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Study Finds HPV Infection Common in U.S.

February 27, 2007

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Results of a national study suggest that about one in four U.S. females between the ages of 14 and 59 years may have the sexually transmitted infection human papillomarivus (HPV), according to the February 28 issue of JAMA.

Human papillomavirus is estimated to be the most common sexually transmitted infection in the United States. However, there have been no data on the prevalence of HPV among women across a broad age range and representative of the U.S. population.

High-risk HPV types can cause cervical, anal, and other genital cancers. High-risk HPV types are detected in 99 percent of cervical cancers, and worldwide approximately 70 percent of cervical cancers are due to HPV types 16 and 18, according to background information in the article.

A highly effective vaccine against HPV types 6, 11, 16, and 18 was licensed in June 2006 and recommended for routine use in females age 11 to 12 years in the United States but has run into opposition from those who say it would encourage sexual activity.

Data on type-specific prevalence of HPV in the United States could help measure the effectiveness of the vaccine for reducing infection and could help evaluate its impact and cost effectiveness.

Eileen F. Dunne, M.D., M.P.H., of the Centers for Disease Control and Prevention (CDC), Atlanta, and colleagues estimated the prevaccine prevalence of HPV in the U.S. by performing HPV DNA testing on 2,026 self-collected vaginal swabs among females age 14 to 59 years participating in the National Health and Nutrition Examination Survey (NHANES) 2003-2004.

Of the 1,921 adequate specimens, 26.8 percent were positive for any HPV DNA. Using January 2004 population estimates and extrapolating this prevalence rate to the population, the authors estimate that approximately 24.9 million females in this age range have prevalent HPV infection.

Prevalence of any HPV infection was highest among females age 20 to 24 years (44.8 percent); overall HPV prevalence among females age 14 to 24 years was 33.8 percent. This prevalence corresponds with 7.5 million females with HPV infection, which is higher than the previous estimate of 4.6 million HPV infections among females in this same age group in the United States.

There was a significant trend for increasing HPV prevalence with each year of age from 14 to 24 years, followed by a gradual decline in HPV prevalence through 59 years. Independent risk factors for HPV detection were age, marital status and increasing numbers of lifetime and recent sex partners.

Overall, HPV types 6, 11, 16, or 18 were detected in 3.4 percent of the study participants, corresponding with 3.1 million females with prevalent infection with HPV types included in the quadrivalent HPV vaccine.

"Our study provides the first national estimate of prevalent HPV infection among females aged 14 to 59 years in the United States," the authors write. "Our data indicate that the burden of prevalent HPV infection among women was higher than previous estimates."

In an accompanying editorial, Susan C. Weller, Ph.D., and Lawrence R. Stanberry, M.D., Ph.D., of the University of Texas Medical Branch, Galveston note that the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices has provisionally recommended the HPV vaccine for adolescent girls between the ages of 11 and 12 years with catch-up vaccination for those between 13 and 26 years.

The two say they believe more information is needed about the prevalence of HPV-16/18 in women older than 26 years to help determine whether women in this age group would benefit from immunization. Follow-up prevalence studies, they say, will be important not only to evaluate vaccine effectiveness but also to address the question of whether other high-risk oncogenic [causing tumors] HPV types will fill the ecological niche created by the expected decline in HPV-16 and HPV-18.

"Studies of cost-effectiveness of the vaccine have used HPV prevalence estimates from selected populations, including some outside the United States. Now it will be important to assess the cost-effectiveness of the vaccine using these new prevalence data from U.S. females," they conclude.

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