The objective of this study was to evaluate the association between human papillomavirus (HPV) vaccination and uptake of initial Papanicolaou (Pap) testing in Israel among women not previously vaccinated through the national immunization program. In this retrospective cohort we used health provider records of vaccinations and cancer screening attendance among female members of a state-mandated health provider in Israel (Maccabi Healthcare Services, MHS). All eligible female members ( N = 20,904) immunized with at least one dose of HPV vaccine from the date of its introduction in Israel (June 2007) until December 31, 2018 were individually matched with nonvaccinated MHS members on one to one ratio by year of birth, residential area socioeconomic level, and district of residence. Data on the uptake of Pap smears until December 2018 were extracted from MHS central datasets, and the number of Pap smears for each woman during the study period was counted. During the observed follow-up period (mean, 6.6 years; interquartile range, 3.9–8.7 year), the cumulative uptake rate of Pap testing in vaccinated women (26.8%) was significantly ( P < 0.001) greater than among unvaccinated (22.4%) women. In a multivariable model, HPV vaccination was associated with an HR of 1.34 [95% confidence interval (CI), 1.29–1.41] to perform Pap testing. Our findings suggest that uptake of catch-up HPV vaccine was positively correlated to increased uptake of Pap testing. Prevention Relevance: We found that catch-up HPV vaccination was associated with increased attention to long-term cervical screening attendance. Whereas, those who are not vaccinated and unprotected from HPV, are more likely to abstain from secondary prevention screening tests too and further increase their cervical cancer risk.

中文翻译：

---

在国家授权的卫生系统中进行 HPV 疫苗接种和随后的巴氏检测

本研究的目的是评估人乳头瘤病毒 (HPV) 疫苗接种与在以色列以前未通过国家免疫计划接种疫苗的妇女接受初始巴氏 (Pap) 检测之间的关联。在这个回顾性队列中，我们使用了以色列国家授权医疗服务提供者（Maccabi Healthcare Services，MHS）女性成员的疫苗接种和癌症筛查出勤记录。从在以色列推出之日（2007 年 6 月）到 2018 年 12 月 31 日，至少接种一剂 HPV 疫苗的所有符合条件的女性成员（N = 20,904）均与未接种疫苗的 MHS 成员按 1 比 1 的比例单独匹配。出生、居住区社会经济水平和居住区。从 MHS 中央数据集中提取了截至 2018 年 12 月的巴氏涂片吸收数据，并计算了研究期间每位女性的巴氏涂片数量。在观察到的随访期间（平均 6.6 年；四分位距，3.9-8.7 年），接种疫苗的女性（26.8%）的巴氏试验累积吸收率显着（P < 0.001）高于未接种疫苗的女性（22.4%） ） 女性。在多变量模型中，HPV 疫苗接种与进行巴氏涂片检测的 HR 为 1.34 [95% 置信区间 (CI)，1.29–1.41] 相关。我们的研究结果表明，追赶型 HPV 疫苗的摄取与巴氏试验的摄取增加呈正相关。预防相关性：我们发现追赶 HPV 疫苗接种与增加对长期宫颈筛查出勤率的关注有关。然而，