BACKGROUND: No data exist on the population prevalence of, or risk factors for, human papillomavirus (HPV) infection in predominantly Muslim countries in Asia. METHODS: Cervical specimens were obtained from 899 married women aged 15 -59 years from the general population of Karachi, Pakistan and from 91 locally diagnosed invasive cervical cancers (ICCs). HPV was detected using a GP5 þ /6 þ PCR-based assay. RESULTS: The prevalence of HPV in the general population was 2.8%, with no evidence of higher HPV prevalence in young women. The positivity of HPV was associated with women's lifetime number of sexual partners, but particularly with the age difference between spouses and other husbands' characteristics, such as extramarital sexual relationships and regular absence from home. The HPV16/18 accounted for 24 and 88% of HPV-positive women in the general population and ICC, respectively. CONCLUSION: Cervical cancer prevention policies should take into account the low HPV prevalence and low acceptability of gynaecological examination in this population. To date, there are no data on the population prevalence of, or risk factors for, human papillomavirus (HPV) infection in predominantly Muslim countries in Asia, where sexual mores differ from many other world populations (Wellings et al, 2006). These data are essential to assess the potential relevance of HPV vaccination and HPV test-based screening to invasive cervical cancer (ICC) prevention in the region, as well as to identify any changes in risk occurring in young generations. Thus, a study of women with and without cervical cancer was carried out in Karachi, Pakistan, according to the standardised protocol of the International Agency for Research on Cancer (IARC) HPV Prevalence Surveys (Clifford et al, 2005), which was approved by both the IARC and local ethical review committees. METHODSA total of 3882 married women aged 15 -59 years living in Orangi, a densely populated suburb of Karachi, were visited at their homes and invited to join the study, with the aim to enrol B100 women in each 5-year age group. Participation rates were 24.1, 25.7, 25.1 and 23.6% among women aged 15 -24, 25 -34, 35 -44 and 45 -59 years, respectively. All participants signed an informed consent form and were administered a questionnaire. In all, 915 participants came to the study clinic located in the Sindh Government Qatar Hospital, where a sample of exfoliated cervical cells was collected and placed into PreservCyt media (Hologic, Marlborough, MA, USA) for HPV testing and liquid-based cytology.In parallel, formalin-fixed tumour biopsies were retrieved from women presenting with histologically confirmed ICC between 2004 and 2008 to the Ziauddin and Aga Khan University Hospitals, Karachi. After exclusion of 40 biopsies that were b-globin negative and/or without histological evidence of tumour, 91 ICCs remained (79 squamous cell, 3 adeno, 4 small cell and 5 other or unspecified carcinomas).Liquid-based cytology and HPV testing were carried out at the Vrije University, Amsterdam, the Neth...

No data exist on the population prevalence of, nor risk factors for, human papillomavirus (HPV) infection in the predominantly Muslim countries of Northern Africa. Cervical specimens were obtained from 759 married women aged 15-65 years from the general population of Algiers, Algeria. Liquid-based cytology and HPV DNA detection, using a GP51/61-based polymerase chain reaction assay that detects 44 HPV types, were performed according to the standardized protocol of the International Agency for Research on Cancer HPV Prevalence Surveys. HPV prevalence in the general population was 6.3% (4.0% of highrisk types), with no significant variation by age. The prevalence of cervical abnormalities was 3.6%. HPV positivity was significantly higher among divorced women, women in polygamous marriages and those reporting husband's extramarital sexual relationships. HPV16/18 accounted for only 15% of HPV-positive women in the general population, compared with 77% of invasive cervical cancer diagnosed in the same city. In conclusion, we report that HPV infection among married women in Algeria is much lower than in sub-Saharan Africa and also lower than in the majority of high-resource countries.

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The CYD-TDV vaccine is licensed in multiple endemic countries based on vaccine efficacy (VE) against symptomatic, virologically confirmed dengue demonstrated in two phase 3 trials (CYD14, 2-to 14-year-olds, Asia; CYD15, 9-to 16-year-olds, Latin America). 50% plaque reduction neutralization test (PRNT 50 ) titers at baseline and month 13 (post-vaccination) were associated with VE and may enable bridging VE to adults. Two phase 2 trials of CYD-TDV measured baseline and month 13 PRNT 50 titers: CYD22 (9-to 45-year-olds, Vietnam) and CYD47 (18-to 45-year-olds, India). 50% plaque reduction neutralization test distributions were compared between age cohorts, and four versions of an epidemiological bridging method were used to estimate VE against any serotype (dengue virus [DENV]-Any) and against each serotype over 25 months post first vaccination in a hypothetical CYD14 + CYD15 18-to 45-year-old cohort (bridging population 1) and in the actual CYD47 18-to 45-year-old cohort (bridging population 2). Baseline and month 13 geometric mean PRNT 50 titers to each serotype were significantly greater in 18-to 45-year-olds than 9-to 16-year-olds for all comparisons. The four methods estimated VE against DENV-Any at 75.3-86.0% (95% CIs spanning 52.5-100%) for bridging population 1 and 68.4-77.5% (95% CIs spanning 42.3-88.5%) for bridging population 2. The vaccine efficacy against serotype 1, 2, 3, and 4 was estimated at 56.9-76.9%, 68.3-85.8%, 91.4-95.0%, and 93.2-100% (bridging population 1) and 44.5-66.9%, 53.2-69.2%, 79.8-92.0%, and 90.6-95.0% (bridging population 2), respectively; thus, CYD-TDV would likely confer improved efficacy in adults than 9-to 16-year-olds. Using the same methods, we predicted VE against hospitalized DENV-Any over 72 months of follow-up, with estimates 59.1-73.5% (95% CIs spanning 40.9-92.2%) for bridging population 1 and 50.9-65.9% (95% CIs spanning 38.1-82.1%) for bridging population 2.

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