Cervical Coinfection with Human Papillomavirus (HPV) Types and Possible Implications for the Prevention of Cervical Cancer by HPV Vaccines

In developing countries, cervical cancer is the most common cause of cancer related to mortality in women. But the epidemiology of human papillomavirus (HPV) in different areas of Bangladesh is largely unknown both in risk groups and in the general population. The objective of the present study was to determine the risk factors associated with having HPV and the prevalence of high-risk HPV types among women with highrisk behaviour and to assess its potential impact on preventive strategies as the sex workers are at increased risk for sexually transmitted infections (STI), HPV and hence cervical cancer. Cervical swab from 293 sex workers in Dhaka City between August and September 2003 and between February 2005 and May 2006 were screened for HPV DNA using an HPV short fragment (E6) polymerase chain reaction (PCR) based assay. HPV positive samples were genotyped with nested multiplex polymerase chain reaction (NMPCR) for the highrisk types. The overall HPV prevalence in sex workers was 75.8%, whereas for the high risk type it was 49.8%. Prevalence of single genotype and multiple types of HPV was 33.1 and 16.7% respectively. The most prevalent high-risk HPV types, in order of prevalence rate, were HPV16, HPV18, HPV58, HPV45, HPV31 and HPV33. Both HPV 16 and HPV 18 were present in 21% of the cases. Targeting HPV 16 and 18 with prophylactic vaccines could possibly have an important impact on the incidence of invasive cervical carcinoma in this group of women. Primary prevention and cervical cancer screening programmes should be optimized more and run yearly among the general population. It is proposed to screen sex workers when they enter prostitution regardless of their age. Keywords: Human papillomavirus (HPV); High-risk HPV types; Cervical cancer; Sex workersDOI: http://dx.doi.org/10.3329/bjm.v25i1.4861 Bangladesh J Microbiol, Volume 25, Number 1, June 2008, pp 65-68

Download Full-text

Distribution and Prevalence of High-Risk Human Papillomavirus Genotypes in Cervical Specimens

Flora the Journal of Infectious Diseases and Clinical Microbiology ◽

10.5578/flora.68958 ◽

2020 ◽

Vol 25 (3) ◽

pp. 325-331

Author(s):

Erkan Özmen ◽

Ülkü Altoparlak ◽

Muhammet Hamidullah Uyanık ◽

Abdulkadir Gülen

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Age Groups ◽

Hpv Infection ◽

High Rate ◽

Genotype Distribution ◽

Hpv Dna ◽

Hpv Test ◽

Significant Difference ◽

Hpv Types

Introduction: Human papillomavirus (HPV) is frequently a sexually transmitted virus and can cause cervical cancer in women. Cervical cancer is the second most common type of cancer among the developing countries. In this study, cervical HPV DNA positivity and genotype distributions were investigated in female patients living in our region and the results were compared with different studies. Materials and Methods: Between 1 July, 2017 and 1 March, 2019, 433 cervical swabs were sent to Ataturk University, Medical Faculty Hospital, Medical Microbiology Laboratory due to suspicion of HPV. Swab samples were evaluated for HPV virus using molecular (Polymerase Chain Reaction-PCR) methods. For this purpose, Xpert HPV Test (Cepheid, Inc, Sunnyvale, CA) was used to identify HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68 t in a single sample. Results: Mean age of the patients ranged from 20 to 69 years, with a mean of 39.8 years (± 10.0). Positivity was detected in 62 of the 433 patients. Mean age of the positive patients was 40.2 years (± 11.3). When the positive patients were examined in terms of HPV types, the presence of HPV 16 was observed with a rate of 25.6%, while the HPV 18/45 types were found to be 9.0% in total. When patients were evaluated according to age groups, HPV DNA positivity was highest in the 25-34 age group with 38.7%. In our statistical study, there was no significant difference in HPV DNA positivity rate between the ages of 35 and under 35 years. Conclusion: This study demonstrates the prevalence and viral genotype distribution of HPV infection in women in Erzurum region. HPV type 16 is seen with a high rate in our region.

Download Full-text

Human papillomavirus vaccination: evidence base for efficacy and safety

GYNECOLOGY ◽

10.26442/20795696.2021.2.200742 ◽

2021 ◽

Vol 23 (2) ◽

pp. 125-130

Author(s):

Yuliya E. Dobrokhotova ◽

Ekaterina I. Borovkova

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Hpv Vaccination ◽

Intraepithelial Neoplasia ◽

Evidence Base ◽

Hpv Infection ◽

Efficacy And Safety ◽

Human Papillomavirus Vaccination ◽

Hpv Types ◽

Further Development

The article provides a literature review on the prevention of cervical cancer by human papillomavirus (HPV) vaccination. Currently, 3 vaccines are available: the 4-valent vaccine against HPV types 6, 11, 16 and 18, the 9-valent vaccine against HPV types 6, 11, 16, 18, 31, 33, 45, 52, 58 and the bivalent vaccine against HPV types 16 and 18. Vaccination provides protection for women and men against infection with HPV and further development of HPV-associated diseases. Following immunization, seroconversion develops in 93-100% of women and in 99-100% of men and is effective in preventing incident and persistent HPV infection as well as cervical intraepithelial neoplasia. HPV immunization is ineffective in treating an existing HPV infection, genital warts, or anogenital intraepithelial neoplasia. HPV vaccination status does not affect recommendations for cervical cancer screening.

Download Full-text

Human papillomavirus (HPV) vaccination: from clinical studies to immunization programs

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000582 ◽

2019 ◽

Vol 29 (8) ◽

pp. 1317-1326 ◽

Cited By ~ 6

Author(s):

Raúl Murillo ◽

Camila Ordóñez- Reyes

Keyword(s):

Cervical Cancer ◽

Clinical Trials ◽

Human Papillomavirus ◽

Hpv Vaccine ◽

Hpv Vaccination ◽

Population Based ◽

Immunization Programs ◽

Hpv Vaccines ◽

Middle Income ◽

Middle Income Countries

Cervical cancer incidence and mortality have decreased in high-income countries, but low- and middle-income countries continue to bear a significant burden from the disease. Human papillomavirus (HPV) vaccines are a promising alternative for disease control; however, their introduction is slow in settings with greater need. We conducted a review of HPV vaccine efficacy and effectiveness reported in clinical trials and population-based studies. Efficacy of HPV vaccines is close to 100% when using a three-dose schedule in HPV-negative young women (<25 years old) for protection against persistent infection and HPV vaccine-type associated pre-cancerous lesions. Furthermore, sustained protection for up to 12 years of follow-up has been demonstrated; cross-protection against non-vaccine types is particularly observed for the bivalent vaccine, and preliminary data regarding impact on invasive cancer have emerged. Given its lower efficacy, catch-up vaccination beyond 19 years of age and proposals for vaccinating adult women deserve careful evaluation in accurately designed studies and economic analyses. Despite positive results regarding immunogenicity and post-hoc analysis for cervical intra-epithelial neoplasia in clinical trials, population-based data for prime and booster two-dose schedules are not available. Evaluation of vaccine safety from surveillance systems in immunization programs that have already distributed more than 270 million doses found no association of HPV vaccination with serious side effects. The introduction of HPV vaccination in national immunization programs remains the main challenge in tackling the burden of cervical cancer (up to 2018, only 89 countries have introduced vaccination worldwide, and most of these are high-income countries). Access models and technical capacity require further development to help low- and middle-income countries to increase the pace of vaccine delivery. Alternative approaches such as one-dose schedules and vaccination at younger ages may help reduce the programmatic and economic challenges to adolescent vaccination.

Download Full-text

Comprehensive Human Papillomavirus Genotyping in Cervical Squamous Cell Carcinomas and Its Relevance to Cervical Cancer Prevention in Malawian Women

Journal of Global Oncology ◽

10.1200/jgo.2015.001909 ◽

2017 ◽

Vol 3 (3) ◽

pp. 227-234 ◽

Cited By ~ 4

Author(s):

Brooke E. Howitt ◽

Michael Herfs ◽

Tamiwe Tomoka ◽

Steve Kamiza ◽

Tarik Gheit ◽

...

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Squamous Cell ◽

Vaccine Development ◽

Hpv Vaccination ◽

Significant Proportion ◽

Sub Saharan Africa ◽

Single Infection ◽

Hpv 16 ◽

Hpv Types

Purpose Cervical squamous cell carcinoma (SCC) continues to be a significant cause of cancer morbidity and is the third leading cause of cancer-related death in women worldwide. In sub-Saharan Africa, cervical cancer is not only the most common female cancer but also the leading cause of cancer-related deaths in women. Malawi, in particular, has the highest burden of cervical cancer. With the increasing use of human papillomavirus (HPV) vaccination, documenting the prevalent HPV types in those high-risk populations is necessary to both manage expectations of HPV vaccination and guide future vaccine development. Materials and Methods In this study, we performed HPV typing on 474 cervical SCC samples and analyzed the potential impact of HPV vaccination in this population. Results Ninety-seven percent of tumors were positive for at least one HPV type, and 54% harbored more than one HPV type. HPV 16 was the most common type (82%), followed by HPV 18 (34%), HPV 35 (24%), and HPV 31 (12%). A vaccine against HPV 16 and 18 would ideally prevent 53% of cervical SCC, and the nonavalent HPV vaccine (covering HPV 16, 18, 31, 33, 45, 52, and 58) would prevent 71% of cervical SCC in Malawi (assuming 100% vaccine efficacy). The main reason for a lack of coverage was high prevalence of HPV 35, which was also present as a single infection in a small subset of patients. Conclusion Although any HPV vaccination in this population would likely prevent a significant proportion of cervical cancer, the nonavalent vaccine would provide better coverage. Furthermore, investigation of the role of HPV 35 in this population, including possible cross-protection with other HPV types, should be pursued.

Download Full-text

Global reduction of cervical cancer with human papillomavirus vaccines: insights from the hepatitis B virus vaccine experience

Sexual Health ◽

10.1071/sh09134 ◽

2010 ◽

Vol 7 (3) ◽

pp. 383 ◽

Cited By ~ 8

Author(s):

Margaret E. Heffernan ◽

Suzanne M. Garland ◽

Mark A. Kane

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Hepatitis B Virus ◽

Hepatitis B ◽

Hpv Vaccination ◽

Primary Hepatocellular Carcinoma ◽

Health Providers ◽

Hpv Vaccines ◽

B Virus ◽

Global Reduction

Background: Worldwide, prophylactic vaccines against two major human cancers are now commercially available: hepatitis B virus (HBV) vaccines (first licensed in 1982) against primary hepatocellular carcinoma and human papillomavirus (HPV) vaccines (first licensed 2006) against cervical cancer. Initial implementation strategies for HBV vaccination were not successful in preventing disease in the community: it took 15 years for significant global reduction in the burden of this disease. Methods: We compare and contrast HBV vaccine experiences to challenges for successful global HPV vaccination strategies, and make recommendations accordingly. Results: Lessons from HBV immunisation for successful outcomes with HPV immunisation showed that several factors need to be met: (i) the engagement of key stakeholders in all aspects of planning and delivery of HPV vaccine strategies; (ii) understanding the specific characteristics of targeted population groups; (iii) global cooperation and support with WHO recommendations; (iv) Government supported mass immunization programs and cooperation between public and private entities; (v) affordable HPV vaccines for some regions; (vi) culturally appropriate and diverse public education programs in targeted health promotion strategies; (vii) pro-active health providers and parents in encouraging adolescents to undertake HPV vaccination; and (vii) eventual immunisation of infants. Conclusions: The key to success will be affordable, readily deliverable HPV vaccines to young girls as universal campaigns.

Download Full-text

Cost-effectiveness analysis of the introduction of a quadrivalent human papillomavirus vaccine in France

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462307080026 ◽

2008 ◽

Vol 24 (01) ◽

pp. 10-19 ◽

Cited By ~ 64

Author(s):

Christine Bergeron ◽

Nathalie Largeron ◽

Ruth McAllister ◽

Patrice Mathevet ◽

Vanessa Remy

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Cost Effectiveness ◽

Incremental Cost ◽

Hpv Vaccine ◽

Screening Program ◽

Sensitivity Analyses ◽

Quadrivalent Hpv Vaccine ◽

Hpv Types ◽

Current Screening

Objectives:A vaccine to prevent diseases due to human papillomavirus (HPV) types 6, 11, 16, and 18 is now available in France. The objective of this study was to assess the health and economic impact in France of implementing a quadrivalent HPV vaccine alongside existing screening practices versus screening alone.Methods:A Markov model of the natural history of HPV infection incorporating screening and vaccination, was adapted to the French context. A vaccine that would prevent 100 percent of HPV 6, 11, 16, and 18-associated diseases, with lifetime duration and 80 percent coverage, given to girls at age 14 in conjunction with current screening was compared with screening alone. Results were analyzed from both a direct healthcare cost perspective (DCP) and a third-party payer perspective (TPP). Indirect costs such as productivity loss were not taken into account in this analysis.Results:The incremental cost per life-year gained from vaccination was €12,429 (TPP) and €20,455 (DCP). The incremental cost per quality-adjusted life-year (QALY) for the introduction of HPV vaccination alongside the French cervical cancer screening program was €8,408 (TPP) and €13,809 (DCP). Sensitivity analyses demonstrated that cost-effectiveness was stable, but was most sensitive to the discount rate used for costs and benefits.Conclusions:Considering the commonly accepted threshold of €50,000 per QALY, these analyses support the fact that adding a quadrivalent HPV vaccine to the current screening program in France is a cost-effective strategy for reducing the burden of cervical cancer, precancerous lesions, and genital warts caused by HPV types 6, 11, 16, and 18.

Download Full-text

Dynamics of High-Risk Nonvaccine Human Papillomavirus Types after Actual Vaccination Scheme

Computational and Mathematical Methods in Medicine ◽

10.1155/2014/542923 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Raúl Peralta ◽

Cruz Vargas-De-León ◽

Augusto Cabrera ◽

Pedro Miramontes

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

High Risk ◽

Numerical Simulations ◽

Protective Immunity ◽

Type Model ◽

Vaccination Scheme ◽

Hpv Types ◽

High Risk Hpv ◽

The Impact

Human papillomavirus (HPV) has been identified as the main etiological factor in the developing of cervical cancer (CC). This finding has propitiated the development of vaccines that help to prevent the HPVs 16 and 18 infection. Both genotypes are associated with 70% of CC worldwide. In the present study, we aimed to determine the emergence of high-risk nonvaccine HPV after actual vaccination scheme to estimate the impact of the current HPV vaccines. A SIR-type model was used to study the HPV dynamics after vaccination. According to the results, our model indicates that the application of the vaccine reduces infection by target or vaccine genotypes as expected. However, numerical simulations of the model suggest the presence of the phenomenon called vaccine—induced pathogen strain replacement. Here, we report the following replacement mechanism: if the effectiveness of cross-protective immunity is not larger than the effectiveness of the vaccine, then the high-risk nonvaccine genotypes emerge. In this scenario, further studies of infection dispersion by HPV are necessary to ascertain the real impact of the current vaccines, primarily because of the different high-risk HPV types that are found in CC.

Download Full-text

Prevalence of Human Papillomavirus (HPV) infection in women living in remote riverine communities in the Amazonas, Brazil

10.21203/rs.2.12030/v1 ◽

2019 ◽

Author(s):

Marco Antonio Zonta ◽

Karina Bonilha Roque ◽

Yara Juliano ◽

Anne Liljander ◽

Markus Cavalar ◽

...

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Hpv Infection ◽

Public Health Services ◽

Cervical Lesions ◽

Transmitted Infection ◽

Sexually Transmitted ◽

Remote Areas ◽

Hpv Types ◽

Crucial Part

Abstract Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide. Since some HPV types are associated with the development of cervical cancer, routine screening for HPV plays a crucial part in cancer prevention programs at global level. In Brazil, the cervical cancer rate is among the highest in the world, in particular in indigenous women living in remote areas with limited access to public health services. The objective of this study was to determine the prevalence of HPV infections and their co-occurrence with cervical lesions in Brazilian women living in isolated riverine communities. Moreover, the association between social environment, sexual activity and prevalence of HPV infection was assessed.

Download Full-text