Abstract
The objective of this study was to determine the prevalence and some predictors for vaccine and non-vaccine types of HPV infections among bivalent HPV vaccinated and non-vaccinated young women in Uganda. This was a comparative cross sectional study 5.5 years after a bivalent HPV 16/18 vaccination (Cervarix®, GlaxoSmithKline, Belgium) pilot project in western Uganda. Cervical swabs were collected between July 2014-August 2014 and analyzed with a HPV genotyping test, CLART® HPV2 assay (Genomica, Madrid Spain) which is based on PCR followed by microarray for determination of genotype. Blood samples were also tested for HIV and syphilis infections as well as CD4 and CD8 lymphocyte levels. The age range of the participants was 15–24 years and mean age was 18.6(SD 1.4). Vaccine-type HPV-16/18 strains were significantly less prevalent among vaccinated women compared to non-vaccinated women (0.5% vs 5.6%, p 0.006, OR 95% CI 0.08(0.01–0.64). At type-specific level, significant difference was observed for HPV16 only. Other STIs (HIV/syphilis) were important risk factors for HPV infections including both vaccine types and non-vaccine types. In addition, for non-vaccine HPV types, living in an urban area, having a low BMI, low CD4 count and having had a high number of life time sexual partners were also significant risk factors. Our data concurs with the existing literature from other parts of the world regarding the effectiveness of bivalent HPV-16/18 vaccine in reducing the prevalence of HPV infections particularly vaccine HPV- 16/18 strains among vaccinated women. This study reinforces the recommendation to vaccinate young girls before sexual debut and integrate other STI particularly HIV and syphilis interventions into HPV vaccination packages.
Highlights
Cervical cancer (CC) is the third commonest cancer among women globally, with an estimated 527,624 new cases and 265,672 deaths in 2012 [1]
The age range of the 488 participants eligible for the study which comprised of 51.6% vaccinated young women was 15–24 years and mean age was 18.5
Bivalent Human papillomavirus (HPV) vaccination decreased the likelihood of vaccine HPV infection (B -19.480, 95% CI -20.163 to– 18.796)
Summary
Cervical cancer (CC) is the third commonest cancer among women globally, with an estimated 527,624 new cases and 265,672 deaths in 2012 [1]. The most recent data from Globocan 2012 put Uganda’s age-standardized incidence rate for CC at 44.4 per 100,000 women in 2012, it remains one of the highest in the world [1]. Several mucosal HPV types including HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58 and 59 have been classified as carcinogenic Group 1 or high-risk (HR) strains because of their association with CC [4,5,6,7,8]. Other mucosal HPV types including HPV 6 and 11 were classified as low-risk (LR) because of their association with benign genital warts [10]
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