Prophylactic Vaccination Against Human Papillomavirus (HPV) Infection And Disease And Cervical Cancer In Women: A Quantitative Systematic Review

Objective:To assess the efficacy and safety of prophylactic human papillomavirus (HPV) vaccine in preventing cervical cancer and infection and diseases associated with vaccine-type HPV.Method:According to cochrane Reviewer's Handbook and search strategy, the electronic databases were searched including the Cochrane library Issuel,2008, MEDLINE(1950-2009), CBM(1978-2009), the randomized controlled trials (RCTs) about prophylactic HPV vaccine in preventing cervical cancer and infection and diseases associated with vaccine-type HPV were included. Chinese Journal Of Obstetrics and Gynecology, Journal of Clinical Obstetrics and Gynecology and Foreign Medical Sciences(Section of Obstetrics and Gynecology)were handsearched. The RCT studies meeting the inclusion criteria were selected. Two independent reviewers evaluate the trials. After that, Homogeneity, Meta-analysis were made by RevMan4.2 software. If Meta-analysis can't be done, qualitative descriptions were made.Results:There were 14 trials (11 original studies and 3 follow-up studies) including 65667 women met the inclusion criteria of this review, which were all double-blind, randomized, controlled study. The results of Meta-analysis were expressed with RR,VE and 95%C1.(1) Prophylactic HPV vaccination was associated with a reduction in the frequency of high-grade cervical lesions, adenocarcinoma in situ caused by vaccine-type HPV strains compared with control groups. The difference has statistical significance, (RR=0.04, 95%CI[0.02-0.09],p<0.0001) The VE was 96%.(2) Prophylactic vaccination can reduce the frequency of persistent HPV infection, compared with control groups. The difference has statistical significance, (RR=0.14,95%CI[0.10-0.19], p<0.0001), The VE was 86%.(3) Prophylactic vaccination can also reduce the frequency of any CIN or worse compared with control groups. (RR=0.03,95%Cl[0.01-0.09],p<0.0001),The VE was 97%.(4) Vaccination was also associated with a reduction in the frequency of genital warts. (RR=0.02,95%CI[0.00-0.08]p<0.0001), The VE was 98%.(5) Vaccination was also associated with a reduction in the frequency of HPV-related infection and diseases outcomes, including high-grade vulvar intraepithelial neoplasia or vaginal intraepithelial neoplasia,even worse. (RR=0.05,95%CI [0.01-0.39]p=0.004), The VE was 95%. (6) Prophylactic vaccination can also reduce the frequency of any CIN caused by no-vaccine-type HPV strains (RR=0.81,95%CI[0.73-0.89],p<0.0001), The VE was 19%.(7) The majority of adverse events were minor. The incidence of serious adverse events was balanced between the vaccine and control groups.Conclusions:Prophylactic HPV vaccination was associated with a reduction in the frequency of HPV-related infection and diseases outcomes, including high-grade cervical lesion(CIN II/ III,AIS); persistent HPV infection; any CIN or worse; high-grade vulvar intraepithelial neoplasia or vaginal intraepithelial neoplasia,even worse and genital warts. Prophylactic vaccination can also reduce the frequency of any CIN caused by no-vaccine-type HPV strains. The vaccine efficacy was96%;86%;97%;95%;98%and 19%respectively. The majority of adverse events were minor. The incidence of serious adverse events was balanced between the vaccine and control groups.