Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Dec 23, 2024
Date Accepted: Sep 25, 2025
Temporal Trends in Cervical Human Papillomavirus Prevalence among Females in Xiamen, China (2016–2023): A Cross-Sectional Study
ABSTRACT
Background:
Human papillomavirus (HPV) is a primary causative agent of cervical cancer, responsible for over 90% of cases worldwide. Epidemiological data on regional HPV prevalence and genotype distribution are critical for tailoring targeted cervical cancer prevention strategies, particularly in regions with limited population-based studies.
Objective:
This study aimed to investigate the epidemiological characteristics of cervical HPV infection and the presence of vaccine-targeted HPV genotypes in Xiamen.
Methods:
This cross-sectional study retrospectively analyzed HPV testing data of 63,553 females who underwent cervical exfoliated cell HPV genotyping at Zhongshan Hospital Affiliated with Xiamen University from 2016 to 2023. Data on HPV genotyping, age, and detection time were collected from the hospital's electronic information system. The HPV prevalence rates, temporal changes (pre-pandemic: 2016–2019; pandemic: 2020–2022; post-pandemic: 2023), and age-specific distributions were analyzed.
Results:
The overall HPV prevalence was 25.24%, with high-risk HPV (HR-HPV) at 19.26% and low-risk HPV (LR-HPV) at 10.08%. Vaccine-targeted HPV prevalences were: bivalent (2V-HPV) 3.56%, quadrivalent (4V-HPV) 5.89%, and nine-valent (9V-HPV) 13.64%. Notably, non-vaccine-targeted HPV genotypes accounted for 16.01% of all infections and 63.45% of positive cases. The top 5 HR-HPV genotypes were HPV52 (4.72%), HPV58 (2.98%), HPV53 (2.49%), HPV16 (2.30%) and HPV39 (1.76%), while LR-HPV81 (2.21%), HPV61 (2.00%), and HPV6 (1.73%) were most prevalent. Temporal analysis revealed significant declines in the prevalence of overall HPV, HR-HPV, LR-HPV, 2V-HPV, 4V-HPV, 9V-HPV, and specific genotypes (HPV52, HPV58, HPV16, HPV39, HPV6) from 2016-2019 to 2023 (all P<.001). Conversely, HPV81 prevalence increased significantly in 2023 compared to 2020-2022 (2.44% vs 1.96%, P<.001). Age-stratified analysis of HPV prevalence showed a significant declining trend with increasing age (P<.001), with peak infection rates observed in the ≤20 years age group.
Conclusions:
Cervical HPV infection, particularly by non-vaccine-targeted genotypes, remains a substantial public health burden in Xiamen highlighting the urgency to develop broader-spectrum vaccines, enhancing cervical cancer screening programs, and implementing age-specific interventions—specifically for females aged ≤20 years old. Long-term surveillance of emerging HPV genotypes and vaccination coverage is recommended.
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