Totten S, Severini A, Jayaraman G C, Faybush S T, Johnson G, Demers A A, Sobol I, Mao Y, Wong T
Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON.
National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB.
Can Commun Dis Rep. 2015 Mar 5;41(3):43-51. doi: 10.14745/ccdr.v41i03a01.
To determine the prevalence and distribution of type-specific human papillomavirus (HPV) infections and their association with cytological outcomes in women living in the Canadian territory of Nunavut.
Surveillance of type-specific HPV infection was conducted. Cervical specimens of all Inuit, First Nations and non-Aboriginal women in Nunavut who presented for a Pap test in any clinical setting between January 2008 and March 2009 were tested for HPV infection. The association between high-grade cervical lesions and HPV type was also examined.
HPV results were available for 4,043 individual women (13 to 77 years). Of those with known ethnicity (N=4,033), 89.2% were Inuit, 0.4% were First Nations and 10.4% were non-Aboriginal. First Nations women were included in all analyses except those making comparisons by ethnicity, due to the small number of individuals in this group. Overall, 29.9% of women were found to be infected with HPV (any type) and 19.9% with any high-risk HPV (type 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58 or 59). Most often, women were infected with HPV 16 (6.4%) followed by HPV 31 (3.1%). There were no statistically significant differences between Inuit and non-Aboriginal (reference group) women 20 years of age and older regarding the prevalence of any HPV (odds ratios (OR): 1.19, 95% confidence intervals (CI): 0.92-1.54), high-risk HPV (OR: 1.06, 95% CI: 0.78-1.44) or HPV 16 and 18 (OR: 0.81, 95% CI: 0.51-1.27). HPV 31 was the only type that was significantly more frequent among Inuit than non-Aboriginal women (OR: 3.95, 95% CI: 1.24-12.54). There was no difference in the overall occurrence of cervical abnormalities between non-Aboriginal and Inuit women (p-value = 0.17). HPV 16 was strongly associated with cervical dysplasia, being present in 50.9% of specimens with a high-grade lesion.
HPV is a significant public health issue in the territory of Nunavut. The findings presented in this article are similar to those in other studies among Inuit women, with prevalence of HPV being higher than in studies conducted among non-Inuit women in other regions of Canada. These results provide a baseline of HPV prevalence that precedes the introduction of the Nunavut HPV Immunization Program in 2010 and will allow for future evaluation. The high prevalence of HPV infection among women living in Nunavut can be reduced through immunization and associated high-grade cervical abnormalities mitigated by regular cervical screening.
确定居住在加拿大努纳武特地区的女性中特定类型人乳头瘤病毒（HPV）感染的患病率、分布情况及其与细胞学检查结果的关联。
开展特定类型HPV感染监测。对2008年1月至2009年3月期间在努纳武特地区任何临床环境中接受巴氏试验的所有因纽特人、第一民族和非原住民女性的宫颈样本进行HPV感染检测。还检查了高级别宫颈病变与HPV类型之间的关联。
4043名个体女性（13至77岁）的HPV检测结果可用。在已知种族的女性中（N = 4033），89.2%为因纽特人，0.4%为第一民族，10.4%为非原住民。由于该组个体数量较少，除按种族进行比较的分析外，第一民族女性被纳入所有分析。总体而言，29.9%的女性被发现感染了HPV（任何类型），19.9%感染了任何高危型HPV（16、18、31、33、35、39、45、51、52、56、58或59型）。女性最常感染的是HPV 16（6.4%），其次是HPV 31（3.1%）。20岁及以上的因纽特女性与非原住民（参照组）女性在任何HPV的患病率（优势比（OR）：1.19，95%置信区间（CI）：0.92 - 1.54）、高危型HPV（OR：1.06，95%CI：0.78 - 1.44）或HPV 16和18（OR：0.81，95%CI：0.51 - 1.27）方面无统计学显著差异。HPV 31是唯一在因纽特女性中比非原住民女性更常见的类型（OR：3.95，95%CI：1.24 - 12.54）。非原住民女性和因纽特女性在宫颈异常的总体发生率上无差异（p值 = 0.17）。HPV 16与宫颈发育异常密切相关，在50.9%的高级别病变样本中存在。
HPV是努纳武特地区一个重要的公共卫生问题。本文呈现的研究结果与其他针对因纽特女性的研究相似，HPV患病率高于在加拿大其他地区非因纽特女性中开展的研究。这些结果为2010年努纳武特HPV免疫接种计划实施之前的HPV患病率提供了基线，并将有助于未来的评估。通过免疫接种可降低居住在努纳武特地区女性中HPV的高感染率，并通过定期宫颈筛查减轻相关的高级别宫颈异常情况。
