■在美国,产后人乳头瘤病毒(HPV)疫苗接种是增加HPV疫苗接种量的有希望的策略,特别是接触接种疫苗的妇女和那些在怀孕期间缺乏健康保险的妇女。然而,完成3剂疫苗方案具有挑战性.
评估2剂量产后HPV疫苗接种方案(0和6个月)的免疫原性,并评估其是否不劣于3剂量产后HPV疫苗接种方案(0、1-2和6个月)。
■非劣性,开放标签,非随机免疫原性试验于2020年8月4日至2022年6月23日在巴尔的摩的两家医院分娩的15至45岁的产后患者中进行,马里兰。历史对照是16至26岁的青少年和年轻女性。
■间隔6个月给药两剂非价HPV疫苗。
■与历史对照相比,主要结局是产后妇女HPV-16几何平均滴度(GMT)比率的非劣效性(90%CI,下限>0.67)。次要结果是其他8种HPV类型的GMT比率的非劣效性和每种HPV类型的血清转化百分比。作为一项非劣效性试验,主要分析使用符合方案分析.
■在225名注册参与者中,基线时的平均(SD)年龄为29.9(6.8)岁,和171(76.0%)在基线为HPV-16血清阴性。在这171名参与者中,129人(75.4%)接受了第二次疫苗剂量,并完成了随后4周的血清学测量。相对于历史控制,HPV-16GMT比率为2.29(90%CI,2.03-2.58).在第7个月,2剂量方案后的HPV-16GMT(7213.1mMU/mL[90%CI,6245.0-8331.4mMU/mL])高于3剂量方案后的历史对照(3154.0mMU/mL[90%CI,2860.2-3478.0mMU/mL])。同样,对于8种HPV类型6,11,18,31,33,45,52和58,GMT比率的90%CI下限大于1.134名女性中的118名(88.1%)在第一次给药后,HPV-16血清转化;第二次给药后4周,所有HPV类型的血清转换率均为99%或更高.
■这项研究表明,在产后妇女中间隔6个月给予2剂量HPV疫苗接种方案的免疫原性不劣于年轻的历史对照组中的3剂量方案。大多数女性在2剂量方案的第一剂量后血清转化。这些结果表明,使用减少时间表的产后疫苗接种可能是增加HPV疫苗系列完成的有希望的策略。
■ClinicalTrials.gov标识符:NCT04274153。
UNASSIGNED: Postpartum human papillomavirus (HPV) vaccination is a promising strategy to increase HPV vaccination uptake in the US, particularly for reaching vaccine-naive women and those who lack health insurance beyond the pregnancy period. However, completion of the 3-dose vaccine regimen is challenging.
UNASSIGNED: To evaluate the immunogenicity of a 2-dose postpartum HPV vaccination regimen (0 and 6 months) and assess whether it is noninferior to a 3-dose postpartum HPV vaccination regimen (0, 1-2, and 6 months) administered to historical controls.
UNASSIGNED: A noninferiority, open-label, nonrandomized immunogenicity
trial was conducted from August 4, 2020, to June 23, 2022, of postpartum patients aged 15 to 45 years who delivered at 2 hospitals in Baltimore, Maryland. Historical controls were adolescents and young women aged 16 to 26 years.
UNASSIGNED: Two doses of the nonavalent HPV vaccine administered 6 months apart.
UNASSIGNED: The primary outcome was noninferiority (90% CI, lower bound >0.67) of the geometric mean titer (GMT) ratio for HPV-16 among postpartum women compared with historical controls. Secondary outcomes were noninferiority of GMT ratios for the other 8 HPV types and percentage seroconversion for each HPV type. As a noninferiority
trial, the primary analysis used the per-protocol analysis.
UNASSIGNED: Of 225 enrolled participants, the mean (SD) age at baseline was 29.9 (6.8) years, and 171 (76.0%) were HPV-16 seronegative at baseline. Of these 171 participants, 129 (75.4%) received a second vaccine dose and completed the subsequent 4-week serologic measurements. Relative to historical controls, the HPV-16 GMT ratio was 2.29 (90% CI, 2.03-2.58). At month 7, HPV-16 GMT was higher after the 2-dose regimen (7213.1 mMU/mL [90% CI, 6245.0-8331.4 mMU/mL]) than among historic controls after the 3-dose regimen (3154.0 mMU/mL [90% CI, 2860.2-3478.0 mMU/mL]). Similarly, the lower bound of the 90% CI of the GMT ratio was above 1 for the 8 HPV types 6, 11, 18, 31, 33, 45, 52, and 58. A total of 118 of 134 women (88.1%) seroconverted for HPV-16 after the first dose; 4 weeks after the second dose, the seroconversion rate was 99% or greater for all HPV types.
UNASSIGNED: This
study suggests that immunogenicity of a 2-dose HPV vaccination regimen given 6 months apart among postpartum women was noninferior to a 3-dose regimen among young historical controls. Most women seroconverted after the first dose of the 2-dose regimen. These results demonstrate that postpartum vaccination using a reduced schedule may be a promising strategy to increase HPV vaccine series completion.
UNASSIGNED: ClinicalTrials.gov Identifier: NCT04274153.