Abstract
Cervical cancer is the leading cause of cancer deaths among women in Ethiopia. This may be due to the high prevalence of high-risk human papillomavirus (HR-HPV) genotypes in the population. So far, few studies have been done that showed the presence of HR-HPV genotypes. The HR-HPV-16, -18, -52, -56, -31 and -58 were the most common genotypes reported in Ethiopia. The introduction of HPV vaccines in Ethiopia is likely to go a long way in reducing cervical cancer deaths. However, there are few challenges to the introduction of the vaccines. The target population for HPV vaccination is at the moment not well-defined. Besides, the current HPV vaccines confer only type-specific (HPV-16 and -18) immunity, leaving a small proportion of Ethiopian women unprotected against other HR-HPV genotypes such as 52, 56, 31 and 58. Thus, future HPV vaccines such as the nanovalent vaccine may be more useful to Ethiopia as they will protect women against more genotypes.
Highlights
Cervical cancer is the leading cause of cancer deaths among women in Ethiopia
(4) Approximately 50 of these genotypes are known to be oncogenic or HR types, which cause cancer of the cervix. [2,3,5] Of these, fifteen high-risk human papillomavirus (HR-human papillomaviruses (HPVs)) genotypes: HPV-16, -18, -31, 33, -35, -39, -45, -51, -52,56, -58, -59, -68, 73, and -82 cause more than 95% of all cases of cervical cancer (CC). [5, 6] HPV-16 is the type that is responsible for 50-60% of all CC worldwide [7,8] and HPV-18 is followed by an incidence of 10-20%.(7) HPV-16 and -18 are considered as the types responsible for approximately 70% of CC worldwide.[9,10,11] Currently, public knowledge of HPV and CC is poor in Ethiopia. [12, 13]
(21) The finding from this study indicated that nonmarried relationship and widowhood, increasing number of lifetime sexual partners, human immunodeficiency virus infection and non-traditional housing type was significantly associated with HR-HPV infection
Summary
The human papillomaviruses (HPVs) are a big group of highly ubiquitous, small, nonenveloped double-stranded circular DNA viruses that infect cutaneous and mucosal surfaces and induce squamous epithelial tumors (warts and papillomas) in many different anatomical sites. [1] More than 140 HPV genotypes have been identified. [2, 3] They are classified into high-risk (HR), probable high-risk (PHR) and low-risk (LR) types. [4] Approximately 50 of these genotypes are known to be oncogenic or HR types, which cause cancer of the cervix. [2,3,5] Of these, fifteen HR-HPV genotypes: HPV-16, -18, -31, 33, -35, -39, -45, -51, -52,-56, -58, -59, -68, 73, and -82 cause more than 95% of all cases of cervical cancer (CC). [5, 6] HPV-16 is the type that is responsible for 50-60% of all CC worldwide [7,8] and HPV-18 is followed by an incidence of 10-20%.(7) HPV-16 and -18 are considered as the types responsible for approximately 70% of CC worldwide.[9,10,11] Currently, public knowledge of HPV and CC is poor in Ethiopia. [12, 13]. A hospital-based cross-sectional study was conducted in 448 HIV-positive Ethiopian women from Southern Nations, Nationalities and People Region (SNNPR) to assess the prevalence and risk factors associated with precancerous cervical cancer lesion among HIV-infected women. In a second cross-sectional study (n= 537) was done to assess the cervical HPV prevalence, genotype distribution and associated correlates among female hospital outpatients in Gurage zone, rural Ethiopia. Studies indicated that the high risk HPV genotypes: HPV-52, [21,24] -56, [21,25] -58 [21], and -31 [21] were found in a substantial proportion of women with CC in Ethiopia.women infected with such genotypes will not be fully protected from getting CC by the current vaccines.This challenge has been observed in several other sub-Saharan African countries such as Kenya, [38] Sudan, [39] Benin, [40] Equatorial Guinea, [41] Tanzania, [42] Zambia, [43] Cameroun, [44] Mozambique, [45] and Senegal [46] where other non-16 and 18 genotypes were prevalent. Despite the marketing of HPV vaccines as the solution to CC, the licensing of the vaccines has not translated into universal equitable access. [50] In Ethiopia, vaccine implementation for vulnerable girls and women faces multiple barriers that include high vaccine costs, inadequate delivery infrastructure, and lack of community engagement to generate awareness about CC and early screening tools. [12,13,15,32] for HPV vaccines to work as a public health solution, the quality-assured delivery of cheaper vaccines must be integrated with strengthened capacity for community based health education and screening
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