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Checchi M, Mesher D, Panwar K, Anderson A, Beddows S, Soldan K. The impact of over ten years of HPV vaccination in England: Surveillance of type-specific HPV in young sexually active females. Vaccine 2023; 41:6734-6744. [PMID: 37821315 DOI: 10.1016/j.vaccine.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION The UK national human papillomavirus (HPV) vaccination programme was introduced in 2008 using the bivalent HPV16/18 vaccine, changing to the quadrivalent HPV6/11/16/18 vaccine from 2012. We provide an analysis of type-specific HPV prevalence in young sexually active females in England to end 2020 (when the first routinely HPV vaccinated females were reaching 25 years of age and entering the National Health Service Cervical Screening Programme), showing the impact of over ten years of high coverage HPV vaccination. METHODS Residual vulvovaginal swabs (VVS) were collected from 16 to 24 year old women attending for chlamydia screening between 2010 and 2020, anonymised and tested for type-specific HPV DNA. Trends in vaccine and non-vaccine HPV type prevalence were compared over time and association with vaccination coverage was evaluated within the post-vaccination period. RESULTS A total of 21,168 eligible VVS specimens were tested for HPV DNA. The prevalence of HPV16/18 in sexually active 16-18 year old females who were offered vaccination aged 12-13 years was <1% in the most recent years tested, compared to over 15% prior to the vaccination programme in 2008. The magnitude of these decreases also suggests reduced transmission is offering some herd protection to unvaccinated females. HPV31/33/45 prevalence also steadily decreased, providing evidence of cross-protection. HPV6/11 prevalence remained stable during the bivalent vaccine period, with more recent declines, as expected due to the use of the quadrivalent vaccine. There has been no substantive increase in the prevalence of other high-risk (HR) HPV types. DISCUSSION More than ten years of high coverage HPV vaccination in adolescent females in England has delivered dramatic declines in the prevalence of HPV vaccine-types and closely related HPV types in females in the vaccine eligible age group, and no indication of type replacement. These findings should enable confidence in planning for cervical screening of these females, and in predicting declines in HPV-related cancers.
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Affiliation(s)
- Marta Checchi
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK.
| | - David Mesher
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK
| | - Kavita Panwar
- Virus Reference Department, UK Health Security Agency, London, UK
| | - Anja Anderson
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK
| | - Simon Beddows
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK; Virus Reference Department, UK Health Security Agency, London, UK
| | - Kate Soldan
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK
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Lohan M, Gillespie K, Aventin Á, Gough A, Warren E, Lewis R, Buckley K, McShane T, Brennan-Wilson A, Lagdon S, Adara L, McDaid L, French R, Young H, McDowell C, Logan D, Toase S, Hunter RM, Gabrio A, Clarke M, O'Hare L, Bonell C, Bailey JV, White J. School-based relationship and sexuality education intervention engaging adolescent boys for the reductions of teenage pregnancy: the JACK cluster RCT. PUBLIC HEALTH RESEARCH 2023; 11:1-139. [PMID: 37795864 DOI: 10.3310/ywxq8757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
Background The need to engage boys in gender-transformative relationships and sexuality education (RSE) to reduce adolescent pregnancy is endorsed by the World Health Organization and the United Nations Educational, Scientific and Cultural Organization. Objectives To evaluate the effects of If I Were Jack on the avoidance of unprotected sex and other sexual health outcomes. Design A cluster randomised trial, incorporating health economics and process evaluations. Setting Sixty-six schools across the four nations of the UK. Participants Students aged 13-14 years. Intervention A school-based, teacher-delivered, gender-transformative RSE intervention (If I Were Jack) versus standard RSE. Main outcome measures Self-reported avoidance of unprotected sex (sexual abstinence or reliable contraceptive use at last sex) after 12-14 months. Secondary outcomes included knowledge, attitudes, skills, intentions and sexual behaviours. Results The analysis population comprised 6556 students: 86.6% of students in the intervention group avoided unprotected sex, compared with 86.4% in the control group {adjusted odds ratio 0.85 [95% confidence interval (CI) 0.58 to 1.26], p = 0.42}. An exploratory post hoc analysis showed no difference for sexual abstinence [78.30% intervention group vs. 78.25% control group; adjusted odds ratio 0.85 (95% CI 0.58 to 1.24), p = 0.39], but more intervention group students than control group students used reliable contraception at last sex [39.62% vs. 26.36%; adjusted odds ratio 0.52 (95% CI 0.29 to 0.920), p = 0.025]. Students in schools allocated to receive the intervention had significantly higher scores on knowledge [adjusted mean difference 0.18 (95% CI 0.024 to 0.34), p = 0.02], gender-equitable attitudes and intentions to avoid unintended pregnancy [adjusted mean difference 0.61 (95% CI 0.16 to 1.07), p = 0.01] than students in schools allocated to receive the control. There were positive but non-significant differences in sexual self-efficacy and communication skills. The total mean incremental cost of the intervention compared with standard RSE was £2.83 (95% CI -£2.64 to £8.29) per student. Over a 20-year time horizon, the intervention is likely to be cost-effective owing to its impact on unprotected sex because it would result in 379 (95% CI 231 to 477) fewer unintended pregnancies, 680 (95% CI 189 to 1467) fewer sexually transmitted infections and a gain of 10 (95% CI 5 to 16) quality-adjusted life-years per 100,000 students for a cost saving of £9.89 (95% CI -£15.60 to -£3.83). Limitations The trial is underpowered to detect some effects because four schools withdrew and the intraclass correlation coefficient (0.12) was larger than that in sample size calculation (0.01). Conclusions We present, to our knowledge, the first evidence from a randomised trial that a school-based, male engagement gender-transformative RSE intervention, although not effective in increasing avoidance of unprotected sex (defined as sexual abstinence or use of reliable contraception at last sex) among all students, did increase the use of reliable contraception at last sex among students who were, or became, sexually active by 12-14 months after the intervention. The trial demonstrated that engaging all adolescents early through RSE is important so that, as they become sexually active, rates of unprotected sex are reduced, and that doing so is likely to be cost-effective. Future work Future studies should consider the longer-term effects of gender-transformative RSE as students become sexually active. Gender-transformative RSE could be adapted to address broader sexual health and other settings. Trial registration This trial is registered as ISRCTN10751359. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (PHR 15/181/01) and will be published in full in Public Health Research; Vol. 11, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Maria Lohan
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Kathryn Gillespie
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Áine Aventin
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Aisling Gough
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Emily Warren
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Ruth Lewis
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Kelly Buckley
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | - Theresa McShane
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | - Susan Lagdon
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Linda Adara
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | - Lisa McDaid
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Rebecca French
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Honor Young
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | | | | | - Sorcha Toase
- Northern Ireland Clinical Trials Unit, Belfast, UK
| | - Rachael M Hunter
- Health Economics Analysis and Research Methods Team, University College London, London, UK
| | - Andrea Gabrio
- Care and Public Health Research Institute (CAPHRI) School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Mike Clarke
- Northern Ireland Clinical Trials Unit, Belfast, UK
| | - Liam O'Hare
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| | - Chris Bonell
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | - James White
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
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Vash-Margita A, Kobernik EK, Flagler EN, Quint EH, Dalton VK. National Trends in Cervical Cancer Screening in Adolescents. J Pediatr Adolesc Gynecol 2021; 34:717-724. [PMID: 33601068 DOI: 10.1016/j.jpag.2021.02.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/07/2021] [Accepted: 02/07/2021] [Indexed: 12/26/2022]
Abstract
STUDY OBJECTIVE To characterize patterns of cervical cancer screening among adolescents ages 14-20 years before and after the 2009 American College of Obstetrics and Gynecology recommendations. DESIGN Retrospective cohort study. SETTING National Ambulatory Medical Care Survey 2005-2016 data. PARTICIPANTS Female adolescents and young women ages 14-26 years. INTERVENTIONS Multivariable logistic regression models identified independent predictors of unindicated cervical cancer screening at office-based visits among adolescents ages 14-20 years. MAIN OUTCOME MEASURES Cervical cancer screening in women ages 14-20 and 21-26 years in 2 time periods: 2005-2008 and 2009-2016. RESULTS Between 2005 and 2016, 11,768 office visits were among adolescents ages 14-20 years. Overall, the cervical cancer screening rate for young women ages 14-20 years was 4.0%, which decreased from 4.5% to 0.4% (P = .008) during the study period. Adolescents who received cervical cancer screening during an office visit were older (18-20 years: 24.1% vs 14-17 years: 8.2%; P < .001), had a preventive care visit (preventive care: 79.7% vs other visit types: 20.3%; P < .001), and saw an obstetrician/gynecologist (obstetrician/gynecologist: 74.81% vs other specialties: 25.1%; P < .001). After adjusting for age, year, period, insurance status, region, and provider type, screening for cervical cancer was associated with living in the Southern region of the United States (adjusted odds ratio, 1.88; 95% confidence interval, 1.09-3.25; P = .02) and public insurance (adjusted odds ratio, 0.47, 95% confidence interval, 0.34-0.64; P < .001). CONCLUSION Despite recommendations, cervical cancer screening continued to occur in the adolescent population-especially older adolescents-creating unnecessary costs and potential harms. These findings show a slow uptake of guidelines nationally and the need for initiatives that encourage implementation of performance measures for providers, including ongoing provider and patient education.
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Affiliation(s)
- Alla Vash-Margita
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut.
| | - Emily K Kobernik
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Emily N Flagler
- The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Vanessa K Dalton
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
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Morhason-Bello IO, Baisley K, Pavon MA, Adewole IF, Bakare R, de Sanjosé S, Francis SC, Watson-Jones D. Prevalence and genotype specific concordance of oro-genital and anal human papillomavirus infections among sexually active Nigerian women. Infect Agent Cancer 2021; 16:59. [PMID: 34496909 PMCID: PMC8424803 DOI: 10.1186/s13027-021-00398-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/24/2021] [Indexed: 12/24/2022] Open
Abstract
Background Human papillomavirus (HPV) associated cancers are increasingly reported globally, including in sub-Saharan Africa (SSA). However, with the exception of cervical HPV infection, data from SSA on the epidemiology of oral and genital HPV infections are limited. This study assessed the prevalence and concordance of oro-genital and anal HPV genotype specific infections among women in the general population.
Methods We conducted a cross-sectional study in sexually active women aged 18–45 years in Ibadan, Nigeria. After a face-to-face interview and clinical examination, oral, cervical, vulvar, and anal samples were collected from participants and tested by the Anyplex II 28 HPV assay. Descriptive and multivariable analyses were used to report prevalence and risk factors associated with HPV infections. Results The prevalence of any vulva, cervical, anal, and oral HPV infections was 68.0% (210/309), 59.7% (182/305), 56.8% (172/303), and 16.1% (14/286), respectively. There was an inverse relationship between age-group and HPV prevalence of HPV in all anatomic sites except for the oral HPV infections. HPV 35 was the most prevalent high-risk HPV genotype in the vulva, cervix and oral cavity. Associated risk factors for HPV infection in each of the anatomic sites were reported. Overall, 10.0% (31/310) women had concordance of any HPV type in the four anatomic sites. Conclusion There was a high prevalence of oro-genital and anal HPV infections among sexually active Nigerian women, with concordance of HPV types in the cervix, vulva, anus and oral cavity. We advocate large longitudinal studies that will involve sampling of multiple anatomic sites and inclusion of other women in the community for better understanding of HPV epidemiology in this region. Supplementary Information The online version contains supplementary material available at 10.1186/s13027-021-00398-9.
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Affiliation(s)
- Imran O Morhason-Bello
- Obstetrics and Gynaecology Department, Faculty of Clinical Sciences, College of Medicine/University College Hospital, University of Ibadan, Ibadan, Oyo State, Nigeria. .,Institute of Advance Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Kathy Baisley
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Miquel Angel Pavon
- Infection and Cancer Laboratory, Cancer Epidemiology Research Program, ICO, Bellvitge Biomedical Research Institute (IDIBELL), Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat, Gran Via de l'Hospitalet, 199-203, 08908, Barcelona, Spain
| | - Isaac F Adewole
- Obstetrics and Gynaecology Department, Faculty of Clinical Sciences, College of Medicine/University College Hospital, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Rasheed Bakare
- Department of Microbiology, Faculty of Basic Medical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Silvia de Sanjosé
- Infection and Cancer Laboratory, Cancer Epidemiology Research Program, ICO, Bellvitge Biomedical Research Institute (IDIBELL), Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat, Gran Via de l'Hospitalet, 199-203, 08908, Barcelona, Spain.,Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, USA
| | - Suzanna C Francis
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Deborah Watson-Jones
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.,Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
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Prevalence of HPV infection among sexually active adolescents and young adults in Brazil: The POP-Brazil Study. Sci Rep 2020; 10:4920. [PMID: 32188884 PMCID: PMC7080737 DOI: 10.1038/s41598-020-61582-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/13/2020] [Indexed: 12/02/2022] Open
Abstract
For Brazil, there are no nationwide data on HPV prevalence against which the impact of the HPV immunization program can be measured in the future. Therefore, we aim to evaluate the prevalence of genital HPV infection among adolescents and young adults in Brazil. A cross-sectional, multicentric, nationwide survey was conducted between September 2016 and November 2017. Sexually active unvaccinated women and men aged 16 to 25 years old were recruited from 119 public primary care units, including all 26 state capitals and the Federal District. All participants answered a face-to-face interview and provided biological samples for genital HPV analysis. We used an automated DNA extraction method and HPV genotyping was performed using the Linear Array genotyping test (Roche). Of 7,694 participants, 53.6% (95% CI 51.4–55.8) were positive for any HPV type. The prevalence of high-risk HPV types was significantly higher in women (38.6% vs. 29.2%, P < 0·001). The HPV types included in the quadrivalent vaccine were detected in 1002 (14.8%) specimens, with a different pattern of HPV infection between sexes. Characteristics associated with overall HPV detection included female gender, self-declaration of race as brown/pardo, lower socioeconomic class, single or dating, current smoking and having 2 or more sex partners in the past year. We found a high prevalence of HPV, with significant differences between regions. Our data provide information that may be considered when developing HPV prevention policies and constitute a baseline against which the impact of the HPV immunization program in Brazil can be measured in future years.
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Baskran K, Kumar PK, Santha K, Sivakamasundari II. Cofactors and Their Association with Cancer of the Uterine Cervix in Women Infected with High-Risk Human Papillomavirus in South India. Asian Pac J Cancer Prev 2019; 20:3415-3419. [PMID: 31759367 PMCID: PMC7063002 DOI: 10.31557/apjcp.2019.20.11.3415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Indexed: 02/06/2023] Open
Abstract
Background: Human papilloma viruses (HPVs) are recognized as the major etiological agents of most pre invasive and invasive cancer of the uterine cervix. Many cofactors in association with high-risk HPV (HR-HPV) trigger infection which leads to cervical carcinogenesis. The aim was to study various cofactors and their association with cervical cancer in women infected with HR-HPV. Methods: The present study screened a total of 156 subjects for the presence of HPV infection. Association of various cofactors with cervical cancer was estimated using binary logistic regression analysis. Results: The HR-HPV infection showed a very significant risk factor for cervical cancer. Among the cofactors, the education level, early sexual exposure and age at pregnancy had no significant association while low socioeconomic status (SES) and high parity showed significant association as risk factors for cervical cancer. Tobacco chewing with betel quid was not significantly associated with cervical cancer. Conclusions: The present study indicates that low SES is a major risk factor associated with cervical cancer. Bringing awareness about HPV infection and intensifying routine screening programs for cervical cancer will help reduce the risk of cervical cancer among women with low SES in this region.
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Affiliation(s)
- Krishnan Baskran
- Department of Biochemistry, Rajah Muthiah Medical College and Hospital, Annamalai University, Annamalainagar, Tamil Nadu, India
| | - P Kranthi Kumar
- Department of Genetics, Narayana Medical College & Hospital, Nellore, Andhra Pradesh, India
| | - K Santha
- Department of Biochemistry, Rajah Muthiah Medical College and Hospital, Annamalai University, Annamalainagar, Tamil Nadu, India
| | - Inmozhi I Sivakamasundari
- Department of Biochemistry, Rajah Muthiah Medical College and Hospital, Annamalai University, Annamalainagar, Tamil Nadu, India
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Chow EPF, Tabrizi SN, Fairley CK, Wigan R, Machalek DA, Regan DG, Hocking JS, Garland SM, Cornall AM, Atchison S, Bradshaw CS, McNulty A, Owen L, Marshall L, Russell DB, Kaldor JM, Chen MY. Prevalence of human papillomavirus in teenage heterosexual males following the implementation of female and male school-based vaccination in Australia: 2014-2017. Vaccine 2019; 37:6907-6914. [PMID: 31562001 DOI: 10.1016/j.vaccine.2019.09.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/13/2019] [Accepted: 09/15/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Australia introduced a school-based human papillomavirus (HPV) vaccination program for females aged 12-13 years in 2007, with a three-year catch-up to age 26; and for boys aged 12-13 from 2013, with a two-year catch-up to age 15. This study aimed to compare the prevalence of penile HPV between teenage heterosexual males in cohorts eligible or non-eligible for the school-based male vaccination program. METHODS Between 2014 and 2017, sexually active heterosexual males aged 17-19 were recruited from sexual health centres and community sources across Australia. Males provided a self-collected penile swab for 37 HPV genotypes using Roche Linear Array and completed a questionnaire. We calculated adjusted prevalence ratios (aPR) of HPV between males in two periods: 2014-2015 (preceding implementation of school-based male vaccination) and 2016-2017 (eligible for school-based male vaccination). Self-reported vaccine doses were confirmed with doses reported to the National HPV Vaccination Program Register. RESULTS Overall, 152 males were recruited in 2014-2015 and 146 in 2016-2017. Numbers of female sex partners and condom use did not differ between the two periods. The prevalence of quadrivalent vaccine-preventable [4vHPV] genotypes (6/11/16/18) was low in both periods (2.6% [2014-15] versus 0.7% [2016-17]; p = 0.371; aPR 0.28 [95% CI: 0.03-2.62]). Compared with men in 2014-2015, men in 2016-2017 had a lower prevalence of any of the 37 HPV genotypes tested (21.7% versus 11.6%; aPR 0.62 [95% CI: 0.36-1.07]) and any of the 13 high-risk genotypes tested (15.8% versus 7.5%; aPR 0.59 [95% CI: 0.30-1.19]). Prevalence of low-risk HPV genotypes did not differ between the two periods. Of the males recruited in 2016-2017, 55% had received ≥1 vaccine dose. CONCLUSION The prevalence of 4vHPV genotypes among teenage heterosexual males in both cohorts was low, presumably due to herd protection from the female-only vaccination program. Further studies are required to determine the impact of universal HPV vaccination on HPV prevalence in males.
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Affiliation(s)
- Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia.
| | - Sepehr N Tabrizi
- Department of Obstetrics Gynaecology, University of Melbourne, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia.
| | - Rebecca Wigan
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
| | - Dorothy A Machalek
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia; Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.
| | - David G Regan
- The Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia.
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia.
| | - Suzanne M Garland
- Department of Obstetrics Gynaecology, University of Melbourne, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia; Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.
| | - Alyssa M Cornall
- Department of Obstetrics Gynaecology, University of Melbourne, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia; Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.
| | - Steph Atchison
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia.
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, New South Wales, Australia; School of Public Health and Community Medicine, UNSW Sydney, Kensington, New South Wales, Australia.
| | - Louise Owen
- Statewide Sexual Health Service Tasmania, Tasmania, Australia.
| | - Lewis Marshall
- South Terrace Clinic, Fremantle Hospital, Perth, Western Australia, Australia.
| | - Darren B Russell
- Cairns Sexual Health Service, Queensland Health, Cairns, North Queensland, Australia; College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia.
| | - John M Kaldor
- The Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia.
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia.
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Puerto D, Reyes V, Lozano C, Buitrago L, Garcia D, Murillo RH, Muñoz N, Hernandez GA, Sanchez L, Wiesner C, Combita AL. Detection and Genotyping of HPV DNA in a Group of Unvaccinated Young Women from Colombia: Baseline Measures Prior to Future Monitoring Program. Cancer Prev Res (Phila) 2018; 11:581-592. [PMID: 29991579 DOI: 10.1158/1940-6207.capr-17-0439] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 05/12/2018] [Accepted: 06/22/2018] [Indexed: 11/16/2022]
Abstract
In 2012, Colombia launched human papillomavirus (HPV) vaccination program for girls ages 9 to 12, and in 2013, the target age was expanded to 9 to 17 years. Monitoring the changes of HPV infection prevalence among young women has been proposed as an endpoint for early assessment of HPV vaccination programs. However, the data on HPV prevalence in young ages are very limited. The purpose of this study was to determine the prevalence of HPV infection and the distribution of genotypes in a group of nonvaccinated women ages 18 to 25 years old in three Colombian cities as baseline for the monitoring of the HPV national vaccination program. A total of 1,782 sexually active women were included. Cervical smear samples were collected to perform the Pap smear and HPV DNA detection using a Linear Array HPV assay. Of the 1,782 specimens analyzed, 60.3% were positive for any HPV type; 42.2% were positive for high-risk HPV (HR-HVP) types, and 44.4% for low-risk HPV (LR-HPV) types. Multiple and single infections were identified in 37.1% and 23.2% of samples, respectively. HR-HPV types -16, -52, and -51 were the most predominant with proportions of 11.3%, 7.92%, and 7.9%, correspondingly. The prevalence for HR-HPV 16/18 was 14.4%. HR-HPV prevalence in women with abnormal cytology (75.16%) was higher than in women with normal cytology (38.6%). In conclusion, a high prevalence of HR-HPV was observed among younger women. This HPV type-specific prevalence baseline may be used to monitor postvaccination longitudinal changes and to determine its impact on HPV-related disease incidence in Colombia population. Cancer Prev Res; 11(9); 581-92. ©2018 AACR.
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Affiliation(s)
- Devi Puerto
- Grupo de Investigación en Salud Pública y Epidemiología, Instituto Nacional de Cancerología (INC), Bogotá, Colombia
| | - Viviana Reyes
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología (INC), Bogotá, Colombia
| | - Cristina Lozano
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología (INC), Bogotá, Colombia
| | - Lina Buitrago
- Unidad de Análisis, Instituto Nacional de Cancerología (INC), Bogotá, Colombia
| | - Diego Garcia
- Grupo Enfermedades Transmisibles-PAI, Ministerio de Salud y Protección Social, Colombia
| | - Raúl H Murillo
- Grupo de Investigación en Salud Pública y Epidemiología, Instituto Nacional de Cancerología (INC), Bogotá, Colombia
| | - Nubia Muñoz
- Grupo de Investigación en Salud Pública y Epidemiología, Instituto Nacional de Cancerología (INC), Bogotá, Colombia
| | - Gustavo A Hernandez
- Grupo de Investigación en Salud Pública y Epidemiología, Instituto Nacional de Cancerología (INC), Bogotá, Colombia
| | - Laura Sanchez
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología (INC), Bogotá, Colombia
| | - Carolina Wiesner
- Grupo de Investigación en Salud Pública y Epidemiología, Instituto Nacional de Cancerología (INC), Bogotá, Colombia
| | - Alba L Combita
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología (INC), Bogotá, Colombia. .,Departamento de Microbiología. Facultad de Medicina. Universidad Nacional de Colombia. Bogotá, Colombia
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Alsbeih G. Exploring the Causes of the Low Incidence of Cervical Cancer in Western Asia. Asian Pac J Cancer Prev 2018; 19:1425-1429. [PMID: 29936711 PMCID: PMC6103560 DOI: 10.22034/apjcp.2018.19.6.1425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Anecdotal epidemiologic observations can provide valuable tools to study various biologic elements in complex diseases such as cancer. Although cervical cancer is one of the most frequent malignancy affecting women in the world, it displays wide geographical variations remnant of socioeconomic, ethnic and genetic predisposing factors. The observed low incidence of cervical cancer in western Asia has triggered scientists to try to delineate the causes of this reduced occurrence. Although this region including Saudi Arabia is known for being conservative societies with low incidence of sexually transmitted infections including human papillomavirus (HPV) and associated cervical cancer, scientific research points out multifaceted biological explanations including host genetic variations. Researchers observed that a protective genetic variant TP53 codon 72 proline allele was more commonly found in this population and appear to be over-transmitted compared to others known for their high rate of cervical cancer. Thus, the combination of relative low rate of HPV infection, over-transmission of protective genetic variant along with societal variables are the rationale behind the low incidence of cervical cancer in women in the region of western Asia. The influence of the genetic makeup of the patients has impact on personalized preventive medicine to gauge the risk of developing cervical cancer.
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Affiliation(s)
- Ghazi Alsbeih
- Department of Biomedical Physics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
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10
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Mesher D, Panwar K, Thomas SL, Edmundson C, Choi YH, Beddows S, Soldan K. The Impact of the National HPV Vaccination Program in England Using the Bivalent HPV Vaccine: Surveillance of Type-Specific HPV in Young Females, 2010–2016. J Infect Dis 2018; 218:911-921. [DOI: 10.1093/infdis/jiy249] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/09/2018] [Indexed: 01/22/2023] Open
Affiliation(s)
- David Mesher
- HIV and STI Department, Centre for Infectious Disease Surveillance and Control, London, United Kingdom
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kavita Panwar
- Virus Reference Department, Public Health England, London, United Kingdom
| | - Sara L Thomas
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Claire Edmundson
- HIV and STI Department, Centre for Infectious Disease Surveillance and Control, London, United Kingdom
| | - Yoon Hong Choi
- Statistics, Modeling, and Economics Department, Public Health England, London, United Kingdom
| | - Simon Beddows
- Virus Reference Department, Public Health England, London, United Kingdom
| | - Kate Soldan
- HIV and STI Department, Centre for Infectious Disease Surveillance and Control, London, United Kingdom
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11
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Leng T, Keeling MJ. Concurrency of partnerships, consistency with data, and control of sexually transmitted infections. Epidemics 2018; 25:35-46. [PMID: 29798812 DOI: 10.1016/j.epidem.2018.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/18/2018] [Accepted: 05/13/2018] [Indexed: 11/28/2022] Open
Abstract
Sexually transmitted infections (STIs) are a globally increasing public health problem. Mathematical models, carefully matched to available epidemiological and behavioural data, have an important role to play in predicting the action of control measures. Here, we explore the effect of concurrent sexual partnerships on the control of a generic STI with susceptible-infected-susceptible dynamics. Concurrency refers to being in more than one sexual partnership at the same time, and is difficult to measure accurately. We assess the impact of concurrency through the development of three nested pair-formation models: one where infection can only be transmitted via stable sexual partnerships, one where infection can also be transmitted via casual partnerships between single individuals, and one where those individuals in stable partnerships can also acquire infection from casual partnerships. For each model, we include the action of vaccination before sexual debut to inform about the ability to control. As expected, for a fixed transmission rate, concurrency increases both the endemic prevalence of infection and critical level of vaccination required to eliminate the disease significantly. However, when the transmission rate is scaled to maintain a fixed endemic prevalence across models, concurrency has a far smaller impact upon the critical level of vaccination required. Further, when we also constrain the models to have a fixed number of new partnerships over time (both long-term and casual), then increasing concurrency can slightly decrease the critical level of vaccination. These results highlight that accurate measures and models of concurrency may not always be needed for reliable forecasts when models are closely matched to prevalence data. We find that, while increases in concurrency within a population are likely to generate public-health problems, the inclusion of concurrency may be unnecessary when constructing models to determine the efficacy of the control of STIs by vaccination.
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Affiliation(s)
- Trystan Leng
- EPSRC & MRC Centre for Doctoral Training in Mathematics for Real-World Systems, University of Warwick, United Kingdom.
| | - Matt J Keeling
- Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, Mathematics Institute and School of Life Sciences, University of Warwick, United Kingdom
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12
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Patel H, Moss EL, Sherman SM. HPV primary cervical screening in England: Women's awareness and attitudes. Psychooncology 2018. [PMID: 29521462 DOI: 10.1002/pon.4694] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Primary human papillomavirus (HPV) cervical screening is due to be implemented in England within the next 2 years; however, the acceptability of HPV testing as the primary screening test is unclear. This study explores women's awareness and attitudes toward HPV testing/screening. METHODS Qualitative interviews (semistructured and focus group) were conducted with 46 women (aged 25-65 years) from community and secondary care settings. Data were analyzed by using the inductive-framework method. RESULTS Women were unaware that cervical screening currently includes HPV testing and lacked HPV-related knowledge. Emotions of shock, fear, and anxiety were reported upon receiving a positive HPV result. For women in long-term relationships, the realization that HPV is a sexually transmitted infection was seen as a barrier to primary HPV testing. Knowledge that HPV testing is a screening test to prevent cervical cancer did not change their attitudes. Women debated the need for continued screening following a negative result. Women feared judgment by the community if they participated with primary HPV screening because they were being tested for a sexually transmitted infection, with the possible attendant perception that they had adopted a high-risk lifestyle in comparison to nonattenders. CONCLUSIONS The acceptability of HPV testing may be a limiting factor in encouraging participation with screening in the future.
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Affiliation(s)
- Hersha Patel
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Esther L Moss
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
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13
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Genetic Predisposition to Cervical Cancer and the Association With XRCC1 and TGFB1 Polymorphisms. Int J Gynecol Cancer 2017; 27:1949-1956. [DOI: 10.1097/igc.0000000000001103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
ObjectiveCervical carcinoma (CC), a multifactorial cancer, is assumed to have a host genetic predisposition component that modulates its susceptibility in various populations. We investigated the association between CC risk in Saudi women and 6 single-nucleotide polymorphisms (SNPs) in hypothesis-driven candidate genes.MethodsA total of 545 females were included, comprising 232 CC patients and 313 age-/sex-matched control subjects. Six SNPs (CDKN1A C31A, ATM G1853A, HDM2 T309G, TGFB1 T10C, XRCC1 G399A, and XRCC3 C241T) were genotyped by direct sequencing.ResultsOf the 6 SNPs studied, TGFB1 T10C (odds ratio, 0.74; 95% confidence interval, 0.57–0.94) and XRCC1 G399A (odds ratio, 1.45; 95% confidence interval, 1.11–1.90) displayed different frequencies in cancer patients and control subjects and showed statistically significant association in univariate (P = 0.017, P = 0.005, respectively) analysis. The Cochran-Armitage trend test had confirmed the results (P = 0.027 and P = 0.006, respectively), indicating an ordering in the effect of the risk alleles in CC patients. The 2 SNPs, TGFB1 T10C and XRCC1 G399A, showed also degrees of deviation from Hardy-Weinberg equilibrium in cancer patients (P = 0.001 and P = 0.083, respectively) but not in the control subjects. Furthermore, correction for multiple testing using multivariate logistic regression to assess the joint effect of all SNPs has sustained significant statistical association (P = 0.025 and P = 0.009, respectively).ConclusionsTGFB1 T10C and XRCC1 G399A SNPs were associated with CC risk in univariate and multivariate analysis and displayed allele-dosage effects and coselection in cancer patients. Patients harboring the majority allele TGFB1 T10 (Leu) or the variant allele XRCC1 399A (Gln) have approximately 1.5-fold increased risk to develop CC. Host SNPs genotyping may provide relevant biomarkers for CC risk assessment in personalized preventive medicine.
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14
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Protasov AD, Zhestkov AV, Tezikov YV, Lipatov IS, Kostinov MP, Lavrent’eva NE. Anogenital Warts: New Opportunities for Prevention and Treatment. Vaccines (Basel) 2017. [DOI: 10.5772/intechopen.69263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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15
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Galati L, Peronace C, Fiorillo MT, Masciari R, Giraldi C, Nisticò S, Minchella P, Maiolo V, Barreca GS, Marascio N, Lamberti AG, Giancotti A, Lepore MG, Greco F, Mauro MV, Borelli A, Bocchiaro GL, Surace G, Liberto MC, Focà A. Six years genotype distribution of Human Papillomavirus in Calabria Region, Southern Italy: a retrospective study. Infect Agent Cancer 2017; 12:43. [PMID: 28770002 PMCID: PMC5531005 DOI: 10.1186/s13027-017-0154-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although analysis of the Human papillomavirus (HPV) genotype spread in a particular area has a crucial impact on public health and prevention programmes, there is a lack of epidemiological data regarding HPV in the Calabria region of Italy. We therefore update information on HPV age/genotype distribution by retrospectively analysing a cohort of women, with and without cervical lesions, living in Calabria, who underwent HPV DNA testing; moreover, we also evaluated HPV age/genotype distribution in a subset of patients with cervical lesions. METHODS Cervical scrape specimens obtained from 9590 women (age range 20-75 years) from January 2010 to December 2015 were tested for HPV DNA. Viral types were genotyped by Linear Array HPV Genotyping® test (Roche, USA) at the Clinical Microbiology Operative Unit of six hospitals located in four provinces of the Calabria region. Cervical scrape specimens were also used to perform Pap smears for cytological analysis in a subset of 405 women; cytological classification of the samples was performed according to the Bethesda classification system. RESULTS A total of 2974 women (31%) (C.I. 95% 30.09-31.94) were found to be HPV DNA positive for at least one (57.3%) or several (42.7%) HPV genotypes. Of single genotype HPV infections, 46.5% and 36.4 % were classed as high-risk (HR, Group 1) and low-risk (LR, Group 3) respectively, while 16.9% were classed as probably/possibly carcinogenic and 0.2% undetermined risk. Stratified by age, total HPV distribution, showed the highest prevalence within the range 30-39 years (37.2%), while single genotype infection distribution displayed a peak in women from the age range 20-29 years (37.5%). The most common high-risk HPV type was HPV 16 (19.1%), followed by HPV 31 (9.1%). CONCLUSIONS We provide epidemiological data on HPV age/genotype distribution in women living in the Calabria region with or without cytological abnormalities, further to the enhancement of HPV screening/prevention programmes for the local population.
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Affiliation(s)
- Luisa Galati
- Institute of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University, Viale Europa, 88100 Catanzaro, Italy
| | - Cinzia Peronace
- Institute of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University, Viale Europa, 88100 Catanzaro, Italy
| | - Maria Teresa Fiorillo
- Unit of Microbiology and Virology, Polo Sanitario Nord ASP 5, Reggio Calabria, Italy
| | - Rosanna Masciari
- Unit of Mirobiology and Virology, "Pugliese-Ciaccio" Hospital, Catanzaro, Italy
| | - Cristina Giraldi
- Unit of Microbiology and Virology, "Annunziata" Hospital, Cosenza, Italy
| | - Salvatore Nisticò
- Unit of Microbiology and Virology, General Hospital, Lamezia Terme, Italy
| | - Pasquale Minchella
- Unit of Mirobiology and Virology, "Pugliese-Ciaccio" Hospital, Catanzaro, Italy
| | - Vincenzo Maiolo
- Unit of Microbiology and Virology, "G. Jazzolino" Hospital, Vibo Valentia, Italy
| | - Giorgio Settimo Barreca
- Institute of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University, Viale Europa, 88100 Catanzaro, Italy
| | - Nadia Marascio
- Institute of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University, Viale Europa, 88100 Catanzaro, Italy
| | - Angelo Giuseppe Lamberti
- Institute of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University, Viale Europa, 88100 Catanzaro, Italy
| | - Aida Giancotti
- Institute of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University, Viale Europa, 88100 Catanzaro, Italy
| | | | - Francesca Greco
- Unit of Microbiology and Virology, "Annunziata" Hospital, Cosenza, Italy
| | | | - Annelisa Borelli
- Unit of Microbiology and Virology, General Hospital, Lamezia Terme, Italy
| | - Giuseppa Lo Bocchiaro
- Unit of Microbiology and Virology, Polo Sanitario Nord ASP 5, Reggio Calabria, Italy
| | - Giovanni Surace
- Unit of Microbiology and Virology, Polo Sanitario Nord ASP 5, Reggio Calabria, Italy
| | - Maria Carla Liberto
- Institute of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University, Viale Europa, 88100 Catanzaro, Italy
| | - Alfredo Focà
- Institute of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University, Viale Europa, 88100 Catanzaro, Italy
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Sabol I, Milutin Gašperov N, Matovina M, Božinović K, Grubišić G, Fistonić I, Belci D, Alemany L, Džebro S, Dominis M, Šekerija M, Tous S, de Sanjosé S, Grce M. Cervical HPV type-specific pre-vaccination prevalence and age distribution in Croatia. PLoS One 2017; 12:e0180480. [PMID: 28692681 PMCID: PMC5503252 DOI: 10.1371/journal.pone.0180480] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/15/2017] [Indexed: 11/18/2022] Open
Abstract
The main etiological factor of precancerous lesion and invasive cervical cancer are oncogenic human papillomaviruses types (HPVs). The objective of this study was to establish the distribution of the most common HPVs in different cervical lesions and cancer prior to the implementation of organized population-based cervical screening and HPV vaccination in Croatia. In this study, 4,432 cervical specimens, collected through a 16-year period, were tested for the presence of HPV-DNA by polymerase chain reaction (PCR) with three sets of broad-spectrum primers and type-specific primers for most common low-risk (LR) types (HPV-6, 11) and the most common high-risk (HR) types (HPV-16, 18, 31, 33, 45, 52, 58). Additional 35 archival formalin-fixed, paraffin embedded tissue of cervical cancer specimens were analyzed using LiPA25 assay. The highest age-specific HPV-prevalence was in the group 18-24 years, which decreased continuously with age (P<0.0001) regardless of the cytological diagnosis. The prevalence of HR-HPV types significantly increased (P<0.0001) with the severity of cervical lesions. HPV-16 was the most common type found with a prevalence (with or without another HPV-type) of 6.9% in normal cytology, 15.5% in atypical squamous cells of undetermined significance, 14.4% in low-grade squamous intraepithelial lesions, 33.3% in high-grade squamous intraepithelial lesions, and 60.9% in cervical cancer specimens (P<0.0001). This study provides comprehensive and extensive data on the distribution of the most common HPV types among Croatian women, which will enable to predict and to monitor the impact of HPV-vaccination and to design effective screening strategies in Croatia.
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Affiliation(s)
- Ivan Sabol
- Department of Molecular Medicine, Ruđer Bošković Institute, Zagreb, Croatia
| | | | - Mihaela Matovina
- Department of Molecular Medicine, Ruđer Bošković Institute, Zagreb, Croatia
| | - Ksenija Božinović
- Department of Molecular Medicine, Ruđer Bošković Institute, Zagreb, Croatia
| | - Goran Grubišić
- University Hospital Sisters of Mercy, Clinic of Obstetrics and Gynaecology, Zagreb, Croatia
| | - Ivan Fistonić
- Obstetrics, Gynecology and Menopause Clinic, Zagreb, Croatia
| | - Dragan Belci
- Department of Gynecology and Obstetrics, General Hospital Pula, Pula, Croatia
| | - Laia Alemany
- Cancer Epidemiology Research Program, Unit of Infections and Cancer, Catalan Institute of Oncology, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Sonja Džebro
- Department of Pathology and Cytology, University of Zagreb, School of Medicine, University Hospital Merkur, Zagreb, Croatia
| | - Mara Dominis
- Department of Pathology and Cytology, University of Zagreb, School of Medicine, University Hospital Merkur, Zagreb, Croatia
| | - Mario Šekerija
- Croatian National Cancer Registry, Croatian Institute of Public Health, Zagreb, Croatia
- School of Medicine, Andrija Štampar School of Public Health, University of Zagreb, Zagreb, Croatia
| | - Sara Tous
- Cancer Epidemiology Research Program, Unit of Infections and Cancer, Catalan Institute of Oncology, Barcelona, Spain
| | - Silvia de Sanjosé
- Cancer Epidemiology Research Program, Unit of Infections and Cancer, Catalan Institute of Oncology, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Magdalena Grce
- Department of Molecular Medicine, Ruđer Bošković Institute, Zagreb, Croatia
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Lin CY, Li L. Comparison of DNA testing strategies in monitoring human papillomavirus infection prevalence through simulation. BMC Infect Dis 2016; 16:642. [PMID: 27821079 PMCID: PMC5100169 DOI: 10.1186/s12879-016-1969-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 10/25/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND HPV DNA diagnostic tests for epidemiology monitoring (research purpose) or cervical cancer screening (clinical purpose) have often been considered separately. Women with positive Linear Array (LA) polymerase chain reaction (PCR) research test results typically are neither informed nor referred for colposcopy. Recently, a sequential testing by using Hybrid Capture 2 (HC2) HPV clinical test as a triage before genotype by LA has been adopted for monitoring HPV infections. Also, HC2 has been reported as a more feasible screening approach for cervical cancer in low-resource countries. Thus, knowing the performance of testing strategies incorporating HPV clinical test (i.e., HC2-only or using HC2 as a triage before genotype by LA) compared with LA-only testing in measuring HPV prevalence will be informative for public health practice. METHOD We conducted a Monte Carlo simulation study. Data were generated using mathematical algorithms. We designated the reported HPV infection prevalence in the U.S. and Latin America as the "true" underlying type-specific HPV prevalence. Analytical sensitivity of HC2 for detecting 14 high-risk (oncogenic) types was considered to be less than LA. Estimated-to-true prevalence ratios and percentage reductions were calculated. RESULTS When the "true" HPV prevalence was designated as the reported prevalence in the U.S., with LA genotyping sensitivity and specificity of (0.95, 0.95), estimated-to-true prevalence ratios of 14 high-risk types were 2.132, 1.056, 0.958 for LA-only, HC2-only, and sequential testing, respectively. Estimated-to-true prevalence ratios of two vaccine-associated high-risk types were 2.359 and 1.063 for LA-only and sequential testing, respectively. When designated type-specific prevalence of HPV16 and 18 were reduced by 50 %, using either LA-only or sequential testing, prevalence estimates were reduced by 18 %. CONCLUSION Estimated-to-true HPV infection prevalence ratios using LA-only testing strategy are generally higher than using HC2-only or using HC2 as a triage before genotype by LA. HPV clinical testing can be incorporated to monitor HPV prevalence or vaccine effectiveness. Caution is needed when comparing apparent prevalence from different testing strategies.
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Affiliation(s)
- Carol Y. Lin
- Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Ling Li
- United Arab Emirates University, Al Ain, UAE
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Molden T, Feiring B, Ambur OH, Christiansen IK, Hansen M, Laake I, Meisal R, Myrvang E, Jonassen CM, Trogstad L. Human papillomavirus prevalence and type distribution in urine samples from Norwegian women aged 17 and 21 years: A nationwide cross-sectional study of three non-vaccinated birth cohorts. PAPILLOMAVIRUS RESEARCH 2016; 2:153-158. [PMID: 29074174 PMCID: PMC5886875 DOI: 10.1016/j.pvr.2016.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/06/2016] [Accepted: 05/07/2016] [Indexed: 11/25/2022]
Abstract
Background The aim of the current study was to assess the HPV prevalence in unscreened and unvaccinated young women living in Norway, to provide important baseline data for early estimation of the impact of the HPV vaccination program. Methods A total of 13,129 self-sampled urine samples from two complete birth-cohorts of 17-year old women born in 1994 and 1996 and one third of a birth-cohort of 21-year old women born in 1990, were analysed for the presence of 37 HPV types using PCR and a DNA hybridization technique. Results In the two birth cohorts of 17-year old women, HPV was detected in 19.9% (95% CI 18.8–20.9) and 15.4% (95% CI 14.5–16.3), respectively. High-risk HPV types were detected in 11.2% (95% CI 10.3–12.0) and 7.6% (95% CI 6.9–8.2), respectively, while vaccine types were detected in 7.4% (95% CI 6.7–8.1) and 6.0% (95% CI 5.4–6.6), respectively. Among the 21-year old women HPV was detected in 45.4% (95% CI 42.9–47.8), whereas high-risk types were detected in 29.8% (95% CI 27.5–32.0). Vaccine types (HPV 6, 11, 16, 18) were detected in 16.2% (95% CI 14.4–18.1). Conclusion This large population based study confirms that HPV testing in urine samples is easy and highly feasible for epidemiological studies and vaccine surveillance in young women. HPV was very common and a broad spectrum of HPV types was identified. Differences in HPV prevalence was seen both between age groups and between the two birth cohorts of 17-year old women. Self-sampled urine proved suitable for large scale HPV testing. HPV 16 and 18 was very common among young girls. A wide variety of HPV types circulates in the population. HPV was detected in nearly half of the 21-year old women. HPV was detected in 15–20% of the 17-year old women.
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Affiliation(s)
- Tor Molden
- Norwegian Institute of Public Health, PO Box, 4404 Nydalen, 0403 Oslo, Norway.
| | - Berit Feiring
- Norwegian Institute of Public Health, PO Box, 4404 Nydalen, 0403 Oslo, Norway.
| | - Ole Herman Ambur
- Akershus University Hospital, PO Box 1000, 1478 Lørenskog, Norway.
| | | | - Mona Hansen
- Akershus University Hospital, PO Box 1000, 1478 Lørenskog, Norway.
| | - Ida Laake
- Norwegian Institute of Public Health, PO Box, 4404 Nydalen, 0403 Oslo, Norway.
| | - Roger Meisal
- Akershus University Hospital, PO Box 1000, 1478 Lørenskog, Norway.
| | - Ellen Myrvang
- Akershus University Hospital, PO Box 1000, 1478 Lørenskog, Norway.
| | - Christine Monceyron Jonassen
- Akershus University Hospital, PO Box 1000, 1478 Lørenskog, Norway; Østfold Hospital Trust, PO Box 300, 1714 Grålum, Norway.
| | - Lill Trogstad
- Norwegian Institute of Public Health, PO Box, 4404 Nydalen, 0403 Oslo, Norway.
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Mesher D, Panwar K, Thomas SL, Beddows S, Soldan K. Continuing reductions in HPV 16/18 in a population with high coverage of bivalent HPV vaccination in England: an ongoing cross-sectional study. BMJ Open 2016; 6:e009915. [PMID: 26868944 PMCID: PMC4762111 DOI: 10.1136/bmjopen-2015-009915] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The human papillomavirus (HPV) immunisation programme in England was introduced in 2008. Monitoring changes in type-specific HPV prevalence allows assessment of the population impact of this vaccination programme. METHODS Residual vulva-vaginal swab specimens were collected from young sexually active women (aged 16-24 years) attending for chlamydia screening across England. Specimens were collected between 2010 and 2013 for type-specific HPV-DNA testing. HPV prevalence was compared to a similar survey conducted in 2008 prior to the introduction of HPV vaccination. RESULTS A total of 7321 specimens collected in the postvaccination period, and 2354 specimens from the prevaccination period were included in this analysis. Among the individuals aged 16-18 years, with an estimated vaccination coverage of 67%, the prevalence of HPV16/18 infection decreased from 17.6% in 2008 to 6.1% in the postvaccination period. Within the postvaccination period, there was a trend towards lower HPV16/18 prevalence with higher vaccination coverage and increasing time since vaccine introduction from 8.5% in the period 2-3 years postvaccination to 4.0% in the period 4-5 years postvaccination. The prevalence of HPV31 reduced from 3.7% in the prevaccination period to 0.9% after vaccine introduction, although this no longer reached statistical significance after additional consideration of the uncertainty due to the assay change. Smaller reductions were seen in the individuals aged 19-21 years with lower estimated vaccination coverage, but there was no evidence of a reduction in the older unvaccinated women. Some overall increase in non-vaccine types was seen in the youngest age groups (ORs (95% CI); 1.3 (1.0 to 1.7) and 1.5 (1.1 to 2.0) for individuals aged 16-18 and 19-21 years, respectively, when adjusted for known population changes and the change in assay) although this should be interpreted with caution given the potential unmasking effect. CONCLUSIONS These data demonstrate a reduction in the HPV vaccine types in the age group with the highest HPV vaccination coverage.
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Affiliation(s)
- David Mesher
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Kavita Panwar
- Virus Reference Department, Public Health England, London, UK
| | - Sara L Thomas
- Department of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Simon Beddows
- Virus Reference Department, Public Health England, London, UK
| | - Kate Soldan
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
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Naturally Occurring Major and Minor Capsid Protein Variants of Human Papillomavirus 45 (HPV45): Differential Recognition by Cross-Neutralizing Antibodies Generated by HPV Vaccines. J Virol 2015; 90:3247-52. [PMID: 26719255 DOI: 10.1128/jvi.02859-15] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 12/20/2015] [Indexed: 11/20/2022] Open
Abstract
We investigated naturally occurring variation within the major (L1) and minor (L2) capsid proteins of human papillomavirus genotype 45 (HPV45). Pseudoviruses (PsVs) representing HPV45 sublineages A1, A2, A3, B1, and B2 exhibited comparable particle-to-infectivity ratios and morphologies but demonstrated both increased (A2, A3, and B1) and decreased (B2) sensitivities to cross-neutralization by HPV vaccine antibodies compared to that of the A1 sublineage. Mutant PsVs identified HI loop residue 357 as being critical for conferring this differential sensitivity.
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Épidémiologie et caractérisation des génotypes à haut risque de Papillomavirus humain dans une population d’adolescentes sexuellement actives à Ouagadougou. ACTA ACUST UNITED AC 2015; 44:715-22. [DOI: 10.1016/j.jgyn.2014.12.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 12/14/2014] [Accepted: 12/22/2014] [Indexed: 11/22/2022]
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Amino acid motifs in both the major and minor capsid proteins of HPV51 impact antigenicity and infectivity. J Gen Virol 2015; 96:1842-9. [DOI: 10.1099/vir.0.000121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Naturally Occurring Capsid Protein Variants of Human Papillomavirus Genotype 31 Represent a Single L1 Serotype. J Virol 2015; 89:7748-57. [PMID: 25995264 DOI: 10.1128/jvi.00842-15] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 05/06/2015] [Indexed: 01/09/2023] Open
Abstract
UNLABELLED We investigated naturally occurring variation within the major (L1) and minor (L2) capsid proteins of oncogenic human papillomavirus (HPV) genotype 31 (HPV31) to determine the impact on capsid antigenicity. L1L2 pseudoviruses (PsVs) representing the three HPV31 variant lineages, variant lineages A, B, and C, exhibited comparable particle-to-infectivity ratios and morphologies. Lineage-specific L1L2 PsVs demonstrated subtle differences in susceptibility to neutralization by antibodies elicited following vaccination or preclinical L1 virus-like particle (VLP) immunization or by monoclonal antibodies; however, these differences were generally of a low magnitude. These data indicate that the diagnostic lineage-specific single nucleotide polymorphisms within the HPV31 capsid genes have a limited effect on L1 antibody-mediated neutralization and that the three HPV31 variant lineages belong to a single L1 serotype. These data contribute to our understanding of HPV L1 variant antigenicity. IMPORTANCE The virus coat (capsid) of the human papillomavirus contains major (L1) and minor (L2) capsid proteins. These proteins facilitate host cell attachment and viral infectivity and are the targets for antibodies which interfere with these events. In this study, we investigated the impact of naturally occurring variation within these proteins upon susceptibility to viral neutralization by antibodies induced by L1 VLP immunization. We demonstrate that HPV31 L1 and L2 variants exhibit similar susceptibility to antibody-mediated neutralization and that for the purposes of L1 VLP-based vaccines, these variant lineages represent a single serotype.
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Lin CY. Evaluation of using composite HPV genotyping assay results to monitor human papillomavirus infection burden through simulation. BMC Infect Dis 2015; 15:123. [PMID: 25880688 PMCID: PMC4362818 DOI: 10.1186/s12879-015-0851-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 02/19/2015] [Indexed: 01/17/2023] Open
Abstract
Background Researchers often group various HPV types into composite measures based on vaccine subtypes, oncogenic potential, or phylogenetic position. Composite prevalence estimates based on PCR genotyping assay results have been calculated to assess HPV infection burden and to monitor HPV vaccine effectiveness. While prevention and intervention strategies can be made based on these prevalence estimates, the discussion on how well these prevalence estimates measure the true underlying infection burdens is limited. Methods A simulation study was conducted to evaluate accuracy of using composite genotyping assay results to monitor HPV infection burden. Data were generated based on mathematical algorithms with prespecified type-specific infection burdens, assay sensitivity, specificity, and correlations between various HPV types. Estimated-to-true prevalence rate ratios and percent reduction of vaccine types were calculated. Results When “true” underlying type-specific infection burdens were prespecified as the reported prevalence in U.S. and genotyping assay with sensitivity and specificity (0.95, 0.95) was used, estimated-to-true infection prevalence ratios were 2.35, 2.29, 2.18, and 1.46, for the composite measures with 2 high-risk vaccine, 4 vaccine, 14 high-risk and 37 HPV types, respectively. Estimated-to-true prevalence ratios increased when prespecified “true” underlying infection burdens or assay specificity declined. When prespecified “true” type-specific infections of HPV 6, 11, 16 and 18 were reduced by 50%, the composite prevalence estimate of 4 vaccine types only decreased by 17% which is much lower than 48% reduction in the prespecified “true” composite prevalence. Conclusions Composite prevalence estimates calculated based on panels of genotyping assay results generally over-estimate the “true” underlying infection burdens and could under-estimate vaccine effectiveness. Analytical specificity of genotyping assay is as or more important than analytical sensitivity and should be considered in selecting assay to monitor HPV.
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Affiliation(s)
- Carol Y Lin
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS E-63, Atlanta, GA, 30333, USA.
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Lang Kuhs KA, Gonzalez P, Rodriguez AC, van Doorn LJ, Schiffman M, Struijk L, Chen S, Quint W, Lowy DR, Porras C, DelVecchio C, Jimenez S, Safaeian M, Schiller JT, Wacholder S, Herrero R, Hildesheim A, Kreimer AR. Reduced prevalence of vulvar HPV16/18 infection among women who received the HPV16/18 bivalent vaccine: a nested analysis within the Costa Rica Vaccine Trial. J Infect Dis 2014; 210:1890-9. [PMID: 24958910 PMCID: PMC4271025 DOI: 10.1093/infdis/jiu357] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 06/18/2014] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Vaccine efficacy (VE) against vulvar human papillomavirus (HPV) infection has not been reported and data regarding its epidemiology are sparse. METHODS Women (n = 5404) age 22-29 present at the 4-year study visit of the Costa Rica Vaccine Trial provided vulvar and cervical samples. A subset (n = 1044) was tested for HPV DNA (SPF10/LiPA25 version 1). VE against 1-time detection of vulvar HPV16/18 among HPV vaccinated versus unvaccinated women was calculated and compared to the cervix. Prevalence of and risk factors for HPV were evaluated in the control arm (n = 536). RESULTS Vulvar HPV16/18 VE (54.1%; 95% confidence interval [CI], 4.9%-79.1%) was comparable to cervix (45.8%; 95% CI, 6.4%-69.4%). Vulvar and cervical HPV16 prevalence within the control arm was 3.0% and 4.7%, respectively. Independent risk factors for vulvar HPV were similar to cervix and included: age (adjusted odds ratio [aOR] 0.5 [95% CI, .3-.9] ≥28 vs 22-23]); marital status (aOR 2.3 [95% CI, 1.5-3.5] single vs married/living-as-married); and number of sexual partners (aOR 3.6 [95% CI, 1.9-7.0] ≥6 vs 1). CONCLUSIONS In this intention-to-treat analysis, VE against vulvar and cervical HPV16/18 were comparable 4 years following vaccination. Risk factors for HPV were similar by anatomic site. CLINICAL TRIALS REGISTRATION NCT00128661.
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Affiliation(s)
| | - Paula Gonzalez
- Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, Costa Rica
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France
| | | | | | | | - Linda Struijk
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | - Sabrina Chen
- Information Management Services, Calverton, Maryland
| | - Wim Quint
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | | | - Carolina Porras
- Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, Costa Rica
| | | | - Silvia Jimenez
- Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, Costa Rica
| | | | | | | | - Rolando Herrero
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France
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Osborne SL, Tabrizi SN, Brotherton JML, Cornall AM, Wark JD, Wrede CD, Jayasinghe Y, Gertig DM, Pitts MK, Garland SM. Assessing genital human papillomavirus genoprevalence in young Australian women following the introduction of a national vaccination program. Vaccine 2014; 33:201-8. [PMID: 25444787 DOI: 10.1016/j.vaccine.2014.10.045] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 09/28/2014] [Accepted: 10/24/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Following the implementation of Australia's National HPV Vaccination Program in April 2007, this study evaluated the prevalence of vaccine-targeted human papillomavirus (HPV) genotypes (HPV 6, 11, 16, 18) amongst vaccine-eligible young women. METHODS Between September 2011 and August 2013, women from Victoria, Australia aged 18-25 were recruited through targeted advertising on the social networking website Facebook. Participants completed an online questionnaire, and sexually active women were asked to provide a self-collected vaginal swab for HPV deoxyribonucleic acid (DNA) detection and genotyping. Samples positive for HPV were genotyped using the Linear Array HPV genotyping test (Roche Diagnostics). Self-reported HPV vaccination details were verified with the National HPV Vaccination Program Register (NHVPR). RESULTS Of 431 vaginal swabs, 24.8% were positive for HPV DNA. Vaccine-targeted HPV genotypes were detected in only seven (1.6%) samples; all HPV 16 (of the six HPV 16 positive vaccinated women, all had received the vaccine after sexual debut). There were no cases of HPV 6, 11 or 18 identified. HPV types 51, 59, 73, 84, and 89 were the most prevalent genotypes. Vaccination rates were high, with 77.3% of participants having received all three doses of the vaccine, and there was an 89.8% concordance between self-reported and registry-reported HPV vaccination status. Strong associations were observed between vaccination status, age, language spoken at home and country of birth, as well as between HPV detection and the number of male sexual partners. CONCLUSION Preliminary data from this study demonstrate a very low prevalence of vaccine-related HPV genotypes amongst vaccine-eligible women from Victoria, Australia. We were able to use Facebook to effectively reach and recruit young women to participate in the assessment of the impact of Australia's HPV vaccination program.
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Affiliation(s)
- Sarah L Osborne
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Regional HPV Reference Laboratory, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.
| | - Sepehr N Tabrizi
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Regional HPV Reference Laboratory, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.
| | - Julia M L Brotherton
- VCS Incorporated, Carlton, Victoria, Australia; School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia.
| | - Alyssa M Cornall
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Regional HPV Reference Laboratory, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.
| | - John D Wark
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia.
| | - C David Wrede
- The Royal Women's Hospital, Parkville, Victoria, Australia.
| | - Yasmin Jayasinghe
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia; The Royal Women's Hospital, Parkville, Victoria, Australia.
| | | | - Marian K Pitts
- Australian Research Centre in Sex, Health and Society, LaTrobe University, Franklin Street, Melbourne, Victoria, Australia.
| | - Suzanne M Garland
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Regional HPV Reference Laboratory, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.
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High frequency of genital human papillomavirus infections and related cervical dysplasia in adolescent girls in Belgium. Eur J Cancer Prev 2014; 23:288-93. [PMID: 24858715 DOI: 10.1097/cej.0000000000000048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Human papillomavirus (HPV) infections are causally related to cervical cancer and a range of other diseases, both in adults and in minors. Information on the frequency of genital HPV infections in adolescents is sparse. The aim of this study was to gain insight into the genotype-specific distribution of HPV genotypes in patients younger than 18 years of age. This observational retrospective study included 4807 samples of patients presenting for opportunistic screening in Belgium between June 2006 and January 2012. For statistical analysis, only the first visits of patients were withheld, reducing the sample to 4180. Samples were collected in liquid-based cytology medium and analyzed using a series of genotype-specific real-time PCR reactions. Cytology was read with previous knowledge of HPV infection and scored using the Bethesda classification. The mean age was 16.9 years. Most youngsters had no complaints (88.4%), were using hormonal contraception (79.5%), and clinical examination did not show any abnormalities (96.0%). The overall HPV frequency was 15.7%, with the most frequently found types being HPV16 (16.7%), HPV51 (14.6%), HPV66 (10.4%), HPV31 (9.9%), and HPV39 (9.1%). More than one-third (39.0%) of the infected girls harbored an infection with at least two HPV genotypes. Cytological abnormalities were found in 8.2% of samples. L-SIL (4.2%) was most frequently observed, followed by ASC-US (3.6%), HSIL (0.3%), and ASC-H (0.1%). The severity of lesions worsened with increasing age. Our findings indicate that an aberrant HPV genotype profile can be found in adolescent girls; moreover, this group shows a high rate of cervical abnormalities.
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Alsbeih G. HPV Infection in Cervical and Other Cancers in Saudi Arabia: Implication for Prevention and Vaccination. Front Oncol 2014; 4:65. [PMID: 24744990 PMCID: PMC3978341 DOI: 10.3389/fonc.2014.00065] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 03/17/2014] [Indexed: 01/13/2023] Open
Abstract
Human papillomavirus (HPV) is closely associated with cervical cancer that the incidence of this tumor is regarded as a surrogate marker for HPV infection in countries lacking epidemiological studies. HPV is also implicated in subsets of anogenital and oropharyngeal cancers. Although cervical cancer is the third most common cancer in women worldwide, its reported incidence is low in Saudi Arabia, ranking number 12 between all cancers in females and accounts only for 2.4% of all new cases, despite the lack of national screening programs. However, the limited available studies from Saudi Arabia indicate that HPV prevalence and genotypes' distribution in invasive cervical cancer show similar pattern as in the world. Cytology screening (Pap smear) and HPV vaccinations are the two preventive measures against cervical cancer. The two available vaccines are effective against the two most common HPV genotypes (HPV-16 and -18). Since 92% of cervical tumors in the Kingdom are infected with HPV of which 78% are HPV-16 and -18 genotypes, vaccination is expected to protect against more than two-third of cervical cancers in Saudi Arabia. Nevertheless, due to its low incidence (2.1/100,000 women), a proper cost-effectiveness analysis is required to justify the implementation of a costly vaccine bearing in mind that HPV could potentially be associated with about 3% of all cancers. However, further studies are needed to ascertain the real prevalence of HPV at the population level at large, its association with various types of cancers, and also the impact of local tradition and emerging behavioral trends that could affect HPV transmission and consequently the effectiveness of applying national vaccination program.
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Affiliation(s)
- Ghazi Alsbeih
- Research Centre, King Faisal Specialist Hospital and Research Centre , Riyadh , Saudi Arabia
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29
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Miltz A, Price H, Shahmanesh M, Copas A, Gilson R. Systematic review and meta-analysis of L1-VLP-based human papillomavirus vaccine efficacy against anogenital pre-cancer in women with evidence of prior HPV exposure. PLoS One 2014; 9:e90348. [PMID: 24595046 PMCID: PMC3940851 DOI: 10.1371/journal.pone.0090348] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 01/30/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND It is unclear whether L1-VLP-based human papillomavirus (HPV) vaccines are efficacious in reducing the likelihood of anogenital pre-cancer in women with evidence of prior vaccine-type HPV exposure. This study aims to determine whether the combined results of the vaccine trials published to date provide evidence of efficacy compared with control (hepatitis A vaccine/placebo). METHODS A systematic review and meta-analysis was conducted. Randomized-controlled trials (RCTs) were identified from MEDLINE, Embase, Web of Science, PubMed, Cochrane Central Register of Controlled Trials and references of identified studies. The bivalent vaccine containing HPV-16 and 18 VLPs from GlaxoSmithKline Biologicals (Rixenstart, Belgium), the quadrivalent vaccine containing HPV-6, 11, 16, and 18 VLPs from Merck & Co., Inc., (Whitehouse Station, NJ USA), and the HPV-16 monovalent vaccine from Merck Research Laboratories (West Point, PA USA) were evaluated. FINDINGS Three RCT reports and two post-trial cohort studies were eligible, comprising data from 13,482 women who were included in the vaccine studies but had evidence of HPV infection at study entry. Data on efficacy was synthesized using the Mantel-Haenszel weighted fixed-effect approach, or where there was heterogeneity between studies, the DerSimonian and Laird weighted random-effect approach. The mean odds ratio (OR) and 95% confidence interval (CI) for the association between Cervarix, Gardasil and HPV-16 monovalent vaccine and HPV-associated cervical intraepithelial neoplasia grade 3 or worse was 0·90 (95% CI: 0·56, 1·44). For the association between Gardasil and HPV-associated vulval/vaginal intraepithelial neoplasia grades 2-3, the overall OR and 95% CI was 2.25 (95% CI: 0·78, 6.50). Sample size and follow-up were limited. CONCLUSIONS There was no evidence that HPV vaccines are effective in preventing vaccine-type HPV associated pre-cancer in women with evidence of prior HPV exposure. Small effects of vaccination however cannot be excluded and a longer-term benefit in preventing re-infection remains possible.
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Affiliation(s)
- Ada Miltz
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, Mortimer Market Centre, University College London, London, United Kingdom
- * E-mail:
| | - Huw Price
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, Mortimer Market Centre, University College London, London, United Kingdom
| | - Maryam Shahmanesh
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, Mortimer Market Centre, University College London, London, United Kingdom
| | - Andrew Copas
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, Mortimer Market Centre, University College London, London, United Kingdom
| | - Richard Gilson
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, Mortimer Market Centre, University College London, London, United Kingdom
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Baudu A, Prétet JL, Riethmuller D, Chotard M, Mougin C, Mercier M. Prevalence and risk factors of human papillomavirus infection types 16/18/45 in a cohort of French females aged 15-23 years. J Epidemiol Glob Health 2014; 4:35-43. [PMID: 24534334 PMCID: PMC7320404 DOI: 10.1016/j.jegh.2013.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 10/19/2013] [Accepted: 11/29/2013] [Indexed: 11/18/2022] Open
Abstract
Investigation of the prevalence and risk factors of human papillomavirus (HPV) infection is the basis for developing prophylactic strategies against cervical cancer, especially for young women. This study aimed to assess the prevalence and risk factors of HPV infection among a cohort of sexually active young French women eligible for catch-up vaccination. Between 1997 and 2007, 2163 women aged 15-23 years attending consultations at the department of gynecology in the Hospital of Besançon (France) were screened for high risk HPV (HR HPV) infection. Risk factors were investigated through a questionnaire sent to all participants in 2010. HPV DNA was detected by HC2 and Probe Set assays. The overall prevalence for HR HPV and HPV16, 18 and/or HPV45 was 44.6% (95% CI, 42.5-46.7%) and 19% (95% CI, 17.3-20.7%), respectively. The response rate to the questionnaire was 22.6%. The prevalence of independent risk factors (age older than 19, smoking, and oral contraception) for HPV 16/18/45 infection in this population was less than 20%. Based on this study, HPV vaccination should be offered not only to teenage girls, but also to young women, regardless of their sexual activity.
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Affiliation(s)
- Ariane Baudu
- Univ Franche-Comte, F-25000 Besancon, France; EA 3181, FED4234, F-25000 Besancon, France
| | - Jean-Luc Prétet
- Univ Franche-Comte, F-25000 Besancon, France; EA 3181, FED4234, F-25000 Besancon, France; CHU Besancon, F-25000, France
| | - Didier Riethmuller
- Univ Franche-Comte, F-25000 Besancon, France; EA 3181, FED4234, F-25000 Besancon, France; CHU Besancon, F-25000, France
| | - Morgane Chotard
- EA 3181, FED4234, F-25000 Besancon, France; CHU Besancon, F-25000, France
| | - Christiane Mougin
- Univ Franche-Comte, F-25000 Besancon, France; EA 3181, FED4234, F-25000 Besancon, France; CHU Besancon, F-25000, France.
| | - Mariette Mercier
- Univ Franche-Comte, F-25000 Besancon, France; EA 3181, FED4234, F-25000 Besancon, France; CHU Besancon, F-25000, France
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Orlando G, Fasolo M, Mazza F, Ricci E, Esposito S, Frati E, Zuccotti GV, Cetin I, Gramegna M, Rizzardini G, Tanzi E. Risk of cervical HPV infection and prevalence of vaccine-type and other high-risk HPV types among sexually active teens and young women (13-26 years) enrolled in the VALHIDATE study. Hum Vaccin Immunother 2014; 10:986-94. [PMID: 24423757 PMCID: PMC4896517 DOI: 10.4161/hv.27682] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
HPV vaccination is expected to reduce the incidence of cervical cancer. The greatest and the earliest health gains will be ensured by high vaccine coverage among all susceptible people. The high costs and the risk of a reduced cost/effectiveness ratio in sexually active girls still represent the main obstacles for a more widespread use of HPV vaccination in many countries. Data on the rate, risk factors, and HPV types in sexually active women could provide information for the evaluation of vaccination policies extended to broader age cohorts. Sexually active women aged 13–26 years enrolled in an Italian cohort study were screened for cervical HPV infections; HPV-DNA positive samples were genotyped by InnoLipa HPV Genotyping Extra or by RFLP genotype analysis. Among the 796 women meeting the inclusion criteria, 10.80% (95% CI 8.65–12.96) were HPV-DNA infected. Age >18 years, lifetime sexual partners >1, and history of STIs were associated to higher risk of HPV infection in the multivariable models adjusted for age, lifetime sexual partners, and time of sexual exposure. The global prevalence of the four HPV vaccine-types was 3.02% (95% CI 1.83–4.20) and the cumulative probability of infection from at least one vaccine-type was 12.82% in 26-years-old women and 0.78% in 18-years-old women. Our data confirm most of the previously reported findings on the risk factors for HPV infections. The low prevalence of the HPV vaccine-types found may be useful for the evaluation of the cost/efficacy and the cost/effectiveness of broader immunization programs beyond the 12-years-old cohort.
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Affiliation(s)
- Giovanna Orlando
- STD Unit; Infectious Diseases I; L Sacco University Hospital; Milan, Italy
| | - Michela Fasolo
- STD Unit; Infectious Diseases I; L Sacco University Hospital; Milan, Italy
| | - Francesca Mazza
- STD Unit; Infectious Diseases I; L Sacco University Hospital; Milan, Italy
| | - Elena Ricci
- Infectious Diseases I; L Sacco University Hospital; Milan, Italy
| | - Susanna Esposito
- Pediatric Clinic I; Department of Pathophysiology and Transplantation; University of Milan; Milan, Italy
| | - Elena Frati
- Department of Biomedical Sciences for Health; University of Milan; Milan, Italy
| | | | - Irene Cetin
- Gynaecology Unit; L Sacco University Hospital; Milan, Italy
| | - Maria Gramegna
- Unità Organizzativa Governo della Prevenzione e Tutela Sanitaria; Direzione Generale Sanità; Regione Lombardia; Milan, Italy
| | | | - Elisabetta Tanzi
- Department of Biomedical Sciences for Health; University of Milan; Milan, Italy
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Prevalence of human papillomavirus in young Italian women with normal cytology: how should we adapt the national vaccination policy? BMC Infect Dis 2013; 13:575. [PMID: 24313984 PMCID: PMC4029487 DOI: 10.1186/1471-2334-13-575] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 12/02/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Human Papillomavirus (HPV) is the most common sexually transmitted infection. In Italy, HPV vaccination is now offered free of charge to 12-year-old females. However, some regional health authorities have extended free vaccination to other age-groups, especially to girls under 18 years of age. We conducted a multicentre epidemiological study to ascertain the prevalence of different genotypes of HPV in young Italian women with normal cytology, with the aim of evaluating the possibility of extending vaccination to older females. METHODS The study was performed in 2010. Women aged 16-26 years with normal cytology were studied. Cervical samples were analyzed to identify the presence of HPV by PCR amplification of a segment of ORF L1 (450 bp). All positive HPV-DNA samples underwent viral genotype analysis by means of a restriction fragment length polymorphism assay. RESULTS Positivity for at least one HPV genotype was found in 18.2% of the 566 women recruited: 48.1% in the 16-17 age-class, 15.4 in the 18-20 age-class, 21.9% in the 21-23 age-class, and 15.5% in the 24-26 age-class; 10.1% of women were infected by at least one high-risk HPV genotype. HPV-16 was the most prevalent genotype. Only 4 (0.7%), 4 (0.7%) and 3 (0.5%) women were infected by HPV-18, HPV-6 and HPV-11, respectively. Of the HPV-DNA-positive women, 64.1% presented only one viral genotype, while 24.3% had multiple infections. The HPV genotypes most often involved in multiple infections were high-risk. A high prevalence was noted in the first years of sexual activity (48.1% of HPV-DNA-positive women aged 16-17 years); HPV prevalence subsequently declined and stabilized.The estimate of cumulative proportions of young women free from any HPV infection at each age was evaluated; 93.3% and 97.1% of 26 year-old women proved free from HPV-16 and/or HPV-18 and from HPV-6 and/or HPV-11, respectively. CONCLUSIONS Our findings confirm the crucial importance of conducting studies on women without cytological damage, in order to optimise and up-date preventive interventions against HPV infection, and suggest that vaccinating 26-year-old females at the time of their first pap-test is to be recommend, though this issue should be further explored.
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Mesher D, Soldan K, Howell-Jones R, Panwar K, Manyenga P, Jit M, Beddows S, Gill ON. Reduction in HPV 16/18 prevalence in sexually active young women following the introduction of HPV immunisation in England. Vaccine 2013; 32:26-32. [PMID: 24211166 PMCID: PMC3898718 DOI: 10.1016/j.vaccine.2013.10.085] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 10/21/2013] [Accepted: 10/24/2013] [Indexed: 12/12/2022]
Abstract
We monitor HPV infection in sexually active young women in England. The prevalence of HPV 16/18 has reduced within 3 years of HPV immunisation. Reductions in HPV 16/18 were greatest at ages with highest immunisation coverage. The data suggest reductions in HPV 16/18 amongst unvaccinated young women and men.
Background Reduction in the prevalence of vaccine type HPV infection in young women is an early indication of the impact of the HPV immunisation programme and a necessary outcome if the subsequent impact on cervical cancer is to be realised. Methods Residual vulva-vaginal swab (VVS) specimens from young women aged 16–24 years undergoing chlamydia screening in community sexual health services (formerly known as family planning clinics), general practice (GP), and youth clinics in 2010–2012 were submitted from 10 laboratories in seven regions around England. These specimens were linked to demographic and sexual behaviour data reported with the chlamydia test, anonymised, and tested for type-specific HPV DNA using a multiplex PCR and Luminex-based genotyping test. Estimated immunisation coverage was calculated and findings were compared to a baseline survey conducted prior to the introduction of HPV immunisation in 2008. Results A total of 4664 eligible specimens were collected and 4178 had a valid test result. The post-immunisation prevalence of HPV 16/18 infection was lowest in this youngest age group (16–18 years) and increased with age. This increase with age was a reversal of the pattern seen prior to immunisation and was inversely associated with estimates of age-specific immunisation coverage (65% for 16–18 year olds). The prevalence of HPV 16/18 infection in the post-immunisation survey was 6.5% amongst 16–18 year olds, compared to 19.1% in the similar survey conducted prior to the introduction of HPV immunisation. Conclusions These findings are the first indication that the national HPV immunisation programme is successfully preventing HPV 16/18 infection in sexually active young women in England. The reductions seen suggest, for the estimated coverage, high vaccine effectiveness and some herd-protection benefits. Continued surveillance is needed to determine the effects of immunisation on non-vaccine HPV types.
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Affiliation(s)
- D Mesher
- Public Health England, HIV & STI Department, 61 Colindale Avenue, London NW9 5EQ, UK.
| | - K Soldan
- Public Health England, HIV & STI Department, 61 Colindale Avenue, London NW9 5EQ, UK
| | - R Howell-Jones
- Public Health England, HIV & STI Department, 61 Colindale Avenue, London NW9 5EQ, UK
| | - K Panwar
- Public Health England, Virus Reference Department, 61 Colindale Avenue, London NW9 5EQ, UK
| | - P Manyenga
- Public Health England, Virus Reference Department, 61 Colindale Avenue, London NW9 5EQ, UK
| | - M Jit
- Public Health England, Statistics and Modelling Economics Department, 61 Colindale Avenue, London NW9 5EQ, UK
| | - S Beddows
- Public Health England, Virus Reference Department, 61 Colindale Avenue, London NW9 5EQ, UK
| | - O N Gill
- Public Health England, HIV & STI Department, 61 Colindale Avenue, London NW9 5EQ, UK
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Kavanagh K, Sinka K, Cuschieri K, Love J, Potts A, Pollock KGJ, Cubie H, Donaghy M, Robertson C. Estimation of HPV prevalence in young women in Scotland; monitoring of future vaccine impact. BMC Infect Dis 2013; 13:519. [PMID: 24188790 PMCID: PMC4228358 DOI: 10.1186/1471-2334-13-519] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 10/29/2013] [Indexed: 11/28/2022] Open
Abstract
Background Estimation of pre-immunisation prevalence of HPV and distribution of HPV types is fundamental to understanding the subsequent impact of HPV vaccination. We describe the type specific prevalence of HPV in females aged 20–21 in Scotland who attended or defaulted from cervical screening using three specimen types; from attenders liquid based cytology and from defaulters urine or self-taken swabs. Methods Residual liquid based cytology samples (n = 2148), collected from women aged 20–21 attending for their first smear were genotyped for HPV. A sample (n = 709) from women who had defaulted from screening was also made available for HPV testing through the use of postal testing kits (either urine samples (n = 378) or self-taken swabs (n = 331)). Estimates of prevalence weighted by deprivation, and for the postal testing kit, also by reminder status and specimen type were calculated for each HPV type. The distribution of HPV types were compared between specimen types and the occurrence of multiple high-risk infections examined. The influence of demographic factors on high-risk HPV positivity and multiple infections was examined via logistic regression. Results The prevalence of any HPV in young women aged 20–21 was 32.2% for urine, 39.5% for self-taken swab, and 49.4% for LBC specimens. Infection with vaccine specific types (HPV 16, 18) or those associated with cross-protection (HPV 31, 33, 45, 51) was common. Individuals were more likely to test positive for high-risk HPV if they resided in an area of high deprivation or in a rural area. The overall distribution of HPV types did not vary between defaulters and attenders. Multiple infections occurred in 48.1% of high-risk HPV positive individuals. Excluding vaccine types the most common pairing was HPV 56 and 66. Conclusions Understanding of the pre-immunisation prevalence of HPV in young women puts Scotland in a prime position to assess the early effect of vaccination as the first highly vaccinated cohorts of individuals enter the screening programme. Differences in results with different specimen types must be taken into account when monitoring the impact of vaccination programmes.
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Affiliation(s)
- Kimberley Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow G1 1XH, UK.
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Alberts CJ, Schim van der Loeff MF, Papenfuss MR, da Silva RJC, Villa LL, Lazcano-Ponce E, Nyitray AG, Giuliano AR. Association of Chlamydia trachomatis infection and herpes simplex virus type 2 serostatus with genital human papillomavirus infection in men: the HPV in men study. Sex Transm Dis 2013; 40:508-15. [PMID: 23680908 PMCID: PMC3904659 DOI: 10.1097/olq.0b013e318289c186] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Studies in women indicate that some sexually transmitted infections promote human papillomavirus (HPV) persistence and carcinogenesis. Little is known about this association in men; therefore, we assessed whether Chlamydia trachomatis (CT) infection and herpes simplex virus type 2 (HSV-2) serostatus are associated with genital HPV prevalence, an early event in HPV-related pathogenesis. METHODS Genital exfoliated cells, first-void urine, and blood from 3971 men recruited in the United States, Mexico, and Brazil were tested for HPV, CT, and HSV-2 antibodies, respectively. Multivariable logistic regression was used to assess the association of CT infection and HSV-2 serostatus with 4 HPV outcomes (any, oncogenic, nononcogenic only, and multiple infections). RESULTS A total of 64 (1.6%) men were CT positive, and 811 (20.4%) men were HSV-2 seropositive. After adjustment for potential confounders, CT was associated with any HPV (adjusted odds ratio [aOR], 2.19; 95% confidence interval [CI], 1.13-4.24), oncogenic HPV (aOR, 3.10; 95% CI, 1.53-6.28), and multiple HPV (aOR, 3.43; 95% CI, 1.69-6.95) prevalence. Herpes simplex virus type 2 serostatus was associated with any HPV (aOR, 1.25; 95% CI, 1.02-1.52), nononcogenic HPV only (aOR, 1.38; 95% CI, 1.08-1.75), and multiple HPV (aOR, 1.33; 95% CI, 1.06-1.68) prevalence. In analyses stratified by sexual behavior, CT infection was significantly associated with HPV detection among men reporting 2 or more recent sexual partners, whereas HSV-2 serostatus was significantly associated with HPV detection in men reporting 0 to 5 lifetime sexual partners. CONCLUSION In this population, CT infection and HSV-2 serostatus were associated with prevalent genital HPV infection. Future prospective studies should investigate whether these infections influence HPV acquisition and/or persistence.
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Draper E, Bissett SL, Howell-Jones R, Waight P, Soldan K, Jit M, Andrews N, Miller E, Beddows S. A randomized, observer-blinded immunogenicity trial of Cervarix(®) and Gardasil(®) Human Papillomavirus vaccines in 12-15 year old girls. PLoS One 2013; 8:e61825. [PMID: 23650505 PMCID: PMC3641072 DOI: 10.1371/journal.pone.0061825] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 03/12/2013] [Indexed: 12/04/2022] Open
Abstract
Background The current generation of Human Papillomavirus (HPV) vaccines, Cervarix® and Gardasil®, exhibit a high degree of efficacy in clinical trials against the two high-risk (HR) genotypes represented in the vaccines (HPV16 and HPV18). High levels of neutralizing antibodies are elicited against the vaccine types, consistent with preclinical data showing that neutralizing antibodies can mediate type-specific protection in the absence of other immune effectors. The vaccines also confer protection against some closely related non-vaccine HR HPV types, although the vaccines appear to differ in their degree of cross-protection. The mechanism of vaccine-induced cross-protection is unknown. This study sought to compare the breadth and magnitudes of neutralizing antibodies against non-vaccine types elicited by both vaccines and establish whether such antibodies could be detected in the genital secretions of vaccinated individuals. Methods and Findings Serum and genital samples were collected from 12–15 year old girls following vaccination with either Cervarix® (n = 96) or Gardasil® (n = 102) HPV vaccine. Serum-neutralizing antibody responses against non-vaccine HPV types were broader and of higher magnitude in the Cervarix®, compared to the Gardasil®, vaccinated individuals. Levels of neutralizing and binding antibodies in genital secretions were closely associated with those found in the serum (r = 0.869), with Cervarix® having a median 2.5 (inter-quartile range, 1.7–3.5) fold higher geometric mean HPV-specific IgG ratio in serum and genital samples than Gardasil® (p = 0.0047). There was a strong positive association between cross-neutralizing antibody seropositivity and available HPV vaccine trial efficacy data against non-vaccine types. Conclusions These data demonstrate for the first time that cross-neutralizing antibodies can be detected at the genital site of infection and support the possibility that cross-neutralizing antibodies play a role in the cross-protection against HPV infection and disease that has been reported for the current HPV vaccines. Trial Registration ClinicalTrials.gov NCT00956553
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Affiliation(s)
- Eve Draper
- Virus Reference Department, Health Protection Agency, London, United Kingdom
| | - Sara L. Bissett
- Virus Reference Department, Health Protection Agency, London, United Kingdom
| | | | - Pauline Waight
- Immunisation, Hepatitis and Blood Safety Department, Health Protection Agency, London, United Kingdom
| | - Kate Soldan
- HIV/STI Department, Health Protection Agency, London, United Kingdom
| | - Mark Jit
- Statistics, Modelling and Economics Department, Health Protection Agency, London, United Kingdom
| | - Nicholas Andrews
- Statistics, Modelling and Economics Department, Health Protection Agency, London, United Kingdom
| | - Elizabeth Miller
- Immunisation, Hepatitis and Blood Safety Department, Health Protection Agency, London, United Kingdom
| | - Simon Beddows
- Virus Reference Department, Health Protection Agency, London, United Kingdom
- * E-mail:
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Petry KU, Luyten A, Justus A, Iftner A, Strehlke S, Reinecke-Lüthge A, Grunwald E, Schulze-Rath R, Iftner T. Prevalence of high-risk HPV types and associated genital diseases in women born in 1988/89 or 1983/84--results of WOLVES, a population-based epidemiological study in Wolfsburg, Germany. BMC Infect Dis 2013; 13:135. [PMID: 23497108 PMCID: PMC3623770 DOI: 10.1186/1471-2334-13-135] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 03/06/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High-risk human papilloma virus (HR-HPV) infection is associated with the development of cervical cancer. HPV vaccination reduces the risk of developing malignant lesions and is expected to change the dynamics of HPV transmission. Data from non-vaccinated women may provide an important benchmark to allow the impact of HPV vaccination programs to be assessed.This study was designed to prospectively determine the changing dynamics of HR-HPV infection and associated genital diseases in young women, most of whom were non-vaccinated. METHODS Data from a population-based cohort study, comprising women of two predefined birth cohorts (women born in 1983/84 or 1988/89), were analyzed between 19 October 2009 and 31 December 2010 to determine risk factors for high-risk HPV infection and the association between specific HR-HPV types and atypical Pap smear test results. HPV status was determined by Hybrid Capture 2 (HC2) assay and genotyping. RESULTS The prevalence of HR-HPV was 22.8% in the 1983/84 cohort (150/659) and 23.7% in the 1988/99 cohort (142/599). Only the number of sexual partners was a significant risk factor for HPV infection (odds ratios 22.687 and 6.124 for more than five versus one partner 84 cohort,/84 and 1988/89 cohorts, respectively) in multivariate analysis. HPV16 positive-women were significantly more likely to have abnormal Pap smears of any degree than HPV16-negative women (22.0% versus 3.61%, p < 0.0001 for the 1983/84 cohort and 9.09% versus 2.52%, p = 0.0482 for the 1988/89 cohort). CIN3 was diagnosed in six women 84 cohort,/84 cohort and two in the 1988/89 cohort. All women with CIN3 tested positive for HC2-HR and all six CIN3 cases 84 cohort,/84 cohort tested positive for HPV16. In the 1988/89 cohort, the rate of HPV16 infection was significantly lower in vaccinated than non-vaccinated women (1.59% versus 8.88%; p = 0.003). CONCLUSIONS HR-HPV infection was highly prevalent in both cohorts and associated with an increased risk of abnormal Pap smears and biopsy proven CIN2+. HPV16 infection was associated with a high risk of clinically relevant lesions. HPV vaccination significantly decreased the risk of HPV16 infection.
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Affiliation(s)
- Karl Ulrich Petry
- Klinikum Wolfsburg, Frauenklinik, Schwerpunkt gynäkologische Onkologie, Sauerbruchstr.7, Wolfsburg 38440, Germany.
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Development of a generic microfluidic device for simultaneous detection of antibodies and nucleic acids in oral fluids. BIOMED RESEARCH INTERNATIONAL 2013; 2013:543294. [PMID: 23509739 PMCID: PMC3586469 DOI: 10.1155/2013/543294] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 12/30/2012] [Indexed: 12/03/2022]
Abstract
A prototype dual-path microfluidic device (Rheonix CARD) capable of performing simultaneously screening (antigen or antibody) and confirmatory (nucleic acid) detection of pathogens is described. The device fully integrates sample processing, antigen or antibody detection, and nucleic acid amplification and detection, demonstrating rapid and inexpensive “sample-to-result” diagnosis with performance comparable to benchtop analysis. For the chip design, a modular approach was followed allowing the optimization of individual steps in the sample processing process. This modular design provides great versatility accommodating different disease targets independently of the production method. In the detection module, a lateral flow (LF) protocol utilizing upconverting phosphor (UCP) reporters was employed. The nucleic acid (NA) module incorporates a generic microtube containing dry reagents. Lateral flow strips and PCR primers determine the target or disease that is diagnosed. Diagnosis of HIV infection was used as a model to investigate the simultaneous detection of both human antibodies against the virus and viral RNA. The serological result is available in less than 30 min, and the confirmation by RNA amplification takes another 60 min. This approach combines a core serological portable diagnostic with a nucleic acid-based confirmatory test.
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Oakeshott P, Aghaizu A, Reid F, Howell-Jones R, Hay PE, Sadiq ST, Lacey CJ, Beddows S, Soldan K. Frequency and risk factors for prevalent, incident, and persistent genital carcinogenic human papillomavirus infection in sexually active women: community based cohort study. BMJ 2012; 344:e4168. [PMID: 22730542 PMCID: PMC3382227 DOI: 10.1136/bmj.e4168] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2012] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate frequency and risk factors for prevalent, incident, and persistent carcinogenic human papillomavirus (HPV) in young women before the introduction of immunisation against HPV types 16 and 18 for schoolgirls. DESIGN Cohort study SETTING 20 London universities and further education colleges. PARTICIPANTS 2185 sexually active female students, mean age 21 years (range 16-27), 38% from ethnic minorities, who took part in the POPI (prevention of pelvic infection) chlamydia screening trial in 2004-08 and who provided duplicate, self taken vaginal swabs and completed questionnaires at baseline. At follow-up, a median of 16 months later, 821 women (38%) returned repeat vaginal swabs by post. In 2009-10, stored samples were tested for HPV. RESULTS Samples from 404/2185 (18.5% (95% CI 16.9% to 20.2%)) of the cohort were positive for carcinogenic HPV at baseline, including 15.0% (327) positive for non-vaccine carcinogenic genotypes. Reporting two or more sexual partners in the previous year and concurrent Chlamydia trachomatis or bacterial vaginosis were independent risk factors for prevalent vaginal HPV infection. Infection with one or more new HPV types was found in 17.7% (145/821) of follow-up samples, giving an estimated annual incidence of carcinogenic HPV infection of 12.9% (95% CI 11.0% to 15.0%). Incident infection was more common in women reporting two or more partners in the previous year, aged<20, of black ethnicity, or with C trachomatis vaginosis at baseline. Multiple partners was the only independent risk factor for incident infection (adjusted relative risk 1.99 (95% CI 1.46 to 2.72)). Of 143 women with baseline carcinogenic HPV infection, 20 (14% (8.3% to 19.7%) had infection with the same carcinogenic HPV type(s) detected after 12-28 months. Of these women, 13 (65%) had redetected infection with HPV 16 or 18, and nine (45%) with non-vaccine carcinogenic HPV genotypes. CONCLUSION In the first UK cohort study of carcinogenic HPV in young women in the community, multiple sexual partners was an independent predictor of both prevalent and incident infection. Infection with non-vaccine carcinogenic genotypes was common. Although current HPV vaccines offer partial cross protection against some non-vaccine carcinogenic HPV types, immunised women will still need cervical screening.
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Affiliation(s)
- Pippa Oakeshott
- Division of Population Health Sciences, St George's, University of London SW17 0RE, UK.
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