未婚女孩,随机分为两剂或三剂四价HPV疫苗,肌肉注射0.5mL。根据每个方案接受的疫苗剂量数,将参与者分配到四个队列:两个剂量队列(第1天和第180天或之后接受疫苗)、三个剂量队列(第1天、第60天和第180天或之后),两个剂量默认队列(第1天和第60天或更晚),以及单剂量默认队列。每年对参与者进行随访。

从参与者婚后18个月或首次分娩后6个月(以较早者为准)收集宫颈标本,以评估事件和持续性HPV感染。已婚参与者在25岁时接受宫颈癌筛查。招募与已婚接种者年龄相匹配的未接种疫苗的妇女作为对照。对单剂量受试者的持久性HPV 16和18感染的疫苗效力进行分析,并在调整未接种和接种队列之间潜在混杂因素分布的不平衡后,将其与两剂量和三剂量受试者的疫苗效力进行比较。

从上表可以看出,接种疫苗的参与者于2009年9月1日至2010年4月8日(疫苗接种暂停日期)之间招募,并在中位持续时间9.0年内进行随访。4348名参与者用三剂,4980人用两剂(0个月和6个月),4949人用一剂。单剂量默认队列(2135名接受评估的女性)中,受试者对持久性HPV 16和18感染的疫苗有效性在终点可评估为95.4%,在两剂量队列(1452名接受评估的女性)中为93.1%,在三个剂量受试者(1460名接受评估的女性)中为93.3%。

根据对4000多名青少年的系统随访,这些青少年一直持续到接种疫苗后10年。在接受单剂疫苗的女孩中,研究表明,单剂疫苗的效果与观察到的两剂或一剂四价疫苗三剂相同疫苗的效果没有什么不同。单剂HPV疫苗对HPV 16和18的持续感染提供了与两剂或三剂疫苗相似的保护,因此,对于欠发达甚至贫困地区,接种单剂量HPV疫苗是可行的。

参考文献:Partha Basu, Sylla G Malvi, Smita Joshi,et al, Vaccine efficacy against persistent human papillomavirus (HPV) 16/18 infection at 10 years after one, two, and three doses of quadrivalent HPV vaccine in girls in India: a multicentre, prospective, cohort study, The Lancet Oncology, Volume 22, Issue 11, 2021, Pages 1518-1529, ISSN 1470-2045, https://doi.org/10.1016/S1470-2045(21)00453-8.

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    2022-07-05 howi
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    2022-06-26 minlingfeng
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    2021-11-09 ms6000000656440728

    很好的研究,为缺乏疫苗的地区百姓带来**

    0

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    2021-11-09 j3x

    建议推广

    0

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