title: Attribution of 12 high-risk human papillomavirus genotypes to infection and cervical disease.
abstract: BACKGROUND
  We estimated the prevalence and incidence of 14 human papillomavirus (HPV) types (6/11/16/18/31/33/35/39/45/51/52/56/58/59) in cervicovaginal swabs, and the attribution of these HPV types in cervical intraepithelial neoplasia (CIN), and adenocarcinoma in situ (AIS), using predefined algorithms that adjusted for multiple-type infected lesions.
  
  
  METHODS
  A total of 10,656 women ages 15 to 26 years and 1,858 women ages 24 to 45 years were enrolled in the placebo arms of one of three clinical trials of a quadrivalent HPV vaccine. We estimated the cumulative incidence of persistent infection and the proportion of CIN/AIS attributable to individual carcinogenic HPV genotypes, as well as the proportion of CIN/AIS lesions potentially preventable by a prophylactic 9-valent HPV6/11/16/18/31/33/45/52/58 vaccine.
  
  
  RESULTS
  The cumulative incidence of persistent infection with ≥1 of the seven high-risk types included in the 9-valent vaccine was 29%, 12%, and 6% for women ages 15 to 26, 24 to 34, and 35 to 45 years, respectively. A total of 2,507 lesions were diagnosed as CIN or AIS by an expert pathology panel. After adjusting for multiple-type infected lesions, among women ages 15 to 45 years, these seven high-risk types were attributed to 43% to 55% of CIN1, 70% to 78% of CIN2, 85% to 91% of CIN3, and 95% to 100% of AIS lesions, respectively. The other tested types (HPV35/39/51/56/59) were attributed to 23% to 30% of CIN1, 7% to 14% of CIN2, 3% to 4% of CIN3, and 0% of AIS lesions, respectively.
  
  
  CONCLUSIONS
  Approximately 85% or more of CIN3/AIS, >70% CIN2, and approximately 50% of CIN1 lesions worldwide are attributed to HPV6/11/16/18/31/33/45/52/58.
  
  
  CONCLUSIONS
  If 9-valent HPV vaccination programs are effectively implemented, the majority of CIN2 and CIN3 lesions worldwide could be prevented, in addition to approximately one-half of CIN1.
authors.affiliation: Department of Gynecology and Obstetrics, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria. elmar.joura@meduniwien.ac.at.
authors.forename: Elmar A
authors.initials: EA
authors.lastname: Joura
authors.affiliation: Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Ault
authors.affiliation: Institut Catala d'Oncologia, IDIBELL, Barcelona, Spain.
authors.forename: F Xavier
authors.initials: FX
authors.lastname: Bosch
authors.affiliation: Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Darron
authors.initials: D
authors.lastname: Brown
authors.affiliation: Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom.
authors.forename: Jack
authors.initials: J
authors.lastname: Cuzick
authors.affiliation: Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, Georgia.
authors.forename: Daron
authors.initials: D
authors.lastname: Ferris
authors.affiliation: Department of Microbiology Infectious Diseases, The Royal Women's Hospital, Department of Obstetrics and Gynaecology, University of Melbourne, Australia.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Garland
authors.affiliation: Center for Infection Research in Cancer (CIRC), Moffitt Cancer Center, Tampa, Florida.
authors.forename: Anna R
authors.initials: AR
authors.lastname: Giuliano
authors.affiliation: National Institute of Public Health, Cuernavaca, Morelos, Mexico.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Hernandez-Avila
authors.affiliation: Division of Gynecologic Oncology, University of Alabama, Birmingham, Alabama.
authors.forename: Warner
authors.initials: W
authors.lastname: Huh
authors.affiliation: Institute of Clinical Medicine, University of Bergen/Haukeland University Hospital, Bergen, Norway.
authors.forename: Ole-Erik
authors.initials: OE
authors.lastname: Iversen
authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark and Department of Gynecology, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Susanne K
authors.initials: SK
authors.lastname: Kjaer
authors.affiliation: Department of Obstetrics and Gynecology, Clinica Colsanitas, Fundacion Universitaria Sanitas, Bogota, Colombia.
authors.forename: Joaquin
authors.initials: J
authors.lastname: Luna
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Colombia, Vancouver, Canada.
authors.forename: Dianne
authors.initials: D
authors.lastname: Miller
authors.affiliation: Institut du col, Paris, France.
authors.forename: Joseph
authors.initials: J
authors.lastname: Monsonego
authors.affiliation: National Institute of Cancer, Bogotá, Colombia.
authors.forename: Nubia
authors.initials: N
authors.lastname: Munoz
authors.affiliation: Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Evan
authors.initials: E
authors.lastname: Myers
authors.affiliation: Department of Obstetrics and Gynecology, University Central Hospital, Helsinki, Finland.
authors.forename: Jorma
authors.initials: J
authors.lastname: Paavonen
authors.affiliation: Faculty of Tropical Medicine, Mahidol University, Thailand.
authors.forename: Punnee
authors.initials: P
authors.lastname: Pitisuttithum
authors.affiliation: Direction des Risques Biologiques et de la Santé au travail, Institut National de Santé Publique du Québec, Montréal, Quebec, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: Steben
authors.affiliation: Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.
authors.forename: Cosette M
authors.initials: CM
authors.lastname: Wheeler
authors.affiliation: Merck & Co., Inc., Whitehouse Station, New Jersey. Universidad del Rosario, Bogota, Colombia.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Perez
authors.affiliation: Merck & Co., Inc., Whitehouse Station, New Jersey.
authors.forename: Alfred
authors.initials: A
authors.lastname: Saah
authors.affiliation: Merck & Co., Inc., Whitehouse Station, New Jersey.
authors.forename: Alain
authors.initials: A
authors.lastname: Luxembourg
authors.affiliation: Merck & Co., Inc., Whitehouse Station, New Jersey.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Sings
authors.affiliation: Merck & Co., Inc., Whitehouse Station, New Jersey.
authors.forename: Christine
authors.initials: C
authors.lastname: Velicer
mesh_terms: D000293:Adolescent; D000328:Adult; D004311:Double-Blind Method; D005260:Female; D005838:Genotype; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D027383:Papillomaviridae / Q000235:genetics*; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000235:genetics / Q000821:virology*; D053918:Papillomavirus Vaccines / Q000627:therapeutic use; D015995:Prevalence; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control / Q000821:virology*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000517:prevention & control / Q000821:virology*
chemical_list: D053918:Papillomavirus Vaccines