There is only limited data on the distribution of human papillomavirus (HPV) in Germany. We examined nationally representative data on men and women aged 17-79 years to determine the seroprevalence and distribution of 19 HPV types in 1997 to 1999, before the introduction of HPV vaccines in Germany.
The "German National Health Interview and Examination Survey 1998" was carried out by the Robert Koch Institute from 1997 to 1999. A total of 7,124 subjects – a representative sample of the residential population aged 17-79 years – were interviewed and medically examined. Final analyses for HPV seroprevalence included sera and survey data from to date 6,038 subjects. The sera were tested against antibodies to the capsid protein L1 by multiplex serology at the German Cancer Research Center (DKFZ), Heidelberg (HPV types: mucosal high risk (HR): 16, 18, 31, 33, 35, 39, 45, 52, 58, 59; mucosal low risk (LR): 6, 11, cutaneous: 1, 4, 8, 10, 38, 41, 49). HPV seroprevalence was used as a marker of cumulative HPV infections. Previously established HPV type-specific cut-off values were applied for defining HPV seropositivity (1, 2). Weighted data were used to describe seroprevalence stratified by sex and age.
In the survey sample, antibody seroprevalence for at least one of the 19 types analyzed was 73% (95% confidence interval (CI) 71-75%) in women and 74% (95% CI 72-76%) in men. The antibody prevalence of mucosal types was 35% (95% CI 33-37%) in women and 32% (95% CI 30-34%) in men. Antibody prevalence of cutaneous types was 63% (95% CI 61-65%) in women und 65% (95% CI 62-67%) in men. Nine percent (95% CI 8-10%) of the participating women and 5% (95% CI 4-6%) of men were seropositive for the high-risk type HPV 16. Antibody prevalence in vaccine-relevant types regarding the new nonavalent vaccine (HPV types: 6, 11, 16, 18, 31, 33, 52, 58, 45) was 27% (95% CI 24-28%) in women and 23% (95% CI 21-24%) in men. Seroprevalence of any of the nonavalent vaccine types increased with age and peaked in women and men in the 35-49 age groups. A second peak was found in women in the 60-64 age group.
Representative data on the antibody response to HPV is scarce. We assessed the HPV seroprevalence among adult participants aged 17-79 years of a nationwide representative cross-sectional survey. In Germany infections by vaccine-preventable HPV types were highly prevalent before the introduction of HPV vaccines. Our data on HPV seroprevalence in the pre-vaccine era are crucial for the evaluation of the existing HPV vaccination recommendation in Germany.
1. Clifford GM, Shin HR, Oh JK, Waterboer T, Ju YH, Vaccarella S, et al. Serologic response to oncogenic human papillomavirus types in male and female university students in Busan, South Korea. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2007;16(9):1874-9.
2. Michael KM, Waterboer T, Sehr P, Rother A, Reidel U, Boeing H, et al. Seroprevalence of 34 human papillomavirus types in the German general population. PLoS Pathog. 2008;4(6):e1000091.