HPV Genotype Distribution, Vaccine Protection Gaps, and Co-Infection Network Centrality Among 8515 Clinical Women in Wuxi, China: A Retrospective Cross-Sectional Study.

Background/

Objectives

Regional HPV genotype data for the Yangtze River Delta remain scarce, limiting evidence-based vaccine and screening policies. This study characterised the HPV genotype distribution, the vaccine protection gaps, and the co-infection network structure among clinical women in Wuxi, a prefecture-level city in the Yangtze River Delta region of Jiangsu Province, China.

Methods

We retrospectively analysed all 8515 cervical HPV genotyping records from Xishan People's Hospital of Wuxi City (January 2024-June 2025) using a 23-type fluorescent PCR panel classified by the International Agency for Research on Cancer (IARC) criteria.

Results

The overall HPV prevalence was 22.83% (1944/8515; 95% CI 21.9-23.8%). The five leading types were HPV52 (4.82%), HPV58 (3.14%), HPV16 (2.96%), HPV53 (2.50%), and HPV42 (2.08%); HPV18 (0.74%) ranked below two unvaccinated carcinogens, HPV51 (1.76%, IARC Group 1) and HPV68 (1.68%, Group 2A). The age-stratified prevalence was U-shaped (χ2 = 123.27, p < 0.001), peaking at ≤20 years (52.94%; exploratory, n = 51) and ≥61 years (34.66%). Among the 1944 women with positive results, 43.0% were completely unprotected by the nonavalent vaccine, and 60.4% harboured at least one non-9vHPV type; HPV51 and HPV68 together accounted for 15.08% of the positive cases. In the co-infection network (n = 585 multiple-type infections), HPV52 achieved the highest degree centrality (281 co-infection events; normalised degree = 0.0218) and appeared in 8 of the 15 most frequent dual-type pairs, with observed/expected ratios of 6.5-14.8-fold.

Conclusions

These findings reveal a clinically substantial vaccine protection gap and support the prioritisation of HPV51 and HPV68 in next-generation vaccine design.