title: Human papillomavirus infection in Bhutan at the moment of implementation of a national HPV vaccination programme.
abstract: BACKGROUND
  Cervical cancer is the most common female cancer in Bhutan, the first low/middle-income country to implement a national human papillomavirus (HPV) vaccination programme.
  
  
  METHODS
  To provide a robust baseline for future evaluations of vaccine effectiveness, cervical cell specimens were obtained from 2,505 women aged 18-69 years from the general population, and biopsies from 211 cervical intraepithelial neoplasia grade 3 (CIN3) and 112 invasive cervical cancer (ICC) cases. Samples were tested for HPV using GP5+/6+ PCR.
  
  
  RESULTS
  Among the general population, HPV prevalence was 26%, being highest (33%) in women ≤24 years, but remaining above 15% in all age-groups. Determinants of HPV included age, marital status, and number of sexual partners. Among the eight percent with cytological abnormalities, 24 CIN3 and 4 ICC were histologically confirmed. Even after additional testing with a sensitive E7 PCR, no infections with vaccine-targeted HPV types were detected in the few vaccinated women (n = 34) compared to 6% prevalence in unvaccinated women of similar age (p = 0 · 215).
  
  
  CONCLUSIONS
  Based upon type-specific prevalence among biopsies, at least 70% of ICC in Bhutan are theoretically preventable by HPV16/18 vaccination, but screening programmes should be expanded among older women, who have an important underlying burden of CIN3 and ICC.
authors.forename: Ugyen
authors.initials: U
authors.lastname: Tshomo
authors.forename: Silvia
authors.initials: S
authors.lastname: Franceschi
authors.forename: Dorji
authors.initials: D
authors.lastname: Dorji
authors.forename: Iacopo
authors.initials: I
authors.lastname: Baussano
authors.forename: Vanessa
authors.initials: V
authors.lastname: Tenet
authors.forename: Peter J F
authors.initials: PJ
authors.lastname: Snijders
authors.forename: Chris J L M
authors.initials: CJ
authors.lastname: Meijer
authors.forename: Maaike C G
authors.initials: MC
authors.lastname: Bleeker
authors.forename: Tarik
authors.initials: T
authors.lastname: Gheit
authors.forename: Massimo
authors.initials: M
authors.lastname: Tommasino
authors.affiliation: International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon, cedex 08, France. clifford@iarc.fr.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Clifford
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001631:Bhutan / Q000453:epidemiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D009313:National Health Programs; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000517:prevention & control*; D053918:Papillomavirus Vaccines; D015995:Prevalence; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology; D014611:Vaccination; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines