Epidemiologic Evaluation of Human Papillomavirus Type Competition and the Potential for Type Replacement Post-Vaccination.
Epidemiologic Evaluation of Human Papillomavirus Type Competition and the Potential for Type Replacement Post-Vaccination.
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人类乳头瘤病毒类型竞争的流行病学评估和疫苗接种后类型替代的潜力。
DOI：
10.1371/journal.pone.0166329
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Franco EL
中科院分区：
文献类型：
--
作者：
Tota JE;Jiang M;Ramanakumar AV;Walter SD;Kaufman JS;Coutlée F;Richardson H;Burchell AN;Koushik A;Mayrand MH;Villa LL;Franco EL
数百万女性已接种两种第一代人乳头瘤病毒 (HPV) 疫苗中的一种。这两种疫苗仍在使用，并针对两种致癌类型（HPV 16 和 18）；然而，如果这些类型自然地与其他非目标类型竞争，则随着目标类型的流行率降低，可能会发生类型替换。为了探索类型替换的潜力，我们评估了未接种疫苗的女性中 HPV 类型的自然竞争。有效的 HPV DNA 分型信息来自于加拿大和巴西进行的五项流行病学研究（n = 14,685；各研究的入组时间为 1993 年至 2010 年），这些研究使用类似的共识引物 PCR 检测，能够检测多达 40 种 HPV 类型。总共 38,088 份子宫颈阴道样本可纳入我们的分析中，评估涉及疫苗靶向类型（6、11、16 和 18）的 HPV 类型间相互作用，以及与其他 HPV 类型的感染。在所有研究中，参与者的平均年龄从 21.0 岁到 43.7 岁不等。 HPV16 是最常见的类型（患病率范围：1.0% 至 13.8%），一般来说，与单一感染相比，HPV 类型更有可能作为多重感染的一部分被检测到。在我们分别针对每种疫苗针对的 HPV 类型进行的分析中，观察到许多显着的正相关性（特别是涉及 HPV16）；然而，我们没有观察到任何统计上显着的负相关。我们的研究结果表明，自然的 HPV 类型竞争并不存在，并且在接种疫苗的人群中不太可能发生类型替换。
Millions of women have been vaccinated with one of two first-generation human papillomavirus (HPV) vaccines. Both vaccines remain in use and target two oncogenic types (HPVs 16 and 18); however, if these types naturally compete with others that are not targeted, type replacement may occur following reductions in the circulating prevalence of targeted types. To explore the potential for type replacement, we evaluated natural HPV type competition in unvaccinated females. Valid HPV DNA typing information was available from five epidemiological studies conducted in Canada and Brazil (n = 14,685; enrollment across studies took place between1993 and 2010), which used similar consensus-primer PCR assays, capable of detecting up to 40 HPV types. A total of 38,088 cervicovaginal specimens were available for inclusion in our analyses evaluating HPV type-type interactions involving vaccine-targeted types (6, 11, 16, and 18), and infection with each of the other HPV types. Across the studies, the average age of participants ranged from 21.0 to 43.7 years. HPV16 was the most common type (prevalence range: 1.0% to 13.8%), and in general HPV types were more likely to be detected as part of a multiple infection than as single infections. In our analyses focusing on each of the vaccine-targeted HPV types separately, many significant positive associations were observed (particularly involving HPV16); however, we did not observe any statistically significant negative associations. Our findings suggest that natural HPV type competition does not exist, and that type replacement is unlikely to occur in vaccinated populations.