Sustained impact of bivalent HPV immunisation on CIN incidence over two rounds of cervical screening - Research article

Sep 29, 2026

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Vaccination against high-risk HPV reduces the incidence of pre-invasive and invasive cervical disease, yet long-term real-world longitudinal evidence is limited. This population-based analysis links routine cervical screening data from Scotland to evaluate vaccine effectiveness of bivalent HPV immunisation across multiple screening rounds. Adjusted protection is reported for CIN2+ and CIN3+ by age at immunisation, with strongest benefits in women vaccinated at 12–13 years and evidence of herd protection.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Abstract

Background

Methods and data linkage

Results by age at vaccination

Key implications

DOI: 10.1002/ijc.70183 RES EARCH A RTICLE Cancer Therapy a nd Prevention Sustained impact of bivalent HPV immunisation on CIN incidence over two rounds of cervical screening Timothy J. Palmer 1,2 | Kimberley Kavanagh 1,3 | Kate Cuschieri 2,4 | Ross L. Cameron 1 | Catriona Graham 5 | Allan Wilson 6 | Kirsty Roy 1 1Public Health Scotland, Glasgow, UK 2MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK 3Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK 4Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, UK 5Edinburgh Clinical Research Facility, University of Edinburgh, Western General Hospital, Edinburgh, UK 6Scottish Cervical Screening Programme, National Services Division (NSD), Edinburgh, UK Correspondence Timothy J. Palmer, Public Health Scotland, 2 Central Quay, Hydepark Street, Glasgow, G3 8BW, UK; MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh BioQuarter, 47 Little France Crescent, Edinburgh EH16 4TJ, UK. Email: [tim.palmer@ed.ac.uk](tim.palmer@ed.ac.uk) Funding information Scottish Government Abstract Vaccination against high-risk HPV has been shown to reduce significantly the incidence of pre-invasive and invasive cervical disease. Clinical trials show immunity and vaccine effectiveness for over 12 years but real-life longitudinal data are lacking. Vaccination with the bivalent vaccine (3 dose schedule) for women aged 12–18 years began in Scotland in 2008; immunised women entered screening in 2010 . Women immunised at age12–13 years entered screening in 2015 . Linked data from ≤12 years of routine screening activity shows adjusted VE against CIN2+ at age 12–13 of 72􀀁6%(95%CI: 67.7–76.8) and at age 14–16 of 63􀀁2 (CI 60􀀁4–65􀀁8), and against CIN3+ of 81􀀁7 (CI 76􀀁2–78􀀁6; age 12–13) and 68􀀁1 (CI 64􀀁1–71􀀁6; age 14–16) after 3 doses or two doses 5 months apart. Adjusted VE following two doses 1 month apart or one dose only at age14 was 20 . 5 (95%CI: 6 .1–32. 6) for CIN2+ and 34 .9 (95%CI:17 .0–48.9) for CIN3+ . No benefit was seen with vaccination over the age of 18 years. The most deprived women showed the highest incidence of CIN2+ and CIN3+, and the greatest reduction in CIN2+ and CIN3+ following complete immunisation. Herd protection is seen in all immunised cohorts. This population based analysis confirms the long-term effectiveness of the bivalent HPV vaccine, greatest in women from the most deprived areas and reinforces the importance of ensuring high vaccine uptake rates at an early age. Abbreviations: CHI, community health index; CIN, cervical intraepithelial neoplasia; CoxPH, Cox proportional hazard; GBMSM, gay, bisexual and other men who have sex with men; HR, hazard ratio; hr-HPV, high-risk Human Papillomavirus; ICD, International Classification of Diseases; JCVI, Joint Committee on Vaccines and Immunisation; LMIC, low and middle-income countries; py, person-years; SCCRS, Scottish Cervical Call-Recall System; SIMD, Scottish Index of Multiple Deprivation; SNOMED, Systematised Nomenclature of Medicine; VE, vaccine effectiveness. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2025 The Author(s) . International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC. KEYWOR DS age at immunisation, bivalent HPV vaccination, herd protection, high-grade CIN, socioeconomic deprivation What's New? While vaccination against high-risk HPV infection, the primary cause of cervical malignancy, has demonstrated long-term effectiveness in clinical trials, real-life longitudinal data are lacking. Here, the authors present linked long-term screening data on the effectiveness of bivalent HPV vaccination with a minimum follow-up of 54 months. The results show high vaccine effectiveness against high-grade cervical intraepi

FAQs

What is the main aim of this study?

To assess the sustained real-life effectiveness of bivalent HPV immunisation on CIN incidence across two rounds of cervical screening using linked screening data.

How does vaccine effectiveness vary by age at immunisation?

Adjusted vaccine effectiveness is greatest for women vaccinated at 12–13 years, remains significant for those vaccinated at 14–16 and 17–18 years, and shows no benefit for vaccination over age 18.

Is herd protection observed?

Yes. The study reports herd protection across all immunised cohorts, consistent with reduced CIN outcomes beyond directly vaccinated groups.

Sep 29, 2026

Upload by Levi