Trial Lecture – time and place
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Adjudication committee
- First opponent: Professor Kåre Mølbakk, Statens Serum Institutt
- Second opponent: Professor Hester DeMelker, RIVM
- Third member and chair of the evaluation committee: Førsteamanuensis Anne Olaug Olsen, University of Oslo
Chair of the Defence
Professor Per Nafstad, University of Oslo
Principal Supervisor
PhD Lill Trogstad, National Institute of Public Health
Summary
Infection with human papillomavirus (HPV) is a necessary cause of cervical cancer. HPV vaccine was implemented in the childhood immunisation programme in Norway in 2009 targeting 12-year-old girls through school-based vaccination.
The overall aim of this thesis was to evaluate the HPV immunisation programme. The specific aims were to explore socioeconomic determinants for HPV vaccine uptake, vaccine safety with regard to risk of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), establish baseline data of HPV burden in pre-screening, unvaccinated birth cohorts and estimate the population effectiveness of the HPV immunisation programme.
We used data from nationwide registries, collected urine samples from more than 19 000 young Norwegian women through repeated cross-sectional studies, analysed the samples for 37 HPV genotypes and performed statistical analyses.
During the first three programme years, HPV vaccine uptake was 78%. Despite presumably equal access to HPV vaccine, the uptake increased with increasing maternal income, while it decreased with increasing maternal education level.
No increased risk of CFS/ME was observed in girls who received the HPV vaccine as compared to unvaccinated girls.
HPV was detected in 15-20% of 17-year-old girls and in 45% of 21-year-old women not eligible for HPV vaccination. Five years after introduction of the HPV vaccine, a 90% decrease in the prevalence of the four HPV types included in the vaccine was seen in vaccinated girls at age 17. HPV prevalence decreased by more than 50% also in unvaccinated girls, indicating herd protection. A reduction was also seen in several non-vaccine types.
Based on the high vaccine uptake and the high population effectiveness of the HPV immunisation programme in Norway, we are optimistic with regard to future decline in precancerous lesions and cervical cancer in Norway.
Additional information
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