Prevalence of HPV in young

adults in the United States,

2017
By: Maya Enriquez, Alexis Lagasca, Daisy Martinez, Alyssa
Moreno, Bryant Rueda, Sydney Teodoro, Angela Vriese

California State University, Long Beach

Principles of Epidemiology
Extent of the Problem (Sydney)
Morbidity: Refers to disease or any departure from a
state of physiological or psychological health and
well-being (CDC, 2012).

● In 2013-2014:
○ 42.5% in total population
○ 45.2% among men
○ 39.9% among women
(Centers for Disease
(U.S. Department of Health and Human Services, 2017) Control, 2013)

Mortality (WHO, 2017)

● About 266,000 deaths

● Cervical cancer has high mortality rate of 52% globally
Extent of the Problem (cont.)(Sydney)
Economic Impact

● Overall annual direct medical cost: $8.0 billion

○ Routine cervical cancer screening & follow-up
○ Cancer
■ Cervical cancer
■ Oropharyngeal cancer
○ Genital warts
○ Recurrent Respiratory Papillomatosis

(Chesson, Ekwueme, Saraiya, Watson, Lowry, & Markowitz, 2012)

Agent of the Disease (Maya)
Agent: “An infectious microorganism or
pathogen: a virus, bacterium, parasite,
or other microbe” (CDC, 2012).

● Virus
● No cure

Source: Centers for Disease Control and Prevention (CDC). (2016). What is HPV? Retrieved
from https://www.cdc.gov/hpv/parents/whatishpv.html
Condition (Maya)
● Genital warts
● No symptoms
● Cancer

Source: Centers for Disease Control and Prevention (CDC). (2016). What is HPV? Retrieved
from https://www.cdc.gov/hpv/parents/whatishpv.html
Mode of Transmission (Maya)
● Penetrative sex
● Oral sex
● Skin-to-skin contact

Source: Centers for Disease Control and Prevention (CDC). (2016). What is
HPV? Retrieved from https://www.cdc.gov/hpv/parents/whatishpv.html
Mechanisms to Control HPV (Daisy)
Primary Prevention (CDC, 2016a)
➔ Abstinence
➔ Practice safe sex
◆ Lessen number of partners
◆ Use condoms
➔ Vaccination (FDA-Approved)
◆ Gardasil and Gardasil 9:
- Women: Prevent genital warts, vaginal, cervical,
vulvar and anal cancers, and precancerous
conditions.
- Men: Prevent genital warts, anal cancer, and
precancerous anal conditions
◆ Cervarix:
- used for HPV-acquired cervical cancer

Epidemiological term:
Risk: the probability that an event will occur (e.g., that a person will be
affected by, or die from, an illness, injury, or other health condition within a
specified time or age span) (CDC, 2014).
Secondary Prevention (Daisy)
Cancer Screening

➔ Papanicolaou (Pap) test: Ages 21 through 65

(CDC, 2016b).
➔ Cancer Prevalence due to HPV:
(National Cancer Institute, 2016):
● Cervical cancer:
○ About 70% related to HPV
● Anal cancer:
○ About 95% of all cancers due to HPV.
● Oropharyngeal (tonsils, tongue, throat and
soft palate) cancers:
○ About 70% Medline Plus. (2017). Pap test. Retrieved from
https://medlineplus.gov/ency/article/003911.htm
● Penile cancer:
○ About 35%
● Vaginal cancers: ● Vulvar cancers:
○ Around 65% ○ Around 50%
 Tertiary Prevention (Daisy)

Aimed at rehabilitation for those with established cancer.

➔ Surgical or ablative therapies (procedure used to

eliminate abnormal tissue), radiotherapy, and
chemotherapy (WHO, 2013).

➔ Cryosurgery - freezes abnormal tissue (The National Cancer

Institute, 2016)
◆ Primarily used for cervical cancer.

➔ Palliative care (WHO, 2013)

◆ Opioid access
◆ Aids in relieving suffering from progressed cancer, like
cervical cancer.
Host Characteristics (Bryant)
Host: The human who is susceptible for getting the disease (CDC, 2012).

● Human papillomavirus infection does not discriminate

when it comes to infecting the host or the person the
host is having sexual relations with
● HPV usually does not present with any symptoms
● Host may pass on the infection without knowing they
themselves have it
● High risk of contracting HPV when a person starts
becoming sexually active

Reference: Mayo Clinic. (2017). HPV infection - Symptoms and causes - Mayo Clinic. Retrieved
from
https://www.mayoclinic.org/diseases-conditions/hpv-infection/symptoms-causes/dxc-2019906
4
Environmental Factors (Alyssa)
● Environmental factors: an extrinsic factor
that affects an agent and the opportunity for
exposure (Centers for Disease Control and
Prevention, 2017)

● Cultural
○ Religion
■ Beliefs on condom use and
vaccines
● Economic
○ Economic status
○ Access to health care
Environmental Factors (continued)
● Geographical Location
○ Rural area vs populated cities
○ Distance to health care facilities

● Educational
○ Knowledge on preventative measures
○ Knowledge on how HPV spreads
Temporal Variation (Alyssa)
The timeline of the progression of HPV from initial
infection to cancer varies by person and by HPV
type.

● There are 120 types of HPV that have been identified

(most cause genital warts)
● There are 40 types of HPV that have been identified
to be present in cervical cancer cases.
● Most cases of HPV will resolve within 1-5 years
● Other cases will persist and lead to a condition called
intraepithelial neoplasia or CIN
● CIN 1 may persist for 1-2 years and lead to higher
grade CIN 2/3
● CIN 2/3 can last decades, possibly regressing, or finally
progressing to cervical cancer

Source: Centers for Disease Control and Prevention

https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/hpv.pdf
Gaps in Knowledge/Suggested Areas for Further Research
(Alexis)
According to Franco, Bosch, Cuzick, Schiller, Garnett, Meheus, & Wright
(2006), the gaps in knowledge and research priorities are:
● Natural history of HPV ● Surveillance of vaccines
○ How does HPV overcome host ○ Doses
defense mechanisms? ○ Chronic and infectious diseases
○ Long-term follow up
● HPV screening ○ Diseases linked to effects of
○ Follow-up period vaccination
○ Health promotion strategies

● Vaccine acceptability
○ Societal determinants
○ Communicating HPV-related
information
○ Factors contributing to refusal of
vaccines
Conclusion (Alexis)
● Recap of HPV
○ Lead to negative health impacts, such as morbidity, and mortality, and can also
lead to economic impacts.
○ HPV is a virus that can be transmitted through sexual contact and cannot be cured.
○ Preventive methods: Abstinence, practicing safe sex, and HPV vaccination.
○ The risk of getting HPV depends on several factors, such as the environment,
economic status, educational attainment, and host characteristics.
● Need for Funding - Why?
○ More research on HPV
○ Prevention efforts
○ Vaccinations
References
Centers for Disease Control and Prevention. (2017a, May 11). Epidemiology Glossary | Data and Statistics | Reproductive Health | CDC. Retrieved from
https://www.cdc.gov/reproductivehealth/data_stats/glossary.html
Centers for Disease Control and Prevention. (2012). Lesson 1: Introduction to Epidemiology. Retrieved from
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Retrieved December 01, 2017, from
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https://www.cdc.gov/std/prevention/default.htm
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Centers for Disease Control and Prevention (2017b) Human Papillomavirus. Retrieved from: https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/hpv.pdf
Center for Disease Control and Prevention. (2017c). Prevalence of HPV in Adults Aged 18–69: United States, 2011–2014

Retrieved from https://www.cdc.gov/nchs/products/databriefs/db280.htm

Centers for Disease Control and Prevention (CDC). (2016c). What is HPV? Retrieved from https://www.cdc.gov/hpv/parents/whatishpv.html

Chesson, H. W., Ekwueme, D. U., Saraiya, M., Watson, M., Lowy, D. R., & Markowitz, L. E.
(2012). Estimates of the annual direct medical costs of the prevention and treatment of disease associated with human papillomavirus in the United States.
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References (cont)
Franco, E., Bosch, X., Cuzick, J., Schiller, J., Garnett, G., Meheus, A., & Wright, T. (2006).
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https://pdfs.semanticscholar.org/9af9/3019ebf7cba6ced519acf84ab158854f89d9.pdf
Medline Plus. (2017). Pap test. Retrieved from https://medlineplus.gov/ency/article/003911.htm
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