| Abstract: | 研究目的：
目前已知致癌型人類乳突病毒（HPV, Human Papillomavirus）感染子宮頸是導致子宮頸癌（Cervical Cancer）發生的主要原因，子宮頸癌也是HPV感染癌症中最大的疾病負擔。婦女懷孕時子宮頸上皮組織變薄，無論是陰道生產造成子宮頸創傷或剖腹生產後的惡露在復原過程中均容易造成子宮頸發炎與微小損傷，因此婦女在產後容易受到HPV感染；有鑑於此，美國婦產科醫學會（ACOG, American Congress of Obstetricians and Gynecologist）建議在產後施打HPV疫苗（Human Papillomavirus Vaccine）；台灣周產期醫學會於2013年12月8日與母胎醫學會於2014年1月9日也分別決議推廣HPV疫苗在產後施打。目前HPV疫苗於年齡滿15歲後需接種三劑；臨床觀察發現，若未能有效監控與管制HPV疫苗施打，婦女接受三劑HPV疫苗完整施打比例可能會下降，根據ACOG資料，美國在13-17歲青少女有50%接受至少一劑HPV疫苗注射，但只有33%完成完整三劑HPV疫苗注射。許多研究均顯示，若未接受完整三劑HPV疫苗注射對於疫苗所提供的保護力會下降，因此，對於此類需接受多次接種的疫苗而言，完成完整疫苗施打與如何提升完整疫苗施打比例便是個很大的挑戰。此外，目前文獻並沒有對於施打與未施打產後HPV疫苗婦女的背景分析報告，本試驗為全世界第一個探討施打與未施打產後HPV疫苗婦女背景差異的研究。
研究方法及資料：
本試驗以回溯性方式，收集自2014年3月至2014年9月間，嘉義長庚醫院婦產科試驗計劃主治醫師接生個案，探討接受產後HPV疫苗施打比率、施打與未施打婦女背景差異、以及在本試驗所設計之產後HPV疫苗施打流程有效監控下，三劑HPV疫苗施打完成率，並與可查之澳洲國家公費HPV疫苗施打完成率、九價HPV疫苗臨床試驗和台灣南部某同型醫院三劑HPV疫苗施打完成率等可得資料做成效分析比較。
研究結果：
本試驗比較產後施打與未施打HPV疫苗產婦背景差異，發現產婦年齡、出生胎兒性別、產婦教育程度與產後子宮頸抹片檢查結果在產後施打與未施打HPV疫苗兩組中有顯著差異。施打與未施打產後HPV疫苗在初產婦/經產婦、是否立即接受產後輸卵管結紮、懷孕時乙型鏈球菌感染、生產時妊娠週數、生產方式、單/雙胞胎、產前唐氏症篩檢選擇、高危險妊娠、生產時併發症產生、出生後新生兒轉送單位、出生後新生兒評分（APGAR score）、產婦血型、產婦宗教信仰以及產婦種族皆無顯著差異。依照本試驗所設計產後HPV疫苗施打流程嚴格監控和追蹤接受產後HPV疫苗施打個案，可以達到非常理想的三劑HPV疫苗施打完成率，本試驗施打完成率成績並不亞於九價HPV疫苗臨床試驗與澳洲國家公費HPV疫苗施打三劑完成率，甚至明顯優於台灣南部某同型醫院三劑HPV疫苗施打完成率。
結論與建議：
產婦年齡、出生胎兒性別、產婦教育程度與產後子宮頸抹片檢查結果在產後施打與未施打HPV疫苗兩組有顯著差異。本試驗所設計之產後HPV疫苗施打流程經驗可以做為全世界提升HPV疫苗三劑施打完成率的標準流程，甚至於可以進一步推廣到此類需接受多次接種時程的疫苗，有效提升疫苗完整施打率。
Background:
There is a need to increase the vaccine completion rates in women who have already received human papillomavirus (HPV) vaccines. Therefore, with vaccines requiring multiple doses, designing a vaccination control program and increasing the proportion of women who complete vaccination are huge challenges. Furthermore, no reports have examined the differences in background characteristics of postpartum women who are vaccinated or unvaccinated with HPV vaccines. There is therefore further need to examine and discuss HPV vaccination. This study aimed to determine the vaccination rates of the second and third doses of HPV vaccination under a feasible HPV vaccination program in postpartum women.
Methods:
A total of 243 pregnant women delivered by a single visiting staff from March 2014 through September 2014 in Chiayi Chang Gung Memorial Hospital were enrolled. The benefit of postpartum HPV vaccination was explained prior to HPV vaccination. While one group received HPV vaccine under a feasible controlled postpartum HPV vaccination program, the other group did not.
The second and third HPV vaccination rates in postpartum women was calculated and compared with available data of the second and third vaccination rates (including clinical trial, national HPV vaccine program, and other hospital achievements). The background characteristics differences between vaccinated and unvaccinated postpartum women were determined.
Results:
Under the controlled postpartum HPV vaccination program, the three doses postpartum HPV vaccination completion rate was 97.2%. The result was non-inferior to that of the 9-Valent HPV vaccine clinical trial and the Australia National HPV Vaccination Program; and superior to the results of another hospital of similar scale in southern Taiwan.
Significant differences occurred in background characteristics between postpartum HPV vaccinated and unvaccinated postpartum women with maternal age, fetal gender, educational level, occupation, and postpartum Pap smear result.
Conclusion:
Significant differences occurred between postpartum HPV vaccinated and unvaccinated groups with maternal age, fetus gender, educational level, occupation, and postpartum Pap smear result. The controlled postpartum HPV vaccination program, a feasible method for achieving excellent three doses of postpartum HPV vaccination completion rate, may be a good model for any multiple dose vaccine. |
