title: The potential impact of HPV-16 reactivation on prevalence in older Australians.
abstract: BACKGROUND
  Some regional cross-sectional human papillomavirus (HPV) DNA prevalence data show an increase in prevalence in older women, the reasons for which are as yet unknown. A recently published study suggests that the increase may be at least partly due to reactivation of latent HPV in menopausal women.
  
  
  METHODS
  We developed a dynamic mathematical model of HPV-16 transmission to estimate the key consequences of hypothetical HPV-16 reactivation in the Australian heterosexual population. We only consider a worst case scenario with regard to reactivation in the Australian setting when all women who are latently infected reactivate and, wherever feasible, we choose model parameter values which may lead to a more pronounced reactivation. The ongoing National HPV vaccination program covering both women and men is incorporated in the model.
  
  
  RESULTS
  We estimate that about 1 in 10 women and men who appear to have cleared HPV-16 infection may be latently infected. The prevalence of HPV-16 in older Australian women will increase by a factor of up to 3.1 between now and 2025 which will be accompanied by an increase by a factor of around 1.9 in older men. However, the long-term impact of the HPV vaccination is not significantly altered by reactivation.
  
  
  CONCLUSIONS
  If the reactivation hypothesis we consider is substantiated, the public health response should be focused on further improvement of cervical screening coverage for older women. Our study also highlights the urgent need for surveillance of HPV prevalence in older Australians.
authors.affiliation: The Kirby Institute, University of New South Wales, 2052 Sydney, Australia. ikorostil@kirby.unsw.edu.au.
authors.forename: Igor A
authors.initials: IA
authors.lastname: Korostil
authors.forename: David G
authors.initials: DG
authors.lastname: Regan
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D052162:Human papillomavirus 16 / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission / Q000821:virology; D053918:Papillomavirus Vaccines; D015995:Prevalence; D014775:Virus Activation; D017735:Virus Latency; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines