The quality of evidence is upgraded by large magnitude of effect.
A study 1 using nationwide Swedish registers assessed the relationship between quadrivalent HPV vaccination and risk of invasive cervical cancer in a population of 1 672 983 girls and women who were 10 to 30 years of age from 2006 through 2017. After adjustment for age at follow-up, the incidence rate ratio for the comparison of the vaccinated population with the unvaccinated population was 0.51 (95% CI 0.32 to 0.82). After adjustment for all covariates, the incidence rate ratio was 0.12 (95% CI 0.00 to 0.34) among women who had been vaccinated before the age of 17 years and 0.47 (95% CI 0.27 to 0.75) among women who had been vaccinated at the age of 17 to 30 years.
A Cochrane review [Abstract] 2 included 26 trials with a total of 73 428 participants. In adolescent girls and women (aged 15 to 26) negative for hrHPV DNA at baseline, HPV vaccines reduce CIN2+, CIN3+, adenocarcinoma-in-situ (AIS) associated with HPV16/18 compared with placebo in adolescent girls and women (table T1). Studies were not of sufficient duration to evaluate cervical cancer outcomes.
| Outcome | Relative effect(95% CI)RR | Risk with placebo | Risk with HPV vaccination (95% CI) | №of participants(studies)Certainty of evidence |
|---|---|---|---|---|
| CIN2+ associated with HPV16/18.Follow-up: 3 to 5 years | 0.01(0.00 to 0.05) | 164 per 10 000 | 2 per 10 000(0 to 8) | 23 676(3) High |
| CIN3+ associated with HPV16/18.Follow-up: 3 to 5 years | 0.01(0.00 to 0.10) | 70 per 10 000 | 0 per 10 000(0 to 7) | 20 214(2) High |
| Adenoca in situ associated with HPV16/18.Follow-up: 3 to 5 years | 0.10(0.01 to 0.82) | 9 per 10 000 | 0 per 10 000(0 to 7) | 20 214(2) Moderate |
| Any CIN2+ irrespective of HPV type, bivalent or quadrivalent vaccineFollow-up: 2 to 6 years | 0.37(0.25 to 0.55) | 287 per 10 000 | 106 per 10 000(72 to 158) | 25 180 (5) High |
| Any CIN3+ irrespective of HPV typeFollow-up (bivalent): 4 years | 0.08(0.03 to 0.23) | 81 per 10 000 | 6 per 10 000(3 to 19) | 11 423(2) High |
| Any CIN3+ irrespective of HPV type Follow-up (quadrivalent): 3.5 years | R0.54(0.36 to 0.82) | 143 per 10 000 | 77 per 10 000(51 to 117 ) | 9296(1) Moderate |
Date of latest search: 2020-10-14
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