title: HPV type attribution in high-grade cervical lesions: assessing the potential benefits of vaccines in a population-based evaluation in the United States.
abstract: BACKGROUND
  Two currently available vaccines targeting human papillomavirus (HPV) types 16 and 18 could prevent 70% of cervical cancers and 50% of high-grade cervical lesions. Next-generation vaccines against additional types, such as a candidate 9-valent vaccine against HPV6/11/16/18/31/33/45/52/58, could further reduce HPV-associated disease burden.
  
  
  METHODS
  HPV was typed in archived tissues from women ages 21 to 39 years residing in five catchment areas in the United States with cervical intraepithelial neoplasia 2/3 and adenocarcinoma in situ (CIN2+) using L1 consensus PCR and type-specific hybridization. Type attribution was estimated using weights to account for lesions with multiple types detected.
  
  
  RESULTS
  From 2008 to 2011, 5,498 of 6,306 (87.2%) specimens obtained from 8,469 women with CIN2+ had valid typing results; HPV DNA was detected in 97.3%. Overall, 50.1% of lesions were attributable to HPV16/18, ranging from 50.3% to 52.4% among those ages 21 to 34 years, and significantly declined in 35 to 39 year-olds (43.5%). HPV16/18 attribution was higher in non-Hispanic whites (56.4%) versus racial/ethnic minorities (range, 41.8%-45.9%; P < 0.001). HPV31/33/45/52/58 attribution was 25.0% overall and increased with age (P < 0.001). A higher proportion of CIN2+ was attributable to HPV31/33/45/52/58 in non-Hispanic black (29.9%), Hispanic (29.2%), and Asian (33.1%) women compared with non-Hispanic whites (22.8%; P < 0.001).
  
  
  CONCLUSIONS
  Overall, 75% of lesions were attributable to 7 oncogenic HPV types: 50% to HPV16/18 and 25% to HPV31/33/45/52/58. HPV16/18 had the largest attributable fraction in CIN2+ across all subpopulations, although to a lesser extent in older women and racial/ethnic minorities.
  
  
  CONCLUSIONS
  Vaccines targeting additional oncogenic HPV types could prevent more high-grade cervical lesions, especially among racial/ethnic minorities.
authors.affiliation: Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia. bse4@cdc.gov.
authors.forename: Susan
authors.initials: S
authors.lastname: Hariri
authors.affiliation: Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Unger
authors.affiliation: HIV/STD/TB Program, Center for Public Health Practice, Oregon Public Health Division, Portland, Oregon.
authors.forename: Sean
authors.initials: S
authors.lastname: Schafer
authors.affiliation: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Niccolai
authors.affiliation: California Department of Public Health, STD Control Branch, Richmond, California.
authors.forename: Ina U
authors.initials: IU
authors.lastname: Park
authors.affiliation: Departments of Medicine and Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Bloch
authors.affiliation: Center for Community Health and Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Bennett
authors.affiliation: Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Martin
authors.initials: M
authors.lastname: Steinau
authors.affiliation: Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Johnson
authors.affiliation: Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Lauri E
authors.initials: LE
authors.lastname: Markowitz
mesh_terms: D065311:Adenocarcinoma in Situ / Q000473:pathology / Q000517:prevention & control / Q000821:virology*; D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D061809:Human Papillomavirus DNA Tests / Q000379:methods; D006801:Humans; D027383:Papillomaviridae / Q000145:classification* / Q000235:genetics; D030361:Papillomavirus Infections / Q000473:pathology / Q000517:prevention & control / Q000821:virology*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000737:chemistry; D016133:Polymerase Chain Reaction; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000517:prevention & control / Q000821:virology*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000517:prevention & control / Q000821:virology*
chemical_list: D004279:DNA, Viral; D053918:Papillomavirus Vaccines