德国的人乳头瘤病毒（HPV）感染以性传播为主，可引发癌症。德国建议9至17岁的女孩和男孩接种HPV疫苗。我们旨在调查在HPV疫苗引入德国10年后（2018-2019年）20至25岁女性的HPV DNA感染率、基因型分布和疫苗效果（VE），并将这些数据与2010-2012年间一项相同设计的研究进行比较。我们随机选择了76个地理集群，并随机选择了每个集群中的61名20至25岁女性参与者。参与者进行子宫颈-阴道自我采样，并回答人口统计学、性行为和HPV疫苗接种的问题。样本检测了18种高危和9种低危HPV基因型。我们进行了卡方检验、费舍尔精确检验、无配对学生t检验和比例t检验，并计算了粗病例比（PR）和95%置信区间。在7858名接触到的女性中，共有1226名同意参与。其中，有94名女性对HPV16型和/或18型呈阳性。HPV16的患病率为7.0%（95% CI 5.6-8.6），HPV18的患病率为0.8%（95% CI 0.4-1.5）。HPV6和HPV11的阳性检测结果很少，只有5例（0.4%; 0.1-0.9）和1例（0%; 95% CI 0.0-0.5）。757名女性（62%）至少接种了一剂HPV疫苗，348名女性（28%）按照当前的建议接种。考虑混杂因素后，对HPV16/18感染的疫苗的调整VE为46.4%（95% CI 4.2-70.1），对四价HPV疫苗覆盖的至少一种HPV基因型感染的VE为49.1%（95% CI 8.2-71.8）。与2010-2012年的研究结果相比，未接种疫苗的参与者中的HPV16/18患病率从22.5%（95% CI 19.0-26.3）下降到10.3%（95% CI 7.5-13.9；p < 0.0001）。德国20至25岁女性中覆盖的HPV基因型很少，并且与HPV疫苗接种计划开始后的时间点相比有所下降。接种了疫苗的参与者中几乎所有覆盖的HPV基因型的患病率明显降低。与2010-2012年的数据相比，未接种疫苗的参与者中甚至观察到了HPV16和HPV18的下降，表明未接种疫苗的女性也获得了间接保护。我们研究中对HPV16/18和HPV6/11/16/18的疫苗效果较低可能是由于研究设计以及（主要是短暂的）HPV DNA阳性的终点选择所致。版权所有© 2023 Loenenbach、Schönfeld、Takla、Wiese-Posselt、Marquis、Thies、Sand、Kaufmann、Wichmann和Harder。

Infections with human papillomaviruses (HPV) are sexually transmitted and can cause cancer. In Germany, vaccination against HPV is recommended for girls and boys aged 9-17 years. We aimed to investigate HPV DNA prevalence, genotype distribution and vaccine effectiveness (VE) in women aged 20-25 years 10 years after the introduction of HPV vaccination in Germany (2018-2019), and compared these data to an equally designed study from 2010-2012.Seventy six geographical clusters were randomly selected, followed by random selection of 61 women aged 20-25 years per cluster. Participants performed cervicovaginal self-sampling and answered questions on demographics, sexual behaviour and HPV vaccination. Samples were tested for 18 high risk and nine low risk HPV genotypes. We performed chi-square tests, Fisher's exact test, unpaired Student's t-test and proportion t-test, and calculated crude and adjusted prevalence ratios (PR) and 95% CIs.Of 7,858 contacted women a total of 1,226 agreed to participate. Of these, 94 women were positive for HPV types 16 and/or 18. HPV16 prevalence was 7.0% (95% CI 5.6-8.6) and HPV18 prevalence was 0.8% (95% CI 0.4-1.5). HPV6 and HPV11 were rare with only five (0.4%; 0.1-0.9) and one (0%; 95% CI 0.0-0.5) positive tests. Seven hundred fifty-seven women (62%) had received at least one HPV vaccine dose and 348 (28%) were vaccinated as currently recommended. Confounder-adjusted VE was 46.4% (95% CI 4.2-70.1) against HPV16/18 infection and 49.1% (95% CI 8.2-71.8) against infection with at least one HPV genotype covered by the quadrivalent HPV vaccine. Compared with the 2010-2012 study results, HPV16/18 prevalence dropped from 22.5% (95% CI 19.0-26.3) to 10.3% (95% CI 7.5-13.9; p < 0.0001) in unvaccinated participants.Vaccine-covered HPV genotypes were rare among 20-25 years old women in Germany and decreased compared to the time point shortly after the start of the HPV vaccination program. HPV prevalence of almost all vaccine-covered genotypes was strongly reduced in vaccinated participants. A decrease of HPV16 and HPV18 was even observed in unvaccinated participants, compared to 2010-2012 data, suggesting indirect protection of unvaccinated women. Low VE against HPV16/18 and HPV6/11/16/18 in our study might be attributable to study design in combination with the endpoint selection of (mainly transient) HPV DNA positivity.Copyright © 2023 Loenenbach, Schönfeld, Takla, Wiese-Posselt, Marquis, Thies, Sand, Kaufmann, Wichmann and Harder.