Routine vaccination of girls aged 12 or 13 years with the human papillomavirus (HPV) vaccine in Scotland has led to a dramatic reduction in cervical disease in later life, finds a study in The BMJ.
Unvaccinated women also showed a reduction in disease, possibly due to herd protection, say the researchers.
HPV is one of the most common sexually transmitted infections and many countries, including the UK, offer vaccination to girls to protect them against cervical cancer, and other related cancers, in later life.
Previous studies suggest that vaccination protects against the most carcinogenic HPV types 16 and 18, which are responsible for 70% of cervical cancer cases globally, but population data on the effect of routine vaccination on disease are lacking.
Scotland introduced a national HPV immunisation programme in 2008 for girls aged 12 and 13, with a catch-up programme up to age 18 years.
A team led by Tim Palmer at the University of Edinburgh has measured the impact of routine vaccination of girls with the bivalent HPV vaccine on levels of abnormal cells and cervical lesions (cervical intraepithelial neoplasia [CIN]).
They found that compared with unvaccinated women born in 1988, vaccinated women born in 1995 and 1996 showed an 89% reduction in CIN grade 3 or worse, an 88% reduction in CIN grade 2 or worse, and a 79% reduction in CIN grade 1.
Younger age at vaccination was associated with increasing vaccine effectiveness.
Unvaccinated women also showed a reduction in disease, suggesting that interruption of HPV transmission in Scotland has created substantial herd protection.
In a linked editorial, Julia Brotherton, Medical Director at VCS Foundation in Australia, says the findings are ‘dramatic and document a considerable reduction in high grade cervical disease over time.’
She added: ‘We must work towards a world in which all girls and their families are offered, and the majority accept, HPV vaccination. We must also actively develop more effective and culturally acceptable strategies for cervical screening, such as self-collection of specimens, if we are to reduce the burden of cervical cancer.’
Palmer T, et al. BMJ 2019;365:l1161
