BMC Infectious Diseases
(Accessed 26 July 2014)
http://www.biomedcentral.com/bmcinfectdis/content

Research article
Human papillomavirus infection in Bhutan at the moment of implementation of a national HPV vaccination programme
Ugyen Tshomo, Silvia Franceschi, Dorji Dorji, Iacopo Baussano, Vanessa Tenet, Peter JF Snijders, Chris JLM Meijer, Maaike CG Bleeker, Tarik Gheit, Massimo Tommasino and Gary M Clifford
Author Affiliations
BMC Infectious Diseases 2014, 14:408 doi:10.1186/1471-2334-14-408
Published: 22 July 2014
Abstract (provisional)
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).
Conclusion
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.