Characteristics of human papillomavirus infections after the introduction of vaccination against cervical cancer

Lasič, Mateja (avtor), Poljak, Mario (mentor), Smrkolj, Špela (komentor)

Introduction The main aetiological factor in the development of cervical cancer is long-term, persistent infection with high-risk human papillomavirus (HPV) types. Due to HPV being a necessary, though not exclusive, causal factor, cervical cancer is unique among human malignancies, as it can be effectively prevented and potentially eliminated through coordinated public health interventions. According to European guidelines for quality assurance in cervical cancer screening, HPV testing is advocated as the primary screening method. However, these guidelines also emphasise the importance of evaluating local epidemiological conditions, particularly HPV prevalence, before transitioning from successful cytology-based screening programmes to HPV-based screening. The Slovenian organised, population-based National Cervical Cancer Screening Programme (NCCSP) for early detection of precancerous lesions and cervical cancer provides triennial cytological screening (Pap tests) for women aged 20–64 years. Since its establishment in 2003, the programme has consistently achieved screening coverage exceeding 70%, and cervical cancer incidence in Slovenia has been reduced by half. However, in the last decade, the cervical cancer incidence has plateaued, highlighting the need to optimise preventive strategies in the era of HPV vaccination. In 2009–2010, the first nationwide cross-sectional survey was carried out to assess cervical HPV prevalence prior to the implementation of school-based HPV vaccination programme in Slovenia. The study included over 4,400 Slovenian women aged 20–64 years participating in routine NCCSP screening. The overall prevalence of cervical infections with 14 HPV types prior to vaccination was estimated at 13.3%, as determined using the clinically validated Alinity m HR HPV Assay, which was also employed in the present study. In the same period, during the 2009/2010 school year, HPV vaccination was introduced into the national immunisation programme for girls in the 5th–6th grades of primary school (ages 11–12), offering free vaccination with three doses of the quadrivalent HPV vaccine. The first seven birth cohorts of women who had the opportunity to receive HPV vaccination through this national school-based programme were aged 20–27 at the time of the present study and had entered the NCCSP screening programme, providing a unique opportunity to evaluate the real-time population impact of HPV vaccination on cervical HPV prevalence in Slovenia. Studies from Western, Northern, and Southern Europe report significant reductions in cervical HPV prevalence following vaccination. conversely, data from Central and Eastern European countries remain limited and methodologically less robust, hindering straightforward comparison with findings from Western and Northern Europe. To the best of our knowledge, this is the first and largest study in the region to assess HPV vaccination effectiveness and associated population-level effects, including herd immunity, cross-protection, and potential genotype replacement. It is also the first study in Central and Eastern Europe with methodologically consistent comparison of cervical HPV prevalence before and after the implementation of a national school-based HPV vaccination programme. Methods We conducted a prospective cross-sectional study enrolling Slovenian women aged 20–64 years attending routine gynaecological screening visits within the NCCSP from December 2023 to March 2025 at 21 participating gynaecological practices throughout Slovenia. Eligible participants included women with a normal Pap result in the previous screening round or women undergoing their first cervical sampling upon programme entry. Exclusion criteria were pregnancy, menstruation, colpitis or cervicitis, hysterectomy, conditions preventing adequate cervical sampling, follow-up smears after pathological results, post-treatment smears, or suspected malignancy. All participants provided written informed consent. The study was approved by the National Medical Ethics Committee of Slovenia (consent number 0120-218/2023/10). Cervical specimens for HPV testing were obtained using a CervexBrush (Rovers Medical Devices, Oss, the Netherlands) and stored in ThinPrep PreservCyt Solution (Hologic Inc., Marlborough, MA, USA). Gynaecologists documented participants’ HPV vaccination status on a standardised form, while participants completed an anonymous questionnaire confirming their HPV vaccination history. All samples and data were anonymised using unique codes. Cervical specimens were tested using the clinically validated Alinity m HR HPV Assay (Abbott Molecular, Des Plaines, IL, USA) on the automated Alinity m system according to manufacturer instructions. All Alinity-positive samples were subsequently tested using the clinically validated Allplex HPV HR Detection Assay (Seegene Inc., Seoul, South Korea) according to manufacturer instructions. We assessed the overall, age-stratified prevalence of cervical infections with 14 HPV types detectable by the Alinity assay (HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) (hereby 14-Alinity targeted HPV types) and the type-specific, age stratified prevalence of cervical infections with 12 high-risk HPV types (HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59) classified as Group 1 “carcinogenic to humans” by the International Agency for Research on Cancer (IARC) (hereby 12-IARC defined hrHPV types), excluding HPV66 and HPV68. We additionally assessed cervical HPV prevalence among women, aged 20–24 at the time of study inclusion, who were eligible for HPV vaccination during adolescence, stratifying the analysis by vaccination status. Data collected in 2023–2025, following the implementation of the school-based HPV vaccination programme, were compared with those from a methodologically comparable cross-sectional study conducted in 2009–2010, prior to the school-based HPV vaccination programme. Both studies enrolled Slovenian women aged 20–64 years attending the NCCSP, applied the same inclusion and exclusion criteria and used the same clinically validated HPV assay, allowing for a direct comparison. HPV prevalence was estimated with 95% confidence intervals (CI) using the Wilson method for proportions. Differences in prevalence were assessed using Pearson’s chi-square test or Fisher’s exact test for small sample sizes. Statistical significance was defined as a two-sided p-value < 0.05. All analyses were performed using IBM SPSS Statistics version 30 (IBM Corp., Armonk, NY, USA) and R version 4.5.1 (Free Software Foundation, Boston, MA, USA). Results A total of 4,419 women were included in the final dataset for analysis. In 2023–2025, the overall prevalence of cervical infections with 14-Alinity targeted HPV types among Slovenian women aged 20–64 years was 10.0% (95% CI: 9.2%–10.9%), significantly lower than the 13.3% prevalence observed in 2009–2010 (95% CI: 12.3%–14.3%; p < 0.001). The most pronounced decline in the overall prevalence of cervical infections with 14-Alinity targeted HPV types was observed in women aged 20–24 years, decreasing from 25.3% (95% CI: 22.0%–29.0%) to 12.8% (95% CI: 10.4%–15.6%) (p < 0.001). The highest overall prevalence of 14 Alinity-targeted HPV types in 2023–2025 was observed in women aged 25–29 (15.9%, 95% CI: 12.8%–19.4%), which remained significantly lower than the 20.9% (95% CI: 18.0%–24.1%) prevalence observed in 2009–2010 (p = 0.026). A secondary peak in 2023–2025 occurred in women aged 45–49, representing an age shift compared with the pre-vaccination 40–44 age group. Prevalence of 12 IARC-defined hrHPV types in Slovenian women aged 20–24 years significantly decreased from 25.2% (95% CI: 21.7%–28.9%) in 2009–2010 to 11.4% (95% CI: 9.0%–14.1%) in 2023–2025 (p < 0.001). In the same age group, HPV16 prevalence dropped from 9.5% (95% CI: 7.4%–12.1%) to 1.3% (95% CI: 0.6%–2.5%) (p < 0.001), and HPV18 from 2.1% (95% CI: 1.2%–3.6%) to 0.6% (95% CI: 0.2%–1.6%) (p=0.041), corresponding to relative reductions of 86.7% (95% CI: 72.2%–93.6%) and 69.4% (95% CI: 5.7%–90.1%), respectively. A significant reduction in HPV16 prevalence was also observed in women aged 25–29. In women aged 20–24 years during the 2023–2025 study period, who had been eligible for school-based HPV vaccination in adolescence, the predominant hrHPV types were HPV51, HPV56, and HPV59 (each 2.4%), followed by HPV52 (1.7%) and HPV39 (1.4%). Previously dominant HPV16 and HPV31 ranked sixth, and HPV18 ninth. Across all age groups (women aged 20–64 years), cervical prevalence of HPV31 (p < 0.001), HPV45 (p = 0.027), HPV51 (p = 0.004), and HPV52 (p = 0.027) also declined following the implementation of the school-based HPV vaccination program. Multiple cervical infections with two or more 12-defined IARC hrHPV types were observed in 17.2% of women in 2023–2025, significantly lower than 22.8% in 2009–2010 (p < 0.001), with the largest reduction in the 20–24 age group. Among women aged 20–24 years in the 2023–2025 study period, 40.0% had received at least one dose of the quadrivalent HPV vaccine before the age of 15. None of these vaccinated women had a cervical infection with HPV16 or HPV18, compared with 2.1% and 1.1% observed among their unvaccinated counterparts. Among vaccinated women, the most frequent HPV types were HPV59 (3.2%) and HPV51 (2.8%), while in unvaccinated women, infections were mainly caused by HPV56 (2.4%), HPV16 (2.1%), and HPV51 (2.1%). Conclusion This study represents the first large-scale, methodologically consistent assessment of HPV vaccination effectiveness in Central and Eastern Europe. It demonstrates a marked reduction in the prevalence of cervical infections with hrHPV types among Slovenian women following implementation of a national school-based HPV vaccination programme, with the largest decline observed in women aged 20–24, who previously carried the highest burden of HPV cervical infections. Crucially, no cases of HPV16 or HPV18 were detected among appropriately vaccinated women, confirming the vaccine’s substantial potential to eliminate these two highly oncogenic HPV types, which together account for over 70% of cervical cancers globally. The concurrent decrease in HPV16/18 prevalence among unvaccinated women supports herd immunity, while reductions in HPV31, HPV45, HPV52, and HPV58 suggest cross-protection. These findings have both national and regional implications. In Slovenia, cervical cancer screening continues to rely on cytology (Pap testing). Our results provide robust evidence to support and guide the transition to primary HPV-based screening, in line with European guidelines recommendations, enabling even more effective screening in the era of HPV vaccination. Continuous monitoring of population-level HPV prevalence and behaviour is crucial for timely detection of epidemiological trends and adaptation of preventive strategies. This is particularly important in Slovenia, where HPV vaccination coverage is relatively low and highly uneven across regions, influenced by broader social factors. This study provides crucial insights for enhancing cervical cancer prevention in Central and Eastern Europe, a region where screening remains inadequate, HPV vaccination has been introduced relatively recently, and/or vaccine uptake is low. Consequently, cervical cancer incidence and mortality in this region remain among the highest worldwide. Considering the comparable distribution of HPV types and common healthcare challenges in the region, our results offer a valuable evidence base to guide coordinated regional strategies for effective cervical cancer control and, ultimately, it’s possible elimination.

• Jezik: Angleški jezik
• Ključne besede: HPV, prevalence, vaccination, cervical cancer, screening, Slovenia
• Vrsta gradiva: Doktorsko delo/naloga
• Organizacija: MF - Medicinska fakulteta
• Leto izida: 2026
• PID: 20.500.12556/RUL-182388
• Datum objave v RUL: 09.05.2026

Sekundarni jezik

• Jezik: Slovenski jezik
• Naslov: Značilnosti okužb s človeškimi papilomavirusi po uvedbi cepljenja proti raku materničnega vratu

Izvleček

Uvod Rak materničnega vratu je posledica dolgotrajne, vztrajajoče okužbe z visokorizičnimi genotipi človeškega papilomavirusa (HPV). Zaradi njegovega sicer ne edinega, vendar nujnega povzročitelja HPV, predstavlja rak materničnega vratu posebnost med človeških malignomov, saj ga je mogoče z usklajenimi javnozdravstvenimi ukrepi ne le učinkovito preprečiti, temveč tudi odpraviti. Evropske smernice za zagotavljanje kakovosti v presejanju za raka materničnega vratu priporočajo HPV testiranje kot primarno presejalno metodo, hkrati pa ob tem poudarjajo pomen skrbne presoje lokalnih razmer, zlasti prevalence HPV, pred spremembo že uspešnih presejalnih programov, ki kot primarno presejalno metodo uporabljajo citologijo. Slovenski državni presejalni program za zgodnje odkrivanje predrakavih sprememb in raka materničnega vratu (ZORA) omogoča triletne presejalne preglede z odvzemom citološkega brisa materničnega vratu (Pap testa) pri ženskah v starosti 20–64 let. Program ZORA konsistentno dosega več kot 70-odstotno pregledanost, pri čemer se je od njegove ustanovitve v letu 2003 incidenca raka materničnega vratu v Sloveniji prepolovila. Kljub visoki pregledanosti je incidenca raka materničnega vratu v zadnjem destletju dosegla plato brez trenda upada, kar poudarja potrebo po nadaljnji optimizaciji preventivnih strategij v dobi cepljenja proti HPV. V letih 2009–2010 je bila v Sloveniji izvedena prva nacionalna presečna raziskava z namenom ocene razširjenosti okužb materničnega vratu s HPV pred uvedbo HPV cepljenja v sklopu nacionalnega programa cepljenja. V raziskavo je bilo vključenih več kot 4,400 slovenskih žensk, starih 20–64 let, ki so se udeležile rednih pregledov v okviru državnega presejalnega programa ZORA. V tej raziskavi je bila ocenjena skupna prevalenca okužb materničnega vratu s 14 genotipi HPV 13.3%. Prevalenca je bila ocenjena s klinično validiranim testom Alinity m HR HPV Assay, ki je bil uporabljen tudi v pričujoči raziskavi. V istem obdobju je v šolskem letu 2009/2010 cepljenje proti HPV postalo del nacionalnega programa cepljenja za deklice v 5.–6. razredu osnovne šole, stare 11–12 let, s čimer jim je bilo omogočeno brezplačno cepljenje s tremi odmerki štirivalentnega HPV cepiva. Prvih sedem rojstnih kohort žensk, ki so bile v otroštvu cepljene proti HPV v okviru nacionalnega programa cepljenja in so danes stare 20–27 let, je vstopilo v presejalni program ZORA. Nastale razmere tako predstavljajo edinstveno priložnost za oceno populacijskega učinka cepljenja proti HPV na razširjenost okužb materničnega vratu v Sloveniji. Raziskave iz držav zahodne, severne in južne Evrope poročajo o pomembnem zmanjšanju prevalence okužb s HPV po uvedbi cepljenja. V nasprotju s tem so podatki iz držav srednje in vzhodne Evrope omejeni in metodološko pomankljivi. Pričujoča raziskava je največja raziskava v regiji, ki je ocenila učinkovitost cepljenja proti HPV in z njim povezane populacijske učinke, vključno s čredno imunostjo, navzkrižno zaščito in morebitnim nadomeščanjem HPV genotipov. Hkrati je to prva raziskava v srednji in vzhodni Evropi, ki omogoča metodološko dosledno primerjavo prevalence HPV pred in po uvedbi cepljenja proti HPV v sklopu nacionalnega programa cepljenja. Metodologija Izvedli smo prospektivno presečno raziskavo, v katero smo vključili slovenske ženske, stare 20–64 let, ki so se med decembrom 2023 in marcem 2025 udeležile rednega ginekološkega pregleda v okviru organiziranega presejalnega programa ZORA v 21 sodelujočih ginekoloških ambulantah po celotni Sloveniji. V raziskavo so bile vključene ženske z normalnim izvidom Pap brisa v prejšnjem presejalnem krogu ali ženske, ki so ob vstopu v program opravile prvi odvzem brisa materničnega vratu. Izključitveni kriteriji so zajemali nosečnost, menstruacijo, kolpitis ali cervicitis, histerektomijo ter kakršnokoli stanje, ki bi onemogočalo ustrezen odvzem brisa materničnega vratu, kot tudi kontrolne brise po patoloških izvidih, po zdravljenju materničnega vratu ali ob sumu na maligno obolenje. Vse udeleženke so podale informirano pisno soglasje. Raziskavo je odobrila Komisija Republike Slovenije za medicinsko etiko (številka soglasja 0120-218/2023/10). Vzorci materničnega vratu za testiranje na HPV so bili odvzeti s CervexBrush krtačko (Rovers Medical Devices, Oss, the Netherlands) in shranjeni v ThinPrep PreservCyt Solution raztopini (Hologic Inc., Marlborough, MA, ZDA). Ginekologi so HPV cepilni status preiskovank zabeležili na standardiziran obrazec, sočasno so preiskovanke izpolnile anonimni vprašalnik, v katerem so zabeležile, ali so bile cepljene proti HPV. Vsa dokumentacija in odvzeti vzorci so bili označeni z edinstvenimi anonimnimi kodami. Vzorci materničnega vratu so bili testirani s klinično validiranim testom Alinity m HR HPV Assay (Abbott Molecular, Des Plaines, IL, ZDA) na avtomatiziranem sistemu Alinity m v skladu z navodili proizvajalca. Vzorci, ki so bili pozitivni s testom Alinity m HR HPV Assay, so bili dodatno testirani s klinično validiranim testom Allplex HPV HR Detection Assay (Seegene Inc., Seul, Južna Koreja) v skladu z navodili proizvajalca. Ocenili smo skupno prevalenco okužb materničnega vratu s 14 HPV genotipi, ki jih zazna test Alinity m HR HPV Assay (HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 in 68), ter prevalenco okužb materničnega vratu s posameznimi 12 visokorizičnimi HPV genotipi (HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58 in 59), ki jih zazna test Allplex HPV HR Detection Assay in ki jih je Mednarodna agencija za raziskave raka (IARC) uvrstila v skupino 1 »rakotvorni za ljudi« (izključujoč HPV66 in HPV68). Navedeno skupno prevalenco in prevalenco posameznih HPV genotipov smo ocenili po starostnih skupinah. Ocenili smo tudi prevalenco okužb materničnega vratu s HPV pri ženskah, ki so bile v času vključitve v raziskavo stare 20–24 let in so bile v adolescenci upravičene do cepljenja proti HPV, pri čemer smo rezultate analizirali glede na HPV cepilni status. Podatke iz 2023–2025 smo primerjali s podatki iz metodološko enako zasnovane presečne raziskave v letih 2009–2010, ki je bila izvedena pred implementacijo HPV cepljenja v nacionalni program cepljenja. V obeh kohortah so bili uporabljeni enaki vključitveni in izključitveni kriteriji ter isti klinično validirani testi, kar je omogočilo neposredno metodološko primerjavo. Prevalenco HPV smo ocenili s 95-odstotnimi intervali zaupanja (IZ) po Wilsonovi metodi za deleže. Razlike v prevalenci smo ocenili s Pearsonovim hi-kvadrat testom ali Fisherjevim testom za majhne vzorce. Za statistično značilne smo upoštevali dvostransko p-vrednost < 0,05. Pri analizi smo uporabili programsko opremo IBM SPSS Statistics, različica 30 (IBM Corp., Armonk, NY, ZDA) in programsko opremo R, različica 4.5.1 (Free Software Foundation, Boston, MA, ZDA). Rezultati V končno analizo smo vključili podatke 4,419 preiskovank. V obdobju 2023–2025 je bila skupna prevalenca 14 HPV genotipov, zaznanih s testom Alinity, med slovenskimi ženskami v starosti 20–64 let 10,0% (95% IZ: 9.2%–10.9%), kar je statistično značilno nižje kot prevalenca pred uvedbo HPV cepljenja, ko je le-ta znašala 13.3 % (95% IZ: 12.3%–14.3%) v obdobju 2009–2010 (p < 0.001). Najbolj izrazit upad prevalence 14 HPV genotipov, zaznanih s testom Alinity, smo zaznali pri ženskah v starosti 20–24 let, pri katerih je prevalenca v 2009–2010 padla iz 25.3% (95% IZ: 22.0%–29.0%) na 12.8% (95% IZ: 10.4%–15.6%) (p < 0.001) v 2023–2025. Najvišjo prevalenco 14 HPV genotipov v obdobju 2023–2025 smo zabeležili pri ženskah v starosti 25–29 let (15.9%, 95% IZ: 12.8%–19.4%), vendar je ta bila še vedno statistično značilno nižja od prevalence 20.9% (95% IZ: 18.0%–24.1%), zabeležene v obdobju 2009–2010 (p = 0.026). Drugi vrh prevalence 14 HPV genotipov v obdobju 2023–2025 se je pojavil pri ženskah v starosti 45–49 let, kar kaže na premik v starejšo starostno skupino v primerjavi z obdobjem pred uvedbo cepljenja, ko je bil vrh prisoten pri ženskah, starih 40–44 let. Prevalenca 12 IARC-opredeljenih visokorizičnih HPV genotipov se je v starostni skupini 20–24 let znižala iz 25.2% (95% IZ: 21.7%–28.9%) v obdobju 2009–2010 na 11.4% (95% IZ: 9.0%–14.1%) v obdobju 2023–2025 (p < 0.001). V isti starostni skupini je prevalenca HPV16 upadla iz 9.5% (95% IZ: 7.4%–12.1 %) na 1.3% (95% IZ: 0.6%–2.5%) (p < 0.001), prevalenca HPV18 pa iz 2.1% (95% IZ: 1.2%–3.6%) na 0.6% (95% IZ: 0.2%–1.6%) (p = 0.041), kar predstavlja relativno zmanjšanje prevalence HPV16 za 86,7% (95% IZ: 72.2%–93.6 %) in HPV18 za 69.4 % (95% IZ: 5.7%–90.1%). Statistično značilen upad prevalence HPV16 je bil prisoten tudi pri ženskah, starih 25–29 let. Najpogostejši visokorizični HPV genotipi med ženskami, starimi 20–24 let, ki so bile v mladosti upravičene do cepljenja proti HPV v sklopu nacionalnega programa cepljenja, so bili v obdobju 2023–2025 HPV51, HPV56 in HPV59 (vsak 2.4%), sledili so HPV52 (1.7%) in HPV39 (1.4%). Predhodno dominantna genotipa, HPV16 in HPV31, sta zasedla šesto mesto, HPV18 deveto. V vseh starostnih skupinah skupaj (20–64 let) je med leti 2009–2010 in 2023–2025 prišlo tudi do padca prevalence genotipov HPV31 (p < 0.001), HPV45 (p = 0.027), HPV51 (p = 0.004) in HPV52 (p = 0.027). Okužbe z dvema ali večimi 12 IARC-oprdeljenimi visokorizičnimi HPV genotipi so bile prisotne pri 17,2% žensk v obdobju 2023–2025, kar je statistično značilno manj kot 22.8% v obdobju 2009–2010 (p < 0.001), pri čemer je bil najizrazitejši upad v starostni skupini 20–24 let. Med ženskami, starimi 20–24 let, ki so bile v mladosti upravičene do cepljenja proti HPV v sklopu nacionalnega programa cepljenja, je 40.0% prejelo vsaj en odmerek štirivalentnega cepiva proti HPV pred 15. letom. Med cepljenimi ni bil zaznan niti enega primera okužbe s HPV16 ali HPV18, v primerjavi z 2.1% oziroma 1.1% primerov pri necepljenih vrstnicah. Najpogostejša HPV genotipa pri cepljenih ženskah sta bila HPV59 (3.2%) in HPV51 (2.8%), medtem ko so pri necepljenih prevladovali HPV56 (2.4%), HPV16 (2.1%) in HPV51 (2.1%). Zaključek Pričujoča raziskava je prva obsežna in metodološko dosledna raziskava učinkovitosti cepljenja proti HPV v srednji in vzhodni Evropi. Raziskava je pokazala znatno znižanje prevalence okužb materničnega vratu z visokorizičnimi genotipi HPV po uvedbi cepljenja proti HPV v okviru nacionalnega programa cepljenja, pri čemer je bil največji upad opažen pri ženskah, starih 20–24 let. Prav ta starostna skupina je v obdobju pred uvedbo cepljenja nosila največje breme okužb s HPV. Med ustrezno cepljenimi ženskami v tej starostni skupini ni bil zaznan niti en primer okužbe s HPV16 ali HPV18, kar potrjuje velik potencial cepiva za eliminacijo teh dveh klinično najbolj onkogenih tipov HPV, ki povzročata več kot 70 % raka materničnega vratu. Sočasen upad prevalence HPV16/18 tudi med necepljenimi ženskami potrjuje, da cepljenje proti HPV zagotavlja posredno zaščito prek čredne imunosti, medtem ko pomembno zmanjšanje prevalence HPV31, HPV45, HPV52 in HPV58 v celotni populaciji nakazuje prisotnost navzkrižne zaščite. Izsledki pričujoče raziskave imajo tako nacionalni kot regionalni pomen. Na nacionalni ravni v Sloveniji presejanje za raka materničnega vratu še vedno temelji na citologiji (Pap testu). V tem okviru naši rezultati zagotavljajo trdne znanstvene dokaze za vzpodbudo in usmerjanje prehoda na primarno presejanje s HPV testom, skladno z evropskimi priporočili, kar omogoča še večjo učinkovitost presejanja v dobi HPV cepljenja. Neprekinjeno spremljanje prevalence HPV in vzorcev vedenja družbe je ključno za pravočasno prepoznavanje epidemioloških trendov ter prilagajanje preventivnih strategij. To je še posebej pomembno v Sloveniji, kjer je precepljenost proti HPV ne samo razmeroma nizka, temveč obstajajo med regijami izrazite razlike v stopnji precepljenosti, ob tem pa nanjo dodatno vplivajo še širši družbeni dejavniki. Naša raziskava nosi tudi pomemben doprinos k učinkovitejšemu preprečevanja raka materničnega vratu v državah srednje in vzhodne Evrope, kjer so presejalni programi še vedno nezadovoljivi, programi cepljenja proti HPV pa so bili uvedeni bodisi razmeroma nedavno, ali pa ostajajo slabo sprejeti. Posledično sta pojavnost in umrljivost zaradi raka materničnega vratu v tej regiji med najvišjimi na svetu. Glede na primerljivo porazdelitev genotipov HPV ter skupne izzive zdravstvenih sistemov v regiji naše ugotovitve predstavljajo pomemben vir dokazov, ki lahko podprejo usklajena regionalna prizadevanja za učinkovitejši nadzor nad rakom materničnega vratu in, dolgoročno, tudi njegovo morebitno odpravo.

• Ključne besede: HPV, prevalenca, cepljenje, rak materničnega vratu, Slovenija