Cervical intraepithelial neoplasia grade 2 or worse in Galicia, Spain: HPV 16 prevalence and vaccination impact / Neoplasia intraepitelial cervical de grado 2 o peor en Galicia (España): prevalencia de HPV 16 e impacto vacunal

INTRODUCTION: The etiology of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) can influence the efficacy of Public Health preventive strategies. This study aimed to determine the high-risk papillomavirus (HR-HPV) prevalence in CIN2+ cases in unvaccinated women in Galicia (Spain), the expected impact of bivalent vaccination, and the distribution of HPV 16 in squamous lesions. MATERIAL AND METHODS: Ninety-four histologically confirmed cases of CIN2+ (2009-2010) were retrospectively studied: 23 CIN2, 58 CIN3− squamous carcinoma in situ (CIN3-CIS), 5 adenocarcinoma in situ (AIS), and 8 invasive squamous cervical cancer (SCC). Linear Array HPV Genotyping Test (Roche Diagnostics, Mannheim, Germany) was performed on the cervical specimens. Bivalent vaccination impact was calculated, based on regional vaccination coverage data, local HR-HPV prevalence, and reported efficacy (direct and cross-protection) of the vaccine. RESULTS: HR-HPV prevalence was 96.8%. The most frequent genotypes were HPV 16 (48.8-58.2%) and HPV 31 (9.3%-12.1%), considering single infections or single-multiple infections, respectively (hierarchical attribution). In squamous lesions, HPV 16 prevalence in women younger than 45 years of age increased in severe lesions (CIN3-CIS/SCC, OR 4.2), and was higher than in older women (OR 5.5). The vaccine could reduce the cumulative incidence of CIN2+ by 50.6% (direct protection), or by 62.7% (direct and cross-protection). CONCLUSION: HPV vaccination could have a great impact in women younger than 45 years of age due to the high prevalence of HPV 16 in their lesions

INTRODUCCIÓN: La etiología de la neoplasia intraepitelial cervical de grado 2 o peor (CIN2+) influirá en la eficacia de las estrategias preventivas de Salud Pública. Se pretende conocer la prevalencia de papilomavirus de alto riesgo (VPH-AR) en CIN2+ en mujeres no vacunadas en Galicia (España), el impacto esperado de la vacunación bivalente y la distribución del VPH 16 en lesiones escamosas. MATERIAL Y MÉTODOS: Se estudiaron retrospectivamente 94 casos confirmados histológicamente de CIN2+ (2009-2010): 23 CIN2, 58 CIN3- carcinoma escamoso in situ (CIN3-CIS), 5 adenocarcinoma in situ (AIS) y 8 carcinoma escamoso invasivo (CES). Se utilizó Linear Array VPH Genotyping Test (Roche Diagnostics, Mannheim, Alemania) en muestras cervicales. El impacto de la vacunación se calculó según la cobertura vacunal autonómica, la prevalencia local de VPH-AR y datos publicados de eficacia (protección directa y cruzada). RESULTADOS: La prevalencia de VPH-AR fue del 96,8%. Los genotipos más frecuentes fueron HPV 16 (48,8-58,2%) y HPV 31 (9,3-12,1%) considerando infecciones simples o infecciones simples-múltiples, respectivamente (atribución jerárquica). En lesiones escamosas, la prevalencia de VPH 16 en mujeres de hasta 45 años aumentó con la severidad de las lesiones (CIN3-CIS/CES; OR 4,2) y fue mayor que en las mujeres mayores (OR 5,5). La vacuna podría reducir la incidencia acumulada de CIN2+ un 50,6% (protección directa) o un 62,7% (protección directa y cruzada). CONCLUSIÓN: La vacunación frente al VPH podría tener un gran impacto en mujeres menores de 45 años debido a la alta prevalencia de VPH 16 en las lesiones que presentan

Cervical intraepithelial neoplasia grade 2 or worse in Galicia, Spain: HPV 16 prevalence and vaccination impact.

INTRODUCTION: The etiology of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) can influence the efficacy of Public Health preventive strategies. This study aimed to determine the high-risk papillomavirus (HR-HPV) prevalence in CIN2+ cases in unvaccinated women in Galicia (Spain), the expected impact of bivalent vaccination, and the distribution of HPV 16 in squamous lesions. MATERIAL AND METHODS: Ninety-four histologically confirmed cases of CIN2+ (2009-2010) were retrospectively studied: 23 CIN2, 58 CIN3- squamous carcinoma in situ (CIN3-CIS), 5 adenocarcinoma in situ (AIS), and 8 invasive squamous cervical cancer (SCC). Linear Array HPV Genotyping Test (Roche Diagnostics, Mannheim, Germany) was performed on the cervical specimens. Bivalent vaccination impact was calculated, based on regional vaccination coverage data, local HR-HPV prevalence, and reported efficacy (direct and cross-protection) of the vaccine. RESULTS: HR-HPV prevalence was 96.8%. The most frequent genotypes were HPV 16 (48.8-58.2%) and HPV 31 (9.3%-12.1%), considering single infections or single-multiple infections, respectively (hierarchical attribution). In squamous lesions, HPV 16 prevalence in women younger than 45 years of age increased in severe lesions (CIN3-CIS/SCC, OR 4.2), and was higher than in older women (OR 5.5). The vaccine could reduce the cumulative incidence of CIN2+ by 50.6% (direct protection), or by 62.7% (direct and cross-protection). CONCLUSION: HPV vaccination could have a great impact in women younger than 45 years of age due to the high prevalence of HPV 16 in their lesions.