Abstract
BackgroundIn Germany, HPV vaccination of adolescent girls was introduced in 2007. Nationally representative data on the distribution of vaccine-relevant HPV types in the pre-vaccination era are, however, only available for the adult population. To obtain data in children and adolescents, we assessed the prevalence and determinants of serological response to 16 different HPV types in a representative sample of 12,257 boys and girls aged 1–17 years living in Germany in 2003–2005.MethodsSerum samples were tested for antibodies to nine mucosal and seven cutaneous HPV types. The samples had been collected during the nationally representative German Health Interview and Examination Survey for Children and Adolescents in 2003–2006. We calculated age- and gender-specific HPV seroprevalence. We used multivariable regression models to identify associations between demographic and behavioral characteristics and HPV seropositivity.ResultsWe found low but non-zero seroprevalence for the majority of tested HPV types among children and adolescents in Germany. The overall seroprevalence of HPV-16 was 2.6%, with slightly higher values in adolescents. Seroprevalence of all mucosal types but HPV-6 ranged from 0.6% for HPV-33, to 6.4% for HPV-31 and did not differ by gender. We found high overall seroprevalence for HPV-6 with 24.8%. Cutaneous HPV type seroprevalence ranged from 4.0% for HPV-38 to 31.7% for HPV-1. In the majority of cutaneous types, seroprevalence did not differ between boys and girls, but increased sharply with age, (e.g., HPV-1 from 1.5% in 1–3-years-old to 45.1% in 10–11-years-old). Associations between behavioral factors and type-specific HPV prevalence were determined to be heterogeneous.ConclusionsWe report the first nationally representative data of naturally acquired HPV antibody reactivity in the pre-HPV-vaccination era among children and adolescents living in Germany. These data can be used as baseline estimates for evaluating the impact of the current HPV vaccination strategy targeting 9–14-years-old boys and girls.
Highlights
In Germany, Human papillomavirus (HPV) vaccination of adolescent girls was introduced in 2007
Overall, 12,257 serum samples of children and adolescents aged 1–17 years with valid HPV serology from the pre-HPV-vaccination era were included in the analysis (Fig. 1)
HPV-6 differed to the other Mucoseal HPV types (mucHPV) with a high overall seroprevalence of 24.8%
Summary
In Germany, HPV vaccination of adolescent girls was introduced in 2007. Nationally representative data on the distribution of vaccine-relevant HPV types in the pre-vaccination era are, only available for the adult population. To obtain data in children and adolescents, we assessed the prevalence and determinants of serologi‐ cal response to 16 different HPV types in a representative sample of 12,257 boys and girls aged 1–17 years living in Germany in 2003–2005. HPV types belong to different genera and species based on their phylogenetic relationship [4]. They can be categorized into two tropism groups, comprising cutaneous HPV types (cutHPV) and mucosal types (mucHPV). A small fraction of mucHPV belonging to the alpha genus, like HPV-16 and HPV-18, are assigned to the socalled high-risk (HR) group, due to their role as causative agents of various types of precancerous lesions and cancer [5, 6]. CutHPV, e.g. HPV-1 or HPV-4, are usually found on healthy skin [10], even though they can be detected in skin lesions such as benign skin warts [4, 6], and some types have been discussed to be involved in skin carcinogenesis [11]
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