Review article
Age-Specific Human Papillomavirus Antibody and Deoxyribonucleic Acid Prevalence: A Global Review

https://doi.org/10.1016/j.jadohealth.2011.10.010Get rights and content

Abstract

Purpose

Global data on human papillomavirus (HPV) serological and deoxyribonucleic acid (DNA) prevalence are essential to optimize HPV prophylactic vaccination strategies.

Methods

We conducted a global review of age-specific HPV antibody and studies with both antibody and DNA prevalence for HPV-16, −18, −6, and −11.

Results

One hundred seventeen studies were included; participants' ages ranged from several hours to >90 years. HPV-16 seroprevalence was generally higher in Africa, Central and South America, and North America, more prevalent among women than among men, and peaked around ages 25–40 years. HPV-18 seroprevalence was generally lower than HPV-16 with a later age peak. Data were limited for HPV-6 and −11, both of which peaked at ages similar to HPV-18. Among 9–26-year-old females, HPV-16 seroprevalence ranged from 0%–31% in North America, 21%–30% in Africa, 0%–23% in Asia/Australia, 0%–33% in Europe, and 13%–43% in Central and South America. HPV-16/-18 DNA prevalence peaked 10–15 years before corresponding HPV-16/-18 antibody prevalence.

Conclusions

Females within the HPV vaccine-eligible age-group (9–26 years) had a range of dual HPV-16 DNA and serology negativity from 81%–87%, whereas 90%–98% were HPV-16 DNA negative. Serology and DNA data are lacking worldwide for females younger than age 15 years, the prime target group for vaccination.

Section snippets

Material reviewed

We conducted a global review by searching MEDLINE for articles published through September 2010. To identify published articles on HPV serology, we used the following search terms: human papillomavirus, human, serology, serologic tests, antibodies, and immunology. For articles with HPV DNA and serology within the same population, we used the same search terms plus DNA. References cited in identified articles were also reviewed. Eligible studies were restricted to peer-reviewed articles with

Serology results

Of more than 2,000 identified abstracts, 117 studies were included in this review (Table 1). Most study populations were from Europe (35%), followed by North America (27%), Asia and Australia (19%), Central and South America (8%), and Africa (6%). Study participants' ages ranged from a few hours to >90 years. Serological antibodies were typically detected with enzyme-linked immunosorbent assay (ELISA) (78%), whereas competitive Luminex assay (12%), glutathione S-transferase capture assay (9%),

Discussion

This review of more than 138,000 study participants worldwide found that HPV seroprevalence was variable and depended on many factors, including geographic location, gender, and age. These differences across studies are consistent with broad ranges of HPV-16 and −18 seroprevalence and DNA prevalence previously observed [28], [85], [87], [116]. Both HPV-16 and −18 seroprevalences were generally higher in Africa, Central and South America, and North America; and lower in Europe, Asia, and

Summary and implications

Several important points can be drawn from this global review. Seroprevalence and DNA prevalence of oncogenic HPV types were globally more common in women than in men and had distinguishable age trends but varied by geographic region. Using HPV serology data, a measure of cumulative exposure, along with HPV DNA data, a measure of acute infection, can contribute to estimating HPV virus exposure on a population level, which is important for vaccine program implementation. Within the 9–26-year-old

Acknowledgments

This work was supported in part by the National Institutes of Health, Office of the Director, Fogarty International Center, Office of AIDS Research, National Cancer Centre, National Eye Institute, National Heart, Blood and Lung Institute, National Institute of Dental and Craniofacial Research, National Institute on Drug Abuse, National Institute of Mental Health, National Institute of Allergy and Infectious Diseases Health, and NIH Office of Women's Health and Research through the International

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    J.S. Smith has received research grants, honoraria, or consultancy fees from GSK or Merck within the last 5 years. No other authors on this manuscript have any conflicts of interest related to this work. A GlaxoSmithKline representative read the article before submission for publication but had no role in study design, analysis of data, or the decision to submit the manuscript for publication. The first draft of the manuscript was jointly written by J. Ji, M.J. Lin, and S.M. Tiggelaar.

    1

    S.M. Tiggelaar and M.J. Lin contributed equally and are co-first authors.

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