人乳头瘤病毒在俄罗斯联邦、前苏联西方国家、高加索地区和中亚的流行情况和型别分布、宫颈癌筛查实践以及疫苗接种实施现状。
Human papillomavirus prevalence and type-distribution, cervical cancer screening practices and current status of vaccination implementation in Russian Federation, the Western countries of the former Soviet Union, Caucasus region and Central Asia.
机构信息
Department of Obstetrics and Gynecology, Russian Medical Academy of Post-graduate Education, Moscow, Russia.
Department of Clinical Laboratory Diagnostics, Russian Medical Academy of Post-graduate Education, Moscow, Russia.
出版信息
Vaccine. 2013 Dec 31;31 Suppl 7:H46-58. doi: 10.1016/j.vaccine.2013.06.043.
Limited data are available on the burden of human papillomavirus (HPV) and its associated diseases in the Russian Federation, the Western Countries of the former Soviet Union (Belarus, Republic of Moldova, Ukraine), the Caucasus region and Central Asia (Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, Uzbekistan). Both the incidence and mortality rate of cervical cancer are higher in these countries than in most Western European countries. In this article, we review available data on HPV prevalence and type distribution in women with normal cytology, women from the general population, cervical precancerous lesions and cervical cancer, as well as data on national policies of cervical cancer screening and HPV vaccination initiatives in these countries. Based on scarce data from the 12 countries, the high-risk HPV (hrHPV) prevalence among 5226 women with normal cytology ranged from 0.0% to 48.4%. In women with low-grade cervical lesions, the hrHPV prevalence among 1062 women varied from 29.2% to 100%. HrHPV infection in 565 women with high-grade cervical lesions ranged from 77.2% to 100% and in 464 invasive cervical cancer samples from 89.8% to 100%. HPV16 was the most commonly detected hrHPV genotype in all categories. As the HPV genotype distribution in cervical diseases seems to be similar to that found in Western Europe the implementation of HPV testing in screening programs might be beneficial. Opportunistic screening programs, the lack of efficient call-recall systems, low coverage, and the absence of quality assured cytology with centralized screening registry are major reasons for low success rates of cervical cancer programs in many of the countries. Finally, HPV vaccination is currently not widely implemented in most of the twelve countries mainly due to pricing, availability, and limited awareness among public and health care providers. Country-specific research, organized nationwide screening programs, registries and well defined vaccination policies are needed. This article forms part of a Regional Report entitled "Comprehensive Control of HPV Infections and Related Diseases in the Central and Eastern Europe and Central Asia Region" Vaccine Volume 31, Supplement 7, 2013. Updates of the progress in the field are presented in a separate monograph entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.
在俄罗斯联邦、前苏联的西方国家(白俄罗斯、摩尔多瓦共和国、乌克兰)、高加索地区和中亚(亚美尼亚、阿塞拜疆、格鲁吉亚、哈萨克斯坦、吉尔吉斯斯坦、塔吉克斯坦、土库曼斯坦、乌兹别克斯坦),人乳头瘤病毒(HPV)及其相关疾病的负担数据有限。这些国家的宫颈癌发病率和死亡率都高于大多数西欧国家。本文综述了这些国家中细胞学正常的妇女、普通人群妇女、宫颈癌前病变和宫颈癌患者中 HPV 流行率和型别分布的现有数据,以及这些国家的宫颈癌筛查国家政策和 HPV 疫苗接种计划的数据。根据 12 个国家的有限数据,5226 例细胞学正常的妇女中高危型 HPV(hrHPV)的流行率为 0.0%至 48.4%。在低级别宫颈病变的 1062 例妇女中,hrHPV 的流行率为 29.2%至 100%。565 例高级别宫颈病变妇女的 hrHPV 感染率为 77.2%至 100%,464 例浸润性宫颈癌样本的感染率为 89.8%至 100%。HPV16 是所有类别中最常见的检出型别。由于宫颈癌疾病中的 HPV 基因型分布似乎与西欧相似,因此在筛查计划中实施 HPV 检测可能有益。机会性筛查计划、缺乏有效的电话召回系统、低覆盖率以及缺乏集中筛查登记处的有质量保证的细胞学检查是许多国家宫颈癌项目成功率低的主要原因。最后,HPV 疫苗接种目前在大多数 12 个国家尚未广泛实施,主要原因是价格、供应以及公众和卫生保健提供者的意识有限。需要进行具体国家的研究,组织全国性的筛查计划、登记处和明确的疫苗接种政策。本文是题为“中东欧和中亚地区 HPV 感染及相关疾病综合控制”的区域报告的一部分,发表于 2013 年疫苗第 31 卷增刊 7。另一篇题为“HPV 感染及相关疾病综合控制”的单独专论介绍了该领域的最新进展,发表于 2012 年疫苗第 30 卷增刊 5。