HPV Prevalence, Subtype Distribution, and Vaccine-Associated Changes in Fuzhou Women Undergoing Health Examinations: An 11-Year Retrospective Study (2014–2025)

Abstract Background: To assess long-term trends in Human Papillomavirus (HPV) infection rates, subtype distribution, and age-specific patterns before and after HPV vaccination in Fuzhou, China, to inform cervical cancer prevention. Methods: This retrospective study analyzed 29,041 women (aged 16–79) who underwent HPV genotyping at Fuzhou University Affiliated Provincial Hospital from February 2014 to December 2025. Participants were grouped into pre-vaccination (2014–2017; n=18,542) and post-vaccination (2020–2025; n=10,499). Using fluorescent microsphere hybridization, 27 HPV subtypes (17 high-risk, 10 low-risk) were detected; overall positivity, high-/low-risk rates, and type-specific prevalence were compared. Age–infection probability was modeled using restricted cubic spline regression. Results: Overall HPV positivity was 15.77% (15.65% pre vs. 15.97% post; P=0.213). A persistent U-shaped age distribution was observed in both phases, peaking at ≤30 and ≥51 years (nadir 31-40). Post-vaccination, high-risk HPV decreased (14.49%→12.90%; RR=0.89; P<0.001), notably in the 31–40 group (RR=0.79); low-risk HPV increased (5.64% to 7.40%; RR=1.31; P<0.001), especially ≤30 years (RR=2.29). Bivalent-targeted types (HPV16/18) fell 48.0% and nine-valent-targeted types 13.4%, with greatest benefit at 31–40. Among young women, HPV16/18 declined while HPV6, HPV81, and HPV44 rose (HPV6 RR=4.24; HPV81 RR=3.17 in ≤30). Conclusions: HPV vaccination in Fuzhou reduced HPV16/18 prevalence, yet rising non-vaccine types (HPV6, HPV81) in young women suggest possible type replacement. Continued molecular surveillance, broader vaccines, and age-specific screening are warranted.