意大利细胞学正常的年轻女性中人类乳头瘤病毒的流行率：我们应该如何调整国家疫苗接种政策？
Prevalence of human papillomavirus in young Italian women with normal cytology: how should we adapt the national vaccination policy?
机构信息
Department of Health Sciences, Genoa University, Via Pastore, 1, Genoa 16132, Italy.
出版信息
BMC Infect Dis. 2013 Dec 6;13:575. doi: 10.1186/1471-2334-13-575.
BACKGROUND
Human Papillomavirus (HPV) is the most common sexually transmitted infection. In Italy, HPV vaccination is now offered free of charge to 12-year-old females. However, some regional health authorities have extended free vaccination to other age-groups, especially to girls under 18 years of age. We conducted a multicentre epidemiological study to ascertain the prevalence of different genotypes of HPV in young Italian women with normal cytology, with the aim of evaluating the possibility of extending vaccination to older females.
METHODS
The study was performed in 2010. Women aged 16-26 years with normal cytology were studied. Cervical samples were analyzed to identify the presence of HPV by PCR amplification of a segment of ORF L1 (450 bp). All positive HPV-DNA samples underwent viral genotype analysis by means of a restriction fragment length polymorphism assay.
RESULTS
Positivity for at least one HPV genotype was found in 18.2% of the 566 women recruited: 48.1% in the 16-17 age-class, 15.4 in the 18-20 age-class, 21.9% in the 21-23 age-class, and 15.5% in the 24-26 age-class; 10.1% of women were infected by at least one high-risk HPV genotype. HPV-16 was the most prevalent genotype. Only 4 (0.7%), 4 (0.7%) and 3 (0.5%) women were infected by HPV-18, HPV-6 and HPV-11, respectively. Of the HPV-DNA-positive women, 64.1% presented only one viral genotype, while 24.3% had multiple infections. The HPV genotypes most often involved in multiple infections were high-risk. A high prevalence was noted in the first years of sexual activity (48.1% of HPV-DNA-positive women aged 16-17 years); HPV prevalence subsequently declined and stabilized.The estimate of cumulative proportions of young women free from any HPV infection at each age was evaluated; 93.3% and 97.1% of 26 year-old women proved free from HPV-16 and/or HPV-18 and from HPV-6 and/or HPV-11, respectively.
CONCLUSIONS
Our findings confirm the crucial importance of conducting studies on women without cytological damage, in order to optimise and up-date preventive interventions against HPV infection, and suggest that vaccinating 26-year-old females at the time of their first pap-test is to be recommend, though this issue should be further explored.
背景
人乳头瘤病毒（HPV）是最常见的性传播感染。在意大利，HPV 疫苗已免费提供给 12 岁的女性。然而，一些地区卫生当局已经将免费接种扩大到其他年龄组，尤其是 18 岁以下的女孩。我们进行了一项多中心流行病学研究，以确定年轻意大利女性细胞学正常者中 HPV 的不同基因型的流行率，目的是评估是否可以将疫苗接种扩大到年龄较大的女性。
方法
该研究于 2010 年进行。研究对象为细胞学正常的 16-26 岁女性。通过 ORF L1 片段（450bp）的 PCR 扩增来检测 HPV 的存在。对所有 HPV-DNA 阳性样本进行病毒基因型分析，采用限制性片段长度多态性分析。
结果
在招募的 566 名女性中，至少有一种 HPV 基因型阳性的比例为 18.2%：16-17 岁年龄组为 48.1%，18-20 岁年龄组为 15.4%，21-23 岁年龄组为 21.9%，24-26 岁年龄组为 15.5%；10.1%的女性感染了至少一种高危 HPV 基因型。HPV-16 是最常见的基因型。分别只有 4（0.7%）、4（0.7%）和 3（0.5%）名女性感染 HPV-18、HPV-6 和 HPV-11。在 HPV-DNA 阳性的女性中，64.1%只存在一种病毒基因型，而 24.3%存在多重感染。多重感染中最常见的 HPV 基因型为高危型。在性活跃的最初几年中，HPV 的流行率较高（16-17 岁 HPV-DNA 阳性女性的 48.1%）；随后 HPV 的流行率下降并稳定下来。评估了各年龄组无 HPV 感染的年轻女性累积比例；26 岁女性中，93.3%和 97.1%分别无 HPV-16 和/或 HPV-18 以及 HPV-6 和/或 HPV-11 感染。
结论
我们的研究结果证实了对细胞学无损伤的女性进行研究的重要性，以优化和更新针对 HPV 感染的预防干预措施，并建议在首次巴氏涂片检查时为 26 岁女性接种疫苗，尽管这一问题需要进一步探讨。
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