Prevalência das lesões HPV-induzidas em mulheres entre 20-24 anos no Brasil e regiões após a campanha de vacinação

Abstract

A major cause of cervical cancer is high-risk human papillomavirus (HPV) infection. Although most HPV infections are transient, persistent infections may lead to the development of precursor lesions and malignancy. HPV vaccines provide high immunogenicity and efficiency against the main oncogenic types and exhibit an outstanding safety profile. In 2014, the Brazilian Ministry of Health included the quadrivalent HPV vaccine in the National Immunization Program. This study aimed to examine the cytological prevalence of cervical preneoplastic and neoplastic lesions in women aged 20–24 years in Brazil and regions before and after the HPV vaccination campaign, and to correlate these findings with vaccination coverage in the same age group. An ecological study was conducted including data from DATASUS from 2020 to 2024. Data on vaccination coverage were collected from women born between 2001 and 2005, along with population projection data and outcomes of normal and HPV-induced lesions in women aged 20–24 years who had oncotic cytology between 2019 and 2024. Prevalence ratios for 2019 and 2020 were calculated, and a Pearson’s correlation test was performed between vaccination coverage and prevalence of HPV-induced lesions. Moreover, a trend analysis was also conducted. Results indicated that Brazil, along with the northern, southeastern, and southern regions, exhibited a decrease in prevalence rates of HPV-induced lesions following vaccination program (in 2023, compared with 2020 [0.85, 0.75, and 0.83, respectively] and 2019 [0.92, 0.76, and 0.89, respectively]). Northeast and central-west regions did not experience significant reductions. In Brazil and in the southeastern and southern regions, a significant negative correlation was found between first and second dose vaccination coverage and HPV-positive lesions. However, trend analysis revealed no significant differences across regions. In conclusion, despite the decline in second dose coverage, 10 yr after the start of the vaccination program, Brazil and the northern, southeastern, and southern regions exhibited a reduction in HPV-induced lesions. Although no temporal trend has yet been observed, there was a correlation between vaccination coverage and reduction in HPV-induced lesions in regions with the highest vaccination coverage.