HPV prevalence and genotype distribution among women in Shandong Province, China: Analysis of 94,489 HPV genotyping results from Shandong’s largest independent pathology laboratory

Abstract

BackgroundData regarding human papillomavirus (HPV) prevalence and genotype distribution are limited in Shandong Province, China. Therefore, we investigated the recent HPV prevalence and genotype distribution among females in Shandong and aimed to provide comprehensive data to guide HPV-based cervical cancer screening and HPV vaccination for this population of Chinese women.MethodsHPV testing results of 94,489 females were retrospectively reviewed and extracted from the database of Jinan KingMed Diagnostics, the largest independent pathology laboratory in Shandong Province, China. HPV was detected by a HPV genotyping panel from January 2011 to June 2017. The overall prevalence, age-specific prevalence, and genotype distribution were analyzed.ResultsA total of 26,839 cases (28.4%) were HPV-positive, with 4.3% positive for low- or undetermined-risk HPV (lr-/urHPV)-only, 18.1% positive for high-risk HPV (hrHPV)-only, and 6.1% positive for mixed lr-/urHPV and hrHPV infections. Single HPV infections accounted for 62.8%, while the rest were multiple HPV infections of two or more genotypes. HPV16 (5.8%), HPV52 (5.1%), HPV58 (3.5%), HPV51 (2.6%), and HPV56 (2.3%) were the five most common hrHPV genotypes; while HPV81 (2.8%), HPV53 (2.8%), and HPV6 (2.3%) were the three most common lr-/urHPV genotypes. HPV18 (1.7%) was only the ninth most common hrHPV genotype. HPV16 but not HPV52 was more common in single infections than in multiple infections. The distribution of both mixed lr-/urHPV and hrHPV as well as overall HPV infections demonstrated a bimodal pattern across age groups, of which the first peak appeared in the younger group and the second peak was found in older women. A similar age-specific distribution was observed in multiple infections of three or more subtypes as well. Moreover, the proportion of mixed lr-/urHPV and hrHPV infection significantly increased, while those of lr-/urHPV-only and hrHPV-only infections declined as the number of co-infections increased during the study period.ConclusionThis large daily clinical practice report shows that HPV prevalence and genotype distribution are different in this population, who had limited cervical cancer screening service, compared to those in developed countries. Therefore, different strategies should be developed for HPV-based cervical cancer screening and vaccine-based HPV prevention in Shandong Province.

HPV genotypic spectrum in Jilin province, China, where non-vaccine-covered HPV53 and 51 are prevalent, exhibits a bimodal age-specific pattern

“…HPV infection rate varies between nations and regions. The overall prevalence of HPV (34.4%) among women in our study was higher than that in other regions of China, such as Shanghai (31.84%) [14], Shandong (28.4%) [2], Zhejiang (22.8%) [15], and Jiangxi (22.49%) [16]. Understanding the epidemiological characteristics of HPV infection is of great importance to the development of prevention and control strategies for HPV.…”

“…HPV infection exhibits a distinct tropism for mucosal or cutaneous squamous epithelia, and the position where cancer derives depends on the site of HPV invasion. HPV infection is involved in a series of diseases of the vagina, vulva, penis, and anus, as well as anogenital warts and recurrent respiratory papillomatosis [2]. In 2018, there were estimated to be 570,000 new cases of cervical cancer and 311,000 deaths related to cervical cancer, representing 6.6% of all female cancers; cervical cancer was ranked as the fourth most frequently diagnosed cancer and the fourth leading cause of cancer death in women [2][3][4].…”

Prevalence and genotype distribution of HPV and cervical pathological results in Sichuan Province, China: a three years surveys prior to mass HPV vaccination

“…The HPV infection prevalence vary considerably from geographically to populations. Globally, the highest HPV infection rate is Sub-Saharan (25.6%), South America (14.3%), Asia (8.7%), Europe (5.2%) of women with normal cytology, [6].Even within a country, the HPV infection rate varies., It is 28.4% in northeast china, 20.16% in south China and 14.2% in northwest China [13][14][15]. The prevalence of neighboring southwest provinces is 26.2% in Chonqing, 16.95% in Guizhou, 12.9% in Yunnan [16][17][18].…”

Prevalence and genotype distribution of HPV infection among 214,715 women from Southern China, 2012-2018: baseline measures prior to mass HPV vaccination

“…According to the previous reports, HPV positive rates range from 6.70% to 44.50% in China [11]. Notably, Western Asia (1.70%) and North America (4.70%) had a low rates of HPV infection, while East Africa (33.6%) and the Caribbean (35.4%) had a high rates of HPV infection [17][18][19]. HR-HPV genotype distribution was also heterogeneous, ranging from 9.90%-27.50% in China, which is 15.17% in current study, as with that in Guangdong (20.02%), Guiyang (20.45%) and Nanning (22.28%) [20].…”

“…Evaluations in the United State showed that young women had the highest HPV prevalence [3], consistent with our the ndings of the highest HPV prevalence (33.11%) among women aged less than 21 years. Young women often have a high infection rate, mainly because they are sexually more active before their immune systems become less sensitive [17]. Although they were known to have high risks for HPV infection, however it is temporary and supposed to disappear within a year or two, and thus its prevalence declined gradually with respect to ages [18].…”