HPV vaccination coverage rate in women undergoing conization for cervical intraepithelial neoplasia in Spain: The COVAR study

Abstract

OBJECTIVE: Females subjected to cervical excisional therapy (conization) due to high-grade squamous intraepithelial lesions/cervical intraepithelial neoplasia HSIL/CIN have a higher risk of developing cervical lesions compared to the general population. Research suggests that HPV vaccination may reduce post-treatment HSIL/CIN risk. Since 2014, HPV vaccination is recommended and funded in Spain at regional level for women who had undergone treatment for cervical precancerous lesions (HSIL/CIN2-3 or any other potentially tumoral cytohistological alteration). In 2018, the Ministry of Health standardized the recommendations but the vaccination coverage rate (VCR) for this population has not been published. The COVAR Study aimed to estimate the annual HPV VCR among women undergoing conization for SIL/CIN in Spain and assess sociodemographic and COVID-19 pandemic influence. METHODS: This was a multicentric, cross-sectional retrospective study conducted in six Spanish public hospitals from January 1, 2019, to December 31, 2021. RESULTS: Annual HPV VCR was 87.3% (1135/1300), increasing to 89.8% (983/1095) in women with a conization for high-grade SIL (HSIL)/CIN. Among vaccinated women, 30.2% (343/1135) were vaccinated after SIL/CIN diagnosis but before conization and 58.3% (662/1135) were vaccinated after conization; the remaining 11.5% (130/1135) received at least one dose before SIL/CIN diagnosis. Of the conizations, 32.4% (517/1594) were performed during the pre-pandemic period, decreasing to 19.6% (312/1594) during the first COVID-19 restriction period; the annual HPV VCR also decreased (30% [259/865] to 20.7% [179/865], P < 0.001), for women vaccinated after conization. CONCLUSION: The annual HPV VCR in our population was 87.3%, reflecting effective vaccination strategies. The COVID-19 pandemic substantially impacted the annual percentage of conizations and HPV vaccination.