Evaluation of dried blood spots and oral fluids as alternatives to serum for human papillomavirus antibody surveillance

Karly S. Louie, Jama Dalel, Caroline Reuter, Sara L. Bissett, Michelle Kleeman, Lesley Ashdown-Barr, Rawinder Banwait, Anna Godi, Peter Sasieni, Simon Beddows*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


Human papillomavirus (HPV) vaccination elicits high-titer genotypespecific antibody responses that are associated with a reduced risk of cervical disease caused by vaccine-incorporated genotypes. Our objective was to evaluate dried blood spots (DBSs) and oral mucosal transudate (OMT) as alternative samples to serum to confirm HPV vaccine antibody status. A study was carried out to evaluate the feasibility of detecting HPV16 and HPV18 antibodies in OMT, DBSs, and sera among women who self-reported being unvaccinated or fully vaccinated with the HPV vaccine. Serum had the highest sensitivity (100%) for detection of antibodies against both HPV16 and HPV18 but the lowest specificity, due to the detection of natural infection antibodies in 16% of unvaccinated women. Conversely, DBSs and OMT had lower sensitivity (96% and 82%, respectively) but high specificity (98%). We confirmed that these antibodies were functional (i.e., neutralizing) and that their detection was quantitatively reproducible and well correlated between sample types when normalized to IgG content. DBSs and OMT are appropriate alternative sample types for HPV vaccine surveillance. These alternative sample types warrant consideration for the purposes of cervical screening, diagnosis, and management, but more work will be needed to establish the stringent parameters required for such application.

Original languageEnglish
Article numbere00043-18
Issue number3
Publication statusPublished - 1 May 2018

Bibliographical note

Funding Information:
This work was supported by Cancer Research UK (C41733/A15037 and C8162/ A16892). The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.


  • Antibodies
  • Dried blood spot
  • HPV vaccine
  • Human papillomavirus
  • Oral fluids
  • Surveillance


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