A cross-sectional study to estimate high-risk human papillomavirus prevalence and type distribution in Italian women aged 18–26 years

BMC Infectious Diseases, Feb 2013

Background Pre-vaccination information on HPV type-specific prevalence in target populations is essential for designing and monitoring immunization strategies for cervical cancer (CC) prevention. Data on HPV prevalence in Italy are available for women over the age of 24 years, target of the population-based CC screening programmes; while data of HPV prevalence in younger ages are very limited. The present study enrolled Italian women aged 18–26 years in order to assess the prevalence and distribution of high-risk (HR) HPV types. Risk-factors correlated with HR-HPV positivity were also described. Methods A sample of 2,289 women was randomly selected from the resident population lists of ten Local Health Units (LHUs) located in six Italian Regions scattered across the country; both rural and urban LHUs were involved. Women aged between 18 and 26 years and living in the selected LHUs were included in the study; pregnant women and women who did not speak Italian were excluded. A total of 1,102 women met the inclusion criteria and agreed to participate. Participants were offered pap test and Hybrid-Capture 2 (HC2) test for HR-HPV types and genotyping was performed on positive smears. Results Out of 1,094 valid samples, 205 (18.7%) were HR-HPV positive. Women with 2–4 (ORadj = 4.15, 95%CI: 2.56-6.72) and ≥5 lifetime partners (ORadj = 10.63, 95%CI: 6.16-18.36) and women who have used any contraceptive in the last six months (ORadj = 1.67, 95%CI: 1.09-2.54) had a higher risk to be infected; women living with their partner had a lower risk (ORadj = 0.56, 95%CI: 0.34-0.92) to acquire infection than women living with parents/friends/alone. Among HC2 positive women, HPV16 was the most prevalent type (30.9%), followed by 31 (19.6%), 66 (12.9%), 51 (11.3%), 18 (8.8%), 56 (8.8%). Co-infections of HR-HC2 targeted types were found in 20.4% of positive samples. The HR-HPV prevalence in women with abnormal cytology (52.4%) was significantly higher than in women with normal cytology (14.6%); however 33.0% of HR-HPV infected women had an abnormal cytology. Conclusion HR-HPV prevalence in Italian women aged 18–26 years was 19%, higher than what detected for older women, by other studies using the same molecular method and laboratory network; this result supports the choice of electing girls before the sexual debut as the primary target of HPV vaccination. The HPV type distribution found in this study may represent a baseline picture; an accurate post-vaccine surveillance is necessary to early detect a possible genotype replacement. The high prevalence of viral types other than vaccine-HPV types supports the necessity to guarantee the progression of CC screening programmes in vaccinated women.

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A cross-sectional study to estimate high-risk human papillomavirus prevalence and type distribution in Italian women aged 18–26 years

Cristina Giambi 0 Serena Donati 0 Francesca Carozzi Stefania Salmaso 0 Silvia Declich 0 Marta L Ciofi degli Atti Guglielmo Ronco Maria P Alibrandi Silvia Brezzi Natalina Collina Daniela Franchi Amedeo Lattanzi Maria C Minna Roberto Nannini Elena Barretta Elena Burroni Anna Gillio-Tos Vincenzo Macallini Paola Pierotti Antonino Bella 0 0 Communicable Disease Epidemiology Unit, National Centre for Epidemiology, Surveillance and Health Promotion; Istituto Superiore di Sanita, Viale Regina Elena 299 , 00161 Rome , Italy Background: Pre-vaccination information on HPV type-specific prevalence in target populations is essential for designing and monitoring immunization strategies for cervical cancer (CC) prevention. Data on HPV prevalence in Italy are available for women over the age of 24 years, target of the population-based CC screening programmes; while data of HPV prevalence in younger ages are very limited. The present study enrolled Italian women aged 1826 years in order to assess the prevalence and distribution of high-risk (HR) HPV types. Risk-factors correlated with HR-HPV positivity were also described. Methods: A sample of 2,289 women was randomly selected from the resident population lists of ten Local Health Units (LHUs) located in six Italian Regions scattered across the country; both rural and urban LHUs were involved. Women aged between 18 and 26 years and living in the selected LHUs were included in the study; pregnant women and women who did not speak Italian were excluded. A total of 1,102 women met the inclusion criteria and agreed to participate. Participants were offered pap test and Hybrid-Capture 2 (HC2) test for HR-HPV types and genotyping was performed on positive smears. Results: Out of 1,094 valid samples, 205 (18.7%) were HR-HPV positive. Women with 2-4 (ORadj = 4.15, 95%CI: 2.566.72) and 5 lifetime partners (ORadj = 10.63, 95%CI: 6.16-18.36) and women who have used any contraceptive in the last six months (ORadj = 1.67, 95%CI: 1.09-2.54) had a higher risk to be infected; women living with their partner had a lower risk (ORadj = 0.56, 95%CI: 0.34-0.92) to acquire infection than women living with parents/friends/alone. Among HC2 positive women, HPV16 was the most prevalent type (30.9%), followed by 31 (19.6%), 66 (12.9%), 51 (11.3%), 18 (8.8%), 56 (8.8%). Co-infections of HR-HC2 targeted types were found in 20.4% of positive samples. The HR-HPV prevalence in women with abnormal cytology (52.4%) was significantly higher than in women with normal cytology (14.6%); however 33.0% of HR-HPV infected women had an abnormal cytology. (Continued on next page) - (Continued from previous page) Conclusion: HR-HPV prevalence in Italian women aged 1826 years was 19%, higher than what detected for older women, by other studies using the same molecular method and laboratory network; this result supports the choice of electing girls before the sexual debut as the primary target of HPV vaccination. The HPV type distribution found in this study may represent a baseline picture; an accurate post-vaccine surveillance is necessary to early detect a possible genotype replacement. The high prevalence of viral types other than vaccine-HPV types supports the necessity to guarantee the progression of CC screening programmes in vaccinated women. Background In the last decade many studies have shown that infection with high-risk (HR) types of human papillomavirus (HPV) is a necessary condition for the development of invasive cervical cancer (CC) [1]. Genital HPV infection is very common in sexually active women and is transient in most cases; only women with persistent infection by HR-HPV types are likely to develop a cervical lesion [2]. These findings led to the development of prophylactic vaccines targeted to provide protection against HPV16 and 18, responsible for the 70% of all cervical cancers; efficacy has been shown to be highest in subjects naf to the infection [3,4]. As of July 2010, 18 European countries had integrated HPV vaccination in their national immunization programmes, most of them targeting pre-adolescent girls; nine countries had also planned catch up programmes for older girls [5]. In Italy HPV vaccination is included in the national immunization program and is offered to 11 year-old girls since 2007 [6]; six of the 21 Italian Regions have also extended the offer to one older birth cohort (varying by Region between 1518 years), and one Region to three cohorts (15, 18 and 24 year-old) [7]. Pre-vaccination distribution of HPV genotypes in target populations is essential for designing, monitoring and evaluating immunization strategies. Baseline prevalence is relevant to estimate vaccine effectiveness against the HPV-vaccine types, to evaluate the cross-protection of the vaccines, and to monitor over time the relative frequency of genotypes under the selective pressure of the vaccines. Data on HPV prevalence in Italy are available for women over the age of 24 years [8-10], target of the pop (...truncated)


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Cristina Giambi, Serena Donati, Francesca Carozzi, Stefania Salmaso, Silvia Declich, Marta L Ciofi degli Atti, Guglielmo Ronco, Maria P Alibrandi, Silvia Brezzi, Natalina Collina, Daniela Franchi, Amedeo Lattanzi, Maria C Minna, Roberto Nannini, Elena Barretta, Elena Burroni, Anna Gillio-Tos, Vincenzo Macallini, Paola Pierotti, Antonino Bella. A cross-sectional study to estimate high-risk human papillomavirus prevalence and type distribution in Italian women aged 18–26 years, BMC Infectious Diseases, 2013, pp. 74, 13, DOI: 10.1186/1471-2334-13-74