Estimation of HPV prevalence in young women in Scotland; monitoring of future vaccine impact

Abstract

BackgroundEstimation 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.MethodsResidual 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.ResultsThe 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.ConclusionsUnderstanding 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.

Changes in the prevalence of human papillomavirus following a national bivalent human papillomavirus vaccination programme in Scotland: a 7-year cross-sectional study

“…In this seven year cross-sectional study (covering birth cohorts 1988-1995) we sampled approximately 1000 samples per year from those attending cervical screening at age [20][21] and tested each for HPV. By linkage to vaccination records we ascertain prevalence by birth cohort and vaccination status.…”

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“…The economic impact of costeffectiveness of vaccination estimated the prevention of the new cases of cervical cancer associated with oncogenic HPV types, and a decrease in the incidence of genital wart in the next 100 years (Kavanagh et al, 2013, Panatto et al, 2013, Uuskula et al, 2013.…”

“…The most commonly used epidemiological design is a cross-sectional study using different clinical specimens as urine, cytology samples, swabs of self-collection (Kavanagh et al, 2013). Multiple infections of HPV, prevalence of the high-risk types and cofactors for the persistence of viral infection have been documented in many studies (Panatto et al 2013, Agyri et al 2013, Clarke et al 2012, Figueiredo Alves et al 2013.…”

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“…Among the clinical specimens analyzed, the oncogenic types HPV-16/18 were detected in 23% of cytology samples, 16.6% collected on swabs and only 10% in urine samples [12].…”

“…Since the implementation of the anti-HPV vaccine in worldwide immunization programs, numerous studies have evaluated the impact of vaccination, and the prevention of thousands of new cases of cervical cancer in the next 50 to 100 years was estimated [12,13,19].…”