Abstract
BackgroundEstimates of Human Papillomavirus (HPV) prevalence in a population prior to and after HPV vaccine introduction are essential to evaluate the short-term impact of vaccination.MethodsBetween 2010 and 2012 we conducted a population-based cross-sectional study in Germany to determine HPV prevalence, genotype distribution and risk factors for HPV-infection in women aged 20-25 years. Women were recruited by a two-step cluster sampling approach. A home-based self-collection of cervicovaginal lavages was used. Specimens were analysed using a general primer GP5+/GP6+-based polymerase chain reaction and genotyped for 18 high-risk and 6 low-risk HPV- strains by Luminex-based multiplexed genotyping.ResultsAmong 787 included women, 512 were not vaccinated against HPV. In the non-vaccinated population, HPV prevalence of any type was 38.1%, with HPV 16 (19.5%) being the most prevalent genotype. Prevalence of any high-risk type was 34.4%, and in 17.4% of all women, more than one genotype was identified. A higher number of lifetime sexual partners and low educational status were independently associated with HPV-infection. In 223 vaccinated women, prevalence of HPV 16/18 was significantly lower compared to non-vaccinated women (13.9% vs. 22.5%, p = 0.007). When stratifying by age groups, this difference was only significant in women aged 20-21 years, who at time of vaccination were on average younger and had less previous sexual contacts than women aged 22-25 years.ConclusionWe demonstrate a high prevalence of high-risk HPV genotypes in non-vaccinated women living in Germany that can be potentially prevented by vaccination. Probable first vaccination effects on the HPV prevalence were observed in women who were vaccinated at younger age. This finding reinforces the recommendation to vaccinate girls in early adolescence.
Highlights
Estimates of Human Papillomavirus (HPV) prevalence in a population prior to and after HPV vaccine introduction are essential to evaluate the short-term impact of vaccination
Factors associated with HPV infection in the nonvaccinated population In univariate analysis, a higher number of lifetime sexual partners significantly increased the probability of HPV infection by any type and by hr-types
Women with 2 or more sexual partners during the past 12 months had a significantly increased risk of HPV infection compared to those who had no partners during this time interval
Summary
Estimates of Human Papillomavirus (HPV) prevalence in a population prior to and after HPV vaccine introduction are essential to evaluate the short-term impact of vaccination. Persistent high-risk (hr) Human Papillomavirus (HPV) infections are essential for development of cervical precancer and cancer. Since it will take several decades until the effects of HPV vaccines on cervical cancer incidence will be visible, monitoring of HPV prevalence and genotype distribution prior to, and after vaccine introduction is essential to evaluate the short-term impact of HPV vaccination in a population. The prevalence of hr-HPV genotypes targeted by the vaccines is expected to decline after vaccine introduction It remains unclear, to what extent the prevalence of certain other genotypes will change due to cross-protection or potentially by replacement by other genotypes.
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