Li Ka Shing Knowledge Institute, St Michael's Hospital, (38 Shuter Street), Toronto, Ontario, (M5B 1T8), Canada.
BMC Infect Dis. 2011 Sep 5;11:235. doi: 10.1186/1471-2334-11-235.
Oncogenic human papillomavirus (HPV) infection prevalence is required to determine optimal vaccination strategies. We systematically reviewed the prevalence of oncogenic cervical HPV infection among Canadian females prior to immunization.
We included studies reporting DNA-confirmed oncogenic HPV prevalence estimates among Canadian females identified through searching electronic databases (e.g., MEDLINE) and public health websites. Two independent reviewers screened literature results, abstracted data and appraised study quality. Prevalence estimates were meta-analyzed among routine screening populations, HPV-positive, and by cytology/histology results.
Thirty studies plus 21 companion reports were included after screening 837 citations and 120 full-text articles. Many of the studies did not address non-response bias (74%) or use a representative sampling strategy (53%). Age-specific prevalence was highest among females aged < 20 years and slowly declined with increasing age. Across all populations, the highest prevalence estimates from the meta-analyses were observed for HPV types 16 (routine screening populations, 8 studies: 8.6% [95% confidence interval 6.5-10.7%]; HPV-infected, 9 studies: 43.5% [28.7-58.2%]; confirmed cervical cancer, 3 studies: 48.8% [34.0-63.6%]) and 18 (routine screening populations, 8 studies: 3.3% [1.5-5.1%]; HPV-infected, 9 studies: 13.6% [6.1-21.1%], confirmed cervical cancer, 4 studies: 17.1% [6.4-27.9%].
Our results support vaccinating females < 20 years of age, along with targeted vaccination of some groups (e.g., under-screened populations). The highest prevalence occurred among HPV types 16 and 18, contributing a combined cervical cancer prevalence of 65.9%. Further cancer protection is expected from cross-protection of non-vaccine HPV types. Poor study quality and heterogeneity suggests that high-quality studies are needed.
为了确定最佳的疫苗接种策略，需要确定致癌人乳头瘤病毒（HPV）感染的流行率。我们系统地回顾了加拿大女性在免疫接种前致癌宫颈 HPV 感染的流行率。
我们纳入了通过搜索电子数据库（如 MEDLINE）和公共卫生网站，报告了加拿大女性中通过 DNA 确认的致癌 HPV 流行率估计的研究。两名独立的审查员筛选文献结果，提取数据并评估研究质量。在常规筛查人群、HPV 阳性人群和细胞学/组织学结果中对流行率估计值进行了荟萃分析。
经过筛选 837 条引文和 120 篇全文文章后，有 30 项研究和 21 份相关报告被纳入。许多研究没有解决非应答偏倚（74%）或使用代表性抽样策略（53%）。在所有人群中，年龄在<20 岁的女性中，年龄特异性流行率最高，并且随着年龄的增长而缓慢下降。在所有人群中，荟萃分析中观察到的最高流行率估计值是 HPV 类型 16（常规筛查人群，8 项研究：8.6%[95%置信区间 6.5-10.7%]；HPV 感染，9 项研究：43.5%[28.7-58.2%]；确诊宫颈癌，3 项研究：48.8%[34.0-63.6%]）和 18（常规筛查人群，8 项研究：3.3%[1.5-5.1%]；HPV 感染，9 项研究：13.6%[6.1-21.1%]，确诊宫颈癌，4 项研究：17.1%[6.4-27.9%]。
我们的结果支持对<20 岁的女性进行疫苗接种，并对某些人群（例如，筛查不足的人群）进行有针对性的疫苗接种。最高的流行率发生在 HPV 类型 16 和 18 中，导致宫颈癌的总流行率为 65.9%。非疫苗 HPV 类型的交叉保护有望进一步提供癌症保护。研究质量差和异质性表明需要高质量的研究。
