Introduction

The objective of this study was to estimate the lifetime risk of hospitalization associated with all major human papillomavirus (HPV)-related diseases in Italy. Moreover, a preliminary vaccination effect was also performed.

Methods

A retrospective, nonrandomized, observational study was developed based on patients hospitalized between 2006 and 2018 in Italy. All hospitalizations were identified through administrative archives, according to the International Classification of Diseases (ICD-9 CM). Information related to the hospital discharges of all accredited public and private hospitals, both for ordinary and day care regimes, was taken into account. We included hospitalizations related to resident patients presenting one of the ICD-9-CM codes as primary or secondary diagnosis: genital warts (GW); ‘cervical intraepithelial neoplasia (CIN)’ (067.32–067.33); ‘condyloma acuminatum’ (078.11); ‘anal cancers’ (AC) (154.2–154.8); oropharyngeal cancers (OC): ‘oropharyngeal cancer’(146.0–146.9) and ‘head, face and neck cancers’ (171.0); genital cancers (GC): ‘penis cancer’ (187.1–187.9) and ‘cervical cancer’ (180.0–180.9). Data were stratified by birth year and divided into two groups: (a) cohort born before 1996 (not vaccinable) and (b) cohort born after 1997 (vaccinable—first cohort that could be vaccinated at the beginning of immunization schedule in girls since 2008 in Italy). Disease-specific hospitalization risks for both groups were estimated by sex, year and age.

Results

Epidemiological data demonstrate that the peak hospitalization risk occurred at 24–26 years of age for GW (both male and female); 33–41 and 47–54 years for AC males and females, respectively; 53–59 and 52–58 years for OC males and females, respectively; and 54–60 and 39–46 years for GC males and females, respectively. Focusing on GW and GC, vaccinable females demonstrate a significant reduction in hospitalization risks (− 54% on average) compared to nonvaccinable females until 21 years of age (maximum follow-up available for girls born after 1997). Comparing the same birth cohort of males, no differences in hospitalization risk were found.

Conclusions

These results support the importance of primary prevention strategies in Italy and suggest that increased VCRs and time of observation (genital cancers for which vaccination is highly effective, have a latency of some decades) will provide useful information for decision-makers.

中文翻译：

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意大利的人乳头瘤病毒：回顾性队列分析和真实世界数据的初步疫苗接种效果

 介绍

本研究的目的是评估意大利与所有主要人乳头瘤病毒 (HPV) 相关疾病相关的终生住院风险。此外，还进行了初步的疫苗接种效果。

 方法

基于 2006 年至 2018 年在意大利住院的患者开展了一项回顾性、非随机、观察性研究。根据国际疾病分类 (ICD-9 CM)，所有住院治疗均通过行政档案进行确定。所有经认可的公立和私立医院的普通和日托护理制度的出院信息均被考虑在内。我们纳入了与住院患者相关的住院治疗，该住院患者提出 ICD-9-CM 代码之一作为主要或次要诊断：生殖器疣 (GW)； “宫颈上皮内瘤变（CIN）”（067.32–067.33）； “尖锐湿疣”(078.11); “肛门癌”（AC）（154.2–154.8）；口咽癌（OC）：“口咽癌”（146.0–146.9）和“头面颈癌”（171.0）；生殖器癌症 (GC)：“阴茎癌”(187.1–187.9) 和“宫颈癌”(180.0–180.9)。数据按出生年份分层并分为两组：(a) 1996 年之前出生的队列（不可接种疫苗）和 (b) 1997 年之后出生的队列（可接种——自 2008 年以来第一批可以在女孩免疫计划开始时接种疫苗的队列）在意大利）。两组的特定疾病住院风险均按性别、年份和年龄进行估计。

 结果

流行病学数据表明，GW（男性和女性）的住院风险高峰发生在24-26岁； AC男性和女性分别为33-41岁和47-54岁； OC 男性和女性分别为 53-59 岁和 52-58 岁； GC 男性和女性分别为 54-60 岁和 39-46 岁。重点关注 GW 和 GC，在 21 岁之前，与未接种疫苗的女性相比，接种疫苗的女性住院风险显着降低（平均下降 54%）（对 1997 年之后出生的女孩可进行最大随访）。比较同一出生队列的男性，没有发现住院风险存在差异。

 结论

这些结果支持了意大利初级预防策略的重要性，并表明增加 VCR 和观察时间（疫苗接种非常有效的生殖器癌症，有数十年的潜伏期）将为决策者提供有用的信息。