Infection with human papillomavirus (HPV) is recognized as one of the major causes of infection-related cancer worldwide, as well as the causal factor in other diseases. Strong evidence for a causal etiology with HPV has been stated by the International Agency for Research on Cancer for cancers of the cervix uteri, penis, vulva, vagina, anus and oropharynx (including base of the tongue and tonsils). Of the estimated 12.7 million new cancers occurring in 2008 worldwide, 4.8% were attributable to HPV infection, with substantially higher incidence and mortality rates seen in developing versus developed countries. In recent years, we have gained tremendous knowledge about HPVs and their interactions with host cells, tissues and the immune system; have validated and implemented strategies for safe and efficacious prophylactic vaccination against HPV infections; have developed increasingly sensitive and specific molecular diagnostic tools for HPV detection for use in cervical cancer screening; and have substantially increased global awareness of HPV and its many associated diseases in women, men, and children. While these achievements exemplify the success of biomedical research in generating important public health interventions, they also generate new and daunting challenges: costs of HPV prevention and medical care, the implementation of what is technically possible, socio-political resistance to prevention opportunities, and the very wide ranges of national economic capabilities and health care systems. Gains and challenges faced in the quest for comprehensive control of HPV infection and HPV-related cancers and other disease are summarized in this review. The information presented may be viewed in terms of a reframed paradigm of prevention of cervical cancer and other HPV-related diseases that will include strategic combinations of at least four major components: 1) routine introduction of HPV vaccines to women in all countries, 2) extension and simplification of existing screening programs using HPV-based technology, 3) extension of adapted screening programs to developing populations, and 4) consideration of the broader spectrum of cancers and other diseases preventable by HPV vaccination in women, as well as in men. Despite the huge advances already achieved, there must be ongoing efforts including international advocacy to achieve widespread—optimally universal—implementation of HPV prevention strategies in both developed and developing countries. This article summarizes information from the chapters presented in a special ICO Monograph ‘Comprehensive Control of HPV Infections and Related Diseases’ Vaccine Volume 30, Supplement 5, 2012. Additional details on each subtopic and full information regarding the supporting literature references may be found in the original chapters.

BackgroundVaginal self-sampling with HPV-DNA tests is a promising primary screening method for cervical cancer. However, women’s experiences, concerns and the acceptability of such tests in low-resource settings remain unknown.MethodsIn India, Nicaragua, and Uganda, a mixed-method design was used to collect data from surveys (N = 3,863), qualitative interviews (N = 72; 20 providers and 52 women) and focus groups (N = 30 women) on women’s and providers’ experiences with self-sampling, women’s opinions of sampling at home, and their future needs.ResultsAmong surveyed women, 90% provided a self- collected sample. Of these, 75% reported it was easy, although 52% were initially concerned about hurting themselves and 24% were worried about not getting a good sample. Most surveyed women preferred self-sampling (78%). However it was not clear if they responded to the privacy of self-sampling or the convenience of avoiding a pelvic examination, or both. In follow-up interviews, most women reported that they didn’t mind self-sampling, but many preferred to have a provider collect the vaginal sample. Most women also preferred clinic-based screening (as opposed to home-based self-sampling), because the sample could be collected by a provider, women could receive treatment if needed, and the clinic was sanitary and provided privacy. Self-sampling acceptability was higher when providers prepared women through education, allowed women to examine the collection brush, and were present during the self-collection process. Among survey respondents, aids that would facilitate self-sampling in the future were: staff help (53%), additional images in the illustrated instructions (31%), and a chance to practice beforehand with a doll/model (26%).ConclusionSelf-and vaginal-sampling are widely acceptable among women in low-resource settings. Providers have a unique opportunity to educate and prepare women for self-sampling and be flexible in accommodating women’s preference for self-sampling.

Cervical cancer kills approximately 270,000 women worldwide each year, with nearly 85% of those deaths occurring in resource-poor settings. 1 Use of the Pap smear for routine screening of women has resulted in a dramatic decline in cervical cancer deaths over the past four decades in wealthier countries. A key reason for continuing high mortality in the developing world is the shortage of efficient, high-quality screening programs in those regions.In 1999, five international health organizations came together to create the Alliance for Cervical Cancer Prevention (ACCP).* For the next eight years, with support from the Bill & Melinda Gates Foundation, the partners worked on a coordinated research agenda aimed at assessing a variety of approaches to cervical cancer screening and treatment (especially ones that may be better suited to low-resource settings), improving service delivery systems, ensuring that community perspectives and needs are incorporated into program design, and increasing awareness of cervical cancer and effective prevention strategies. Several outstanding issues were identified at that time. A general issue was a lack of consensus about the most effective and feasible options for improving cancer screening and treatment. Specific issues included uncertainty about the impact of simple screening methods and a screen-and-treat approach on cervical cancer incidence and mortality; the comparative performance of visual inspection methods of screening-visual inspection with acetic acid (VIA) or Lugol's iodine (VILI) † -and new methods using human papillomavirus (HPV) DNA testing; the optimal ways to reduce false-positive results from visual inspection methods without producing more false-negatives; and any possible links between the use of cryotherapy and subsequent HIV acquisition.Recent studies and analyses have answered some of these questions and have validated earlier findings related to safe, effective, operationally feasible and culturally appropriate strategies for secondary prevention of cervical cancer. ‡ On the basis of these new data and the results of earlier research conducted in 20 African, Asian and Latin American countries, the ACCP partners have summarized and shared key findings and recommendations for effective cervical cancer screening and treatment programs in low-resource settings, as follows. FINDINGS•In low-resource settings, the optimal age-group for cervical cancer screening to achieve the greatest public health impact is 30-39-year-olds. Screening is considered optimal when the smallest amount of resources is used to achieve the greatest benefit. To determine the optimal age for cervical cancer screening, ACCP researchers used two methodologies: modeling and field-based study. Goldie et al. 2 conducted cost-effectiveness modeling comparing screening strategies in five developing countries. Their model predicted that for 35-year-old women screened only once in their life, a single-visit or two-visit approach with the VIA method could reduce the lifetime risk of cervical canc...

Background: Rotavirus gastroenteritis is the leading cause of diarrheal disease mortality among children under five, resulting in 450,000 to 700,000 deaths each year, and another 2 million hospitalizations, mostly in the developing world. Nearly every child in the world is infected with rotavirus at least once before they are five years old.