Cochrane · systematic review · CD009069
Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors
Arbyn, M, Xu, L, Simoens, C, et al. · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library
Gynaecological, Neuro-oncology and Orphan CancerAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
30
current version
GRADE rated
25
No studies
5
Included studies
NR
No studies 5 · 16.7%Ungraded 0 · 0%Very low 0 · 0%Low 1 · 3.3%Moderate 7 · 23.3%High 17 · 56.7%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
HPV vaccine effects on cervical lesions in adolescent girls and women negative for hrHPV DNA at baseline
Population: adolescent girls and women aged 15 to 26 years who are hrHPV negative before vaccination
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cervical cancer ‐ not measured | no estimate extracted | NR | No studies |
CIN2+ associated with HPV16/18. | RR 0.01 [0, 0.05] | 3 studies · 23676 participants | High |
CIN3+ associated with HPV16/18 | RR 0.01 [0, 0.1] | 2 studies · 20214 participants | High |
AIS associated with HPV16/18 | RR 0.1 [0.01, 0.82] | 2 studies · 20214 participants | Moderate Downgraded: imprecision |
Any CIN2+ irrespective of HPV type, bivalent or quadrivalent vaccine | RR 0.37 [0.25, 0.55] | 5 studies · 25180 participants | High |
Any CIN2+ irrespective of HPV type | RR 0.33 [0.25, 0.43] | 4 studies · 15884 participants | High |
Any CIN3+ irrespective of HPV type, bivalent or quadrivalent vaccine | RR 0.21 [0.04, 1.1] | 3 studies · 20719 participants | Moderate Downgraded: imprecision |
Any CIN3+ irrespective of HPV type | RR 0.08 [0.03, 0.23] | 2 studies · 11423 participants | High |
Any AIS irrespective of HPV type | RR 0.1 [0.01, 0.76] | 2 studies · 20214 participants | Moderate Downgraded: imprecision |
HPV vaccine effects on cervical lesions in adolescent girls and women negative for HPV16/18 DNA at baseline
Population: adolescent girls and women aged 15 to 45 years who were HPV16/18 negative before vaccination
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cervical cancer ‐ not measured | no estimate extracted | NR | No studies |
CIN2+ associated with HPV16/18 | RR 0.05 [0.03, 0.1] | 6 studies · 34478 participants | High |
CIN3+ associated with HPV16/18 (age 15 to 26 years) | RR 0.05 [0.02, 0.14] | 3 studies · 33199 participants | High |
AIS associated with HPV16/18 or 6/11/16/18 (age 15 to 26 years) | RR 0.09 [0.01, 0.72] | 2 studies · 17079 participants | Moderate Downgraded: imprecision |
Any CIN2+ irrespective of HPV type (age 15 to 26 years) | RR 0.41 [0.32, 0.52] | 3 studies · 19143 participants | High |
Any CIN3+ irrespective of HPV type ‐ not measured | no estimate extracted | NR | No studies |
Any AIS irrespective of HPV type ‐ not measured | no estimate extracted | NR | No studies |
HPV vaccine effects in adolescent girls and women regardless of HPV DNA status at baseline
Population: adolescent girls and women aged 15 to 45 years regardless of HPV DNA status at baseline
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cervical cancer ‐ not measured | no estimate extracted | NR | No studies |
CIN2+ associated with HPV16/18 | RR 0.46 | 3 studies · 34852 participants | High |
CIN3+ associated with HPV16/18 | RR 0.55 [0.45, 0.67] | 2 studies · 34562 participants | High |
Adeno carcinoma in situ (AIS) associated with HPV16/18 | RR 0.36 [0.17, 0.78] | 2 studies · 34562 participants | High |
Any CIN2+ irrespective of HPV type | RR 0.7 [0.58, 0.85] | 4 studies · 35779 participants | High |
Any CIN3+ irrespective of HPV type (age 15 to 26 years) | RR 0.67 [0.49, 0.93] | 3 studies · 35489 participants | Moderate Downgraded: imprecision, inconsistency |
Any CIN3+ irrespective of HPV type (age 15 to 26 years), | RR 0.55 [0.43, 0.71] | 2 studies · 18329 participants | High |
Any AIS irrespective of HPV type (age 15 to 26 years) | RR 0.32 [0.15, 0.67] | 2 studies · 34562 participants | High |
Serious adverse events | RR 0.98 [0.92, 1.05] | 23 studies · 71597 participants | High |
Deaths | RR 1.29 [0.85, 1.98] | 23 studies · 71176 participants | Low Downgraded: imprecision, inconsistency |
HPV vaccine effects on pregnancy outcomes
Population: adolescent girls and women aged 15 to 45 years who became pregnant during the study
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Spontaneous abortion/miscarriage | RR 0.88 [0.68, 1.14] | 9 studies · 8618 participants | High |
Elective termination/induced abortion | RR 0.9 [0.8, 1.02] | 9 studies · 10909 participants | High |
Stillbirth | RR 1.12 [0.68, 1.83] | 6 studies · 8754 participants | Moderate Downgraded: imprecision |
Babies born with congenital malformations | RR 1.22 [0.88, 1.69] | 5 studies · 9252 participants | Moderate Downgraded: imprecision |