Human papillomavirus (HPV) in Nigeria: Epidemiology, genotype, vaccination and public health implications

Rationale: Human papillomavirus (HPV) infection remains a major public health challenge in Nigeria, contributing substantially to the burden of cervical cancer. Despite the availability of prophylactic vaccines, low immunization coverage and uneven screening uptake exacerbate HPV-related morbidity and mortality. Understanding HPV prevalence, genotype distribution, and vaccination gaps is critical for guiding targeted interventions and public health strategies. 

Objectives: This study aimed to (1) determine the prevalence and genotype distribution of HPV among Nigerian women, (2) assess age-specific HPV infection patterns, (3) evaluate cervical cancer screening uptake relative to HPV burden, (4) compare HPV vaccination coverage between Nigeria and other regions, and (5) propose a framework to enhance HPV vaccination uptake. 

Methods: A comprehensive review and synthesis of epidemiological, clinical, and programmatic data were conducted using national surveillance reports, peer-reviewed studies, and vaccination program records. Data on HPV prevalence, high-risk and low-risk genotype distribution, age-specific infection patterns, cervical screening uptake, and vaccination coverage were extracted and analyzed to identify trends, regional disparities, and operational challenges. Comparative analysis with South Asian countries and the United States was performed to contextualize findings. 

Results: HPV prevalence among women of reproductive age in Nigeria was 42.3%, with cervical cancer cases showing 81.4% HPV positivity. High-risk genotypes, predominantly HPV-16 (19.9-46.7%) and HPV-18 (10-20.5%), were widely distributed, while low-risk genotypes such as HPV-81 (12.9%) occurred at lower frequencies. Infection peaked among women aged 20–29 years, with evidence of persistence in older age groups. Cervical screening coverage was low, particularly in regions with the highest HPV prevalence. HPV vaccination coverage among adolescent girls in Nigeria remained below 20%, contrasting with ~30% in South Asia and >70% in the United States. Barriers included vaccine hesitancy, limited awareness, cost, and rural access constraints. A multi-domain framework integrating policy, healthcare delivery, community engagement, and monitoring was proposed to enhance vaccination uptake. 

Conclusion: High-risk HPV genotypes are prevalent across Nigeria, with insufficient vaccination and screening coverage posing continued risks for cervical cancer development. Targeted interventions and strengthened immunization programs are urgently needed. 

Recommendation: Implement comprehensive, region-specific HPV vaccination strategies, coupled with public awareness campaigns and strengthened screening infrastructure, to reduce HPV transmission and cervical cancer incidence. Addressing HPV prevalence and vaccination gaps in Nigeria can substantially reduce cervical cancer burden, improve women's reproductive health, and strengthen national public health systems.