Sera from 1483 female subjects in England aged 10 -29 years were tested. The age-standardised seroprevalence was 10.7% (95% confidence intervals 9.0 -12.3) for human papillomavirus (HPV) 6, 2.7% (1.8 -3.6) for HPV 11, 11.9% (10.2 -13.6) for HPV 16, 4.7% (3.5 -5.8) for HPV 18, Infection with human papillomavirus (HPV) types identified as 'high-risk' is a pre-requisite for developing cervical cancer (Munoz et al, 2003). HPV types 16 and 18 are associated with 70% of cervical cancers worldwide (Munoz et al, 2003), while HPV types 6 and 11, although not 'high-risk', are associated with over 90% of cases of anogenital warts (von Krogh et al, 2001). Two prophylactic vaccines against HPV (a bivalent vaccine against types 16 and 18, and a quadrivalent vaccine that also includes types 6 and 11) have been shown in clinical trials to reduce persistent HPV infection and associated disease by over 90% in up to 5 years of follow-up (Harper et al, 2004;Villa et al, 2006).Epidemiological knowledge of HPV infection in the UK relies heavily on prevalence studies of HPV DNA in the cervical epithelium of women undergoing cervical sampling (Woodman et al, 2001;Kitchener et al, 2006) and usually relates to female subjects known to be sexually active. These studies indicate the prevalence of current infection, as most HPV infections are transient and become DNA negative within 2 years (Moscicki et al, 2006). In individuals who mount a detectable humoral immune response, HPV type-specific serum antibodies are an indicator of past exposure. Testing of blood samples also offers the opportunity to survey different populations.Enzyme-linked immunosorbent assays (ELISAs) utilising viruslike particles have been used successfully for seroprevalence studies in several countries including the USA (Stone et al, 2002) and Sweden (af Geijersstam et al, 1999). We report on the first population-based study of HPV 6, 11, 16 and 18 seroprevalence in England, in 10-to 29-year-old female subjects -the likely target age range for vaccination, but an age range in which little is known about infection rates.
MATERIALS AND METHODSSerum specimens were obtained from the Health Protection Agency Sero-Epidemiology Unit collection, consisting of unlinked residual sera submitted to laboratories in England for routine microbiological or biochemical investigations. Sera from immunocompromised individuals and repeat sera from the same individuals were excluded (Osborne et al, 2000).Sera were selected from 1483 women aged 10 -29 years, chosen as most important for informing the design of HPV vaccination programmes in the UK. Sera came from 11 laboratories in England that collected samples in 2002 -2004. About 90 samples were selected for each single year of age in the range 10 -19 years, and about 60 samples for each of the ages 20 -29 years. Samples were tested for specific neutralising antibodies to HPV 6, 11, 16 and 18 by Merck and Co Inc., using a multiplexed competitive Luminex s assay with antibody levels reported in milli-Merck units per millilitre (mMu ml À1 ...