|Year : 2018 | Volume
| Issue : 4 | Page : 336-339
Prevalence and nonsexual transmission of human papilloma virus (HPV) in the adolescence girls from rural area of Maharashtra state, India
Atul Budukh1, Amita Maheshwari1, Vrushali Palayekar2, Sonali Bagal1, Pallavi Purwar1, Kedar Deodhar1, Rajesh Dikshit1, Rajendra Badwe1
1 Centre for Cancer Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
2 National Institute for Research and Reproductive Health, Mumbai, Maharashtra, India
|Date of Web Publication||28-Feb-2019|
Centre for Cancer Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
OBJECTIVE: To find out the prevalence of human papilloma virus (HPV) in adolescent girls and to access the nonsexual transmission of HPV from their mother by using the same old cloth used by their mother. METHOD: Menstrual pads were collected from the women of age group years to find out the presence of HPV and whether it can be used as a cervical cancer screening tool. The results of the said study have been published in the European Journal of Cancer Prevention. During this study, menstrual pads of the daughters of participating women were collected to see the nonsexual transmission of HPV. After conducting the health education and obtaining the informed consent, we interviewed 57 mothers (age group 30–50, married, sexually active) and daughters [age group 12–18, unmarried (not exposed to sex)] from the rural area of Pune district of Maharashtra state, India. The menstrual pads were collected and transported to Mumbai for polymerase chain reaction (PCR) testing. HPV testing was carried out by PCR. RESULTS: Out of 57, 28 (49%) daughters and 23 (40.4%) mothers provided menstrual pad. Out of 23 mothers, one was HPV positive [4.3%: 95% confidence interval (CI) 0.2–23.0] and out of 28 girls, 3 (10.7%: 95% CI 2.0–33.0) were HPV positive. The daughter, whose mother was HPV positive, had negative result for HPV. CONCLUSION: The HPV prevalence in adolescence girls was 10.7%. There may be other nonsexual medium that might have caused HPV in adolescence girls, which needs further research.
Keywords: Adolescence girls, HPV prevalence, Polymerase Chain Reaction (PCR testing)
|How to cite this article:|
Budukh A, Maheshwari A, Palayekar V, Bagal S, Purwar P, Deodhar K, Dikshit R, Badwe R. Prevalence and nonsexual transmission of human papilloma virus (HPV) in the adolescence girls from rural area of Maharashtra state, India. Indian J Cancer 2018;55:336-9
|How to cite this URL:|
Budukh A, Maheshwari A, Palayekar V, Bagal S, Purwar P, Deodhar K, Dikshit R, Badwe R. Prevalence and nonsexual transmission of human papilloma virus (HPV) in the adolescence girls from rural area of Maharashtra state, India. Indian J Cancer [serial online] 2018 [cited 2019 May 21];55:336-9. Available from: http://www.indianjcancer.com/text.asp?2018/55/4/336/253283
| » Introduction|| |
Invasive cervical cancer is one of the most common cancers reported by the population based cancer registries in India. The age-adjusted incidence rate varies between 5 and 23 per 100,000 in different regions of India., The population-based rural cancer registries have reported highest incidence rate of cervical cancer compared with urban population. Almost all cervical cancer cases are caused by human papilloma virus (HPV). HPV is the most common sexually transmitted virus in humans. Epidemiological and clinical data support various non-sexual modes of HPV transmission especially at the time of birth and by close contact indicating potential non-sexual transmission of the disease.
Rural Indian women generally use old cloth as a menstrual pad. There is a practice of using same cloth by mother and daughter during their menstrual period in low socioeconomic group. The objective of this study was to find out the HPV prevalence in adolescent girls by testing their menstrual pad by polymerase chain reaction (PCR) and to find out whether there was transmission of HPV from mother to daughter while using the same menstrual pad/cloth.
The project was approved by the Scientific and Ethics Committee of the Tata Memorial Centre (TMC), Mumbai. The funding for the study was provided by the Ministry of Science and Technology, Government of India (Clinical Trial Number CTRI/2013/02/003353).
| » Methods|| |
This is a population-based study conducted in the rural population of Pune district in the state of Maharashtra, India. This study was conducted to find out whether menstrual pad can be used as a cervical cancer screening tool. In this study we have collected menstrual pads from the daughters of the participating women during the period May 2015 to November 2015. We had informed the objective of the study to the parents and their daughters. The medical officer and social worker provided intensive health education on HPV, genital hygiene, and preventive factors of cervical cancer. After providing intensive education and obtaining informed consent, we interviewed the mothers and their daughters. The eligible mothers were in the 30–50 age groups with no history of cervical intraepithelial neoplasia lesions, married, sexually active, physically and mentally fit, menstruating regularly, and permanent residence of the village. The eligible daughters were in the age group of 12–18 years and menstruating regularly, unmarried (not exposed to sex), and permanent resident of the villages whose mothers consented for collection of their menstrual pads. The collection, storage, and transportation of the menstrual pads were described in detail in a previous study. The menstrual pads were tested for HPV at the Central Laboratory of NIRRH. The DNA extraction method by PCR to diagnose the HPV has been reported. The HPV reports were circulated to the participants by the social worker. The HPV positive adolescent girls were provided education on the genital hygiene, risk factors of infection, and precaution to be taken in the group by the medical officer of the project. The HPV-positive mother was called for further diagnosis and treatment at Tata Memorial Centre, Mumbai; however, she refused to attend the colposcopy due to personal family matter.
| » Results|| |
For this study house-to-house visits were conducted and 57 mother and daughter pairs from nearby villages of Mulshi Tahsil of Pune district were interviewed. Of 57 interviewed cases, 28 (49%) girls and 23 (40.4%) mothers had provided menstrual pad for HPV testing by PCR. In 28 girls, there were 26 pairs of mother and daughters and in two houses there were two siblings. Of the 26 mothers, three mothers did not provide their samples. So, we had 23 pairs of mothers and daughters. We were able to collect the menstrual pad in the villages where our health worker was stationed. The samples were collected from eight villages, which was random. The compliance was more than 55% in adolescent girls where health worker was stationed and was 26.7% where health worker was not stationed. The characteristics of participant girls and their mothers are presented in [Table 1].
|Table 1: Characteristics of mothers and daughters who provided their menstrual pad for testing|
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More than 70% of girls used old cloth as a menstrual device and 25% had reported family income of
Of the 28 girls, 3 (10.7%: 95% CI 2.0–33.0) were HPV positive. Those who were found HPV positive used old cloth as a menstrual device and the pad was changed only once in a day. Of the total 23 mothers, only 1 (4.3%: 95% CI 0.2–23.0) was HPV positive; however, her daughter's HPV result was negative. Three daughters have reported HPV positive, and their mother's HPV results were negative. We did not have HPV result of one participant mother. The characteristic of HPV-positive daughter is presented in [Table 2].
| » Discussion|| |
Our study is a population-based study in the rural area of Maharashtra state. We had around 50% compliance from adolescent girls for the HPV testing. This study has shown around 11% HPV prevalence in adolescent girls from the rural area of Maharashtra state. The study conducted in the school of Noida and Delhi had reported 6% prevalence (27 out of 458) in the age group of 8-17 years by testing the midstream urine sample. In our study, HPV prevalence is higher at the age 18 years as compared with the age group 15–17. In the United States, HPV prevalence was reported as 24.5% in the age group 14–19. Traditionally, premarital sexual activity is controlled in rural India. As the marriages are mostly arranged by elders, premarital sex is not the accepted practice in India. In India, the female median age at first sex was reported as 17.8 years. Sexual activity before marriage is rare in the rural area of Maharashtra state. For our research team it was a difficult task to collect the menstrual samples of adolescence girls for HPV testing. The challenges we have faced have been reported. We got moderate compliance from the population due to excellent services provided by the research team as well as good reputation of Tata Memorial Centre, Mumbai in the community.
It is a practice in the low socioeconomic group in the rural area of using the same cloth by mother and daughter during the menstrual period; however, in our study, not a single pair of mother and daughter had reported that they are using the same cloth as a menstrual device. Because the menstrual pad has not been shared by mother and daughter, there is no question of transmission of HPV from mother to daughter. There may be some other nonsexual factors that the girls may have got the HPV infection. It is noted in our study that HPV infected girls are using the old cloth as a menstrual device and their practice of the changing the pad only once in a day as compared to standard practice of changing the pad three times in a day. It is reported that HPV are very stable viruses and able to survive on fomites and surfaces for days. In our opinion using old cloth, poor genital hygiene, and low frequency of changing the menstrual pad may be the cause of HPV infection. Our study has limitations due to small sample size. It has shown the way to find out nonsexual transmission of HPV in a large sample size population in the rural areas, with focus on poor genital hygiene and menstrual practices. Further research is required with larger sample size. There are very few studies of the prevalence of HPV. However, this study has reported population based prevalence of HPV specifically in adolescence girls. There are several low- and middle-income countries that have started vaccination program against HPV for 9-14-year-old girls; however, there is limited information available about the prevalence of HPV in the adolescence girls in these countries. The study indicate HPV prevalence among one in nine adolescence girls. Our study recommends intensive health education to be organized on menstrual practices and genital hygiene in schools and colleges through the public health department to control the HPV infection.
The authors gratefully acknowledge the financial support provided by the Department of Biotechnology. They acknowledge the health authorities of Pune district for their cooperation in running this project, and thank all the participants, their families, and the village administrators for their support. This project was funded by the Ministry of Science and Technology, Department of Biotechnology, Government of India (No/BT/PR4824/SPD/11/1389/2012).
Financial support and sponsorship
This project was funded by the ministry of Science and Technology, Department of Biotechnology, Government of India (No/BT/PR4824/SPD/11/1389/2012).
Conflicts of interest
There are no conflicts of interest.
| » References|| |
National Cancer Registry Programme. Indian Council of Medical Research: Consolidated Report of Population Based Cancer Registries (2012–2014). Publication of National Centre for Disease for Disease Informatics and Research, ICMR: Bengaluru, India; 2016.
Cancer burden in Chandigarh and Punjab state for the year – 2013 and 2014. Summary report of Chandigarh and SAS Nagar, Sangrur, Mansa districts Population Based Cancer Registries of Punjab State, India; 2017.
Budukh A, Palayekar V, Maheshwari A, Deodhar K, Purwar P, Bagal S, et al.
Menstrual pad a cervical cancer screening tool: A population based study in rural India. Eur J Cancer Prev 2018;27:546-52.
Hussain S, Bharawai M, Nasare V, Kumari M, Sharma S, Headau S, et al.
Human papillomavirus infection among young adolescents in India: Impact of vaccination. J Med Virol 2012;84:296-305.
Dunne EF, Unger ER, Sternberg M, McQuillan G, Swan DC, Patel SS, et al.
Prevalence of HPV infection among females in the unites state. J Am Med Assoc 2007;297:813-9.
Chakraborty K, Thakurata R. Indian concepts on sexuality. Indian J Psychiatry 2013;55. Indian Mental Concepts, Supplement January 2013.
Burni L, Barrionuevo-Rosas L, Albero G, Serrano B, Mena M, Gomez D, et al.
ICO Information Centre on HPV and Cancer (HPV Information Centre). Human papillomavirus and related diseases in India. Summary Report 27 July, 2017. Retrieved on 8 February 2017 from www.hpvcentre.net/statistics/reports/Ind.pdf.
Water Supply and Sanitation Collaborative Council, Government of India. Wash and Health for Menstrual Hygiene Management Training of Trainers Manual V10: Mumbai, Government of India; 2013.
Sabeena S, Bhat P, Kamath V, Arunkumar G. Possible non-sexual modes of transmission of human papilloma virus. J Obstet Gynaecol Res 2017;43:429-35.
[Table 1], [Table 2]