title: Use of HPV testing for cervical screening in vaccinated women--Insights from the SHEVa (Scottish HPV Prevalence in Vaccinated Women) study.
abstract: The management of cervical disease is changing worldwide as a result of HPV vaccination and the increasing use of HPV testing for cervical screening. However, the impact of vaccination on the performance of HPV based screening strategies is unknown. The SHEVa (Scottish HPV Prevalence in Vaccinated women) projects are designed to gain insight into the impact of vaccination on the performance of clinically validated HPV assays. Samples collated from women attending for first cervical smear who had been vaccinated as part of a national "catch-up" programme were tested with three clinically validated HPV assays (2 DNA and 1 RNA). Overall HR-HPV and type specific positivity was assessed in total population and according to underlying cytology and compared to a demographically equivalent group of unvaccinated women. HPV prevalence was significantly lower in vaccinated women and was influenced by assay-type, reducing by 23-25% for the DNA based assays and 32% for the RNA assay (p = 0.0008). All assays showed over 75% reduction of HPV16 and/or 18 (p < 0.0001) whereas the prevalence of non 16/18 HR-HPV was not significantly different in vaccinated vs unvaccinated women. In women with low grade abnormalities, the proportion associated with non 16/18 HR-HPV was significantly higher in vaccinated women (p < 0.0001). Clinically validated HPV assays are affected differentially when applied to vaccinated women, dependent on assay chemistry. The increased proportion of non HPV16/18 infections may have implications for clinical performance, consequently, longitudinal studies linking HPV status to disease outcomes in vaccinated women are warranted.
authors: HPV Research Group, University of Edinburgh, Edinburgh, United Kingdom.
authors: Ramya
authors: R
authors: Bhatia
authors: Department of Mathematics and Statistics, Strathclyde University, Glasgow, United Kingdom.
authors: Kimberley
authors: K
authors: Kavanagh
authors: HPV Research Group, University of Edinburgh, Edinburgh, United Kingdom.|Global Health Academy, University of Edinburgh, Edinburgh, United Kingdom.
authors: Heather Ann
authors: HA
authors: Cubie
authors: HPV Research Group, University of Edinburgh, Edinburgh, United Kingdom.
authors: Itziar
authors: I
authors: Serrano
authors: HPV Research Group, University of Edinburgh, Edinburgh, United Kingdom.
authors: Holli
authors: H
authors: Wennington
authors: Liverpool Clinical Laboratories, Royal Liverpool University Hospital, Liverpool, United Kingdom.
authors: Mark
authors: M
authors: Hopkins
authors: Department of Mathematics and Statistics, Strathclyde University, Glasgow, United Kingdom.
authors: Jiafeng
authors: J
authors: Pan
authors: Health Protection Scotland, Glasgow, United Kingdom.
authors: Kevin G
authors: KG
authors: Pollock
authors: Department of Pathology, University of Edinburgh, Edinburgh, United Kingdom.
authors: Tim J
authors: TJ
authors: Palmer
authors: Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, United Kingdom.
authors: Kate
authors: K
authors: Cuschieri
mesh_terms: D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008403:Mass Screening; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology; D015995:Prevalence; D012606:Scotland / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology; D014611:Vaccination; D055815:Young Adult
keywords: HPV; HPV immunisation; cervical screening; clinically validated HPV tests