HPV vaccine prevents high-grade cervical lesion in population with low vaccination uptake

The human papillomavirus (HPV) vaccine helps protect against the risk of developing high-grade cervical lesion even in a population with low vaccination coverage, as shown in a study.

Drawing from the Tennessee Medicaid billing data, the study adopted a validated claims-based model to identify the annual age group‒specific incidence rates of cervical intraepithelial neoplasia grades 2 or 3 or adenocarcinoma in situ events among women aged 18–39 years and the subset of women who were screened for cervical cancer. Significant trends were assessed by Joinpoint.

The analysis included 549,671 TennCare-enrolled women who contributed 2.3 million person-years of data for over 11 years. Of those with known demographics, 34.1 percent of women were White and 65.2 percent were aged 25–39 years. The HPV vaccination coverage in 2019 was 62 percent in terms of initiation and 43 percent in terms of up-to-date vaccination among adolescents aged 13–17 years.

Among all TennCare-enrolled women aged 18–39 years, annual screening for cervical cancer decreased from 40.9 percent in 2008 to 25.4 percent in 2018. The largest declines were observed among women aged 18–20 years (from 46.0 percent to 12.4 percent) and 21–24 years (from 49.2 percent to 30.1 percent).

High-grade cervical lesion incidence showed a marked decline among women aged 18–20 years (average annual percentage change, −31.9, 95 percent confidence interval [CI], −38.6 to −24.6), 21–24 years (average annual percentage change, −12.9, 95 percent CI, −22.3 to −2.4), and 25–29 years (average annual percentage change, −6.4, 95 percent CI, −8.1 to −4.6).

Among screened women, high-grade cervical lesion incidence rates significantly declined for ages 18–20 years (average annual percentage change, −20.3, 95 percent CI, −25.3 to −15.0), 21–24 years (average annual percentage change, −10.2, 95 percent CI, −12.6 to −7.8), and 25–29 years (average annual percentage change, −2.6, 95 percent CI, −3.9 to −1.2).

Meanwhile, trends from 2008 to 2018 were stable for older age groups (30–34 and 35–39 years).