The assessment of neurological function is done by The use of transpedicular fixation two levels above thoracic level and caudally 6.5 mm diameter T12 in 82, 24, and 40 cases respectively. In this using the American Spinal Injury Association and below the fractured vertebra reduce the multiaxial screws were used. The instrumentation series maximum number of patients (92) operated (ASIA) method and graded according to the ASIA kyphosis, instrument failure and collapse of the was applied bilaterally. Fracture reduction and within 15 to 21 days (63%) and maximum fractures Impairment scale. Examination of anal sensation and vertebrae22. LSPF has gained popularity in the last indirect spinal canal decompression both could be were unstable burst in nature 102 (70%). decade as it has the aforementioned advantages as sphincter autonomic contraction should be accomplished by contouring the rod and applying All the patients were decompressed posteriorly and well as relieve pain sufficiently23. performed to identify complete or incomplete compression-distraction forces before tightening the long segment stabilization was done in each case by 6 neurological deficit as a standard protocol . Methods: screws. Long segment posterior fixation was done titanium pedicle screws and rods. Post-operative with autogenous bone grafting from the spinous The management of unstable thoracolumbar 146 patients (age range 15-60, mean 31.5±9.58 Xray showed good hardware position in all patients. process and lamina in all patients and applied fractures remains challenging. Effective correction years) with thoracolumbar fracture (T10– L2) with Adequate decompression was achieved in all the thoracolumbosacral orthosis (Taylor brace) of the deformity, neurological recovery, early incomplete neurological deficit from January2014 to cases. December 2018, studied in NITOR and private postoperatively for 3 months. Figure 1 shows Burst # mobilization and return to work are the fundamentals The mean duration of surgery was 150 ± 21 min settings were included in this study. Inclusions L2 in a 28 years’ male, fixed with LSPF. of the management, and also minimize complication. criteria were: a) single-level fracture; b) neurologic whereas the mean blood loss was 392.47 ml. The A fracture severity score was constructed using Absolute indication of early surgery is progressive function limited to ASIA Grades B, C, or D; c) mean length of hospital stay was 28 days and all the Thoracolumbar Injury Classification and Severity neurological deficit7. Other indication for surgical limited involvement of T10–L2; d) <3 weeks from patients were mobilized in the 1st or 2nd Score (TLICS). A comprehensive severity score of 3 intervention are incomplete neurological deficit, the time of injury, Exclusion criteria were: a) postoperative day. Radiological parameters are listed or less suggests a non-operative injury, while a score in Table-1. >25-300 angle of kyphotic deformity, >50% of loss Complete spinal cord injury (ASIA Grades A) b) of 5 or more suggests that surgical intervention may of vertebral body height, and >40-50% of canal Associated cervical spine & head injury; c) A paired sample T-test was conducted to compare 8 Pathological fracture of spine. This was a be considered. Injuries assigned a total score of 4 narrowing . 25 the means of radiological parameters which was prospective case series and cases were selected by might be handled conservatively or surgically . found statically significant (p-value <0.05) The surgical treatment of unstable fracture and purposive sampling. Correction loss was defined as progressive loss of fracture-dislocations of thoracolumber spine are still The mean Pre and post op VAS is 57.57±9.08 and Cobb angle in the latest follow-up radiographs in debate. Conservative treatment might be an Radiographic outcome was evaluated by measuring 16.4±8.9 (mild) respectively, 90% (131) of which compared to the initial post-operative radiographs. option, but surgery is the modern way of treatment. Cobb angle, kyphotic deformation and beck index end up with mild pain (p-value <0.05). The mean (24). Figure 2 shows measurement of Cobb Angle The fusion status of the patients was determined The goals of surgery are to restore the stability of the ODI at final follow up was 25.27 ± 8.49 which was and kyphotic deformation. Pain status was evaluated primarily with use of plain radiographs according to vertebral column and decompression of spinal canal 67.68±13.20 pre operatively with a p-value<0.05. by a 100-point VAS scale. The functional outcome the classification system of Christensen et al. 200126 (9). Posterior transpedicular fixation has been the Maximum patients (87) 59.6% end up with mild was assessed by Owestry Disability Index (ODI). by two independent observers and finally by choice for stabilizing acute unstable thoracolumbar disability at final follow-up. Neurological recovery was evaluated by ASIA Bridwell fusion grading27. The presence of screw fractures among all other methods10. In our series, pre-operative ASIA grade B was 30 grading. The investigation included X-ray, breakage, screw pullout, peri-implant loosening, and Introduction: 65% of thoracolumbar fractures occur due to motor (20.5 %), C was 48 (36.9%) and D was 68 (46.6%). Either anterior or posterior or both approaches can computed tomography (CT) scanning of the spine rod breakage were considered as criteria for implant Thoracolumbar fracture is the commonest injury of vehicle injuries and fall from height, with reminder After final follow up1 grade improvement occurred be used to stabilize and achieve fusion but the and magnetic resonance imaging (MRI). failure. the axial skeleton and accounts for around 90% ofall contributed by sports injury and violence2. in 116(79.5%) patients and 2 grade improvement in efficacy of either approach is somewhat similar11,12. spinal fractures. Due of the rigid costotransverse Informed written consent was taken from all the Data were collected concerning the age, sex, 36 (20.5%) patients. A cross-tab analysis was Due to the fulcrum of increased motion at Due to less extensile and hazardous approach, most joints of the dorsal spine, it acts as a fulcrum of patients mentioning the details of the procedure as localization, type of injury, presence of neurological conducted to see the significance of status in dorsolumbar junction, collapse of the vertebral body of the spine surgeons advocate posterior fusion as movement in dorsolumbar spine at the time of well as modalities of treatment. An expert deficits, pain, work status, complications and Pre-operative and Post-operative ASIA grading with with associated kyphotic deformity usually occurs. the treatment of choice13-15. injury1. technologist was responsible for gathering the radiologic parameters (Cobb angle, kyphotic grade impro vemen t . A Pe ar so n ch i-square v alu This vertebral collapse usually invades the spinal required information who is unaware of the Long-segment pedicle screw fixation (LSPF) usually deformation of vertebral body, vertebral height and e <0.05 indicates significant improvement in terms Thoracolumbar fractures are frequent in men and canal, which may cause neurological Deficit3. objectives and surgical procedures of this study. involves inserting eight screws: two level above & peak incidence is observed between 20 and 40 years. posterolateral fusion). Clinical and radiographic of neurology post-operatively. Long segment posterior fixation (LSPF) was done in Unstable fracture defined as failure of any two below the fracture. Short- segment pedicle fixation follow-up were done immediately after the operation 48% of cases (70) showed thick fusion mass on one every cases and performed by the same surgeon. column injury including middle column which (SSPF) involves inserting four screws: one level and at 2nd, 6th, 12th, 24th week & then 12 monthly. side i.e. bridwell grade II, 60 patients (41%) showed 16 Patients were placed in a prone position under account for 25%-50% of all fractures in this region. above & below the fracture . Statistical analysis was done using SPSS version grade I fusion and rest of patients’ had doubtful general anesthesia with modified kneeling with two They are very common in younger patients and 25.0 software. The level of statistical significance fusion with lucency. SSPF is the most common and simple treatment. It sand bags under each side of trunk which allowed the could have a great impact on their daily physical offers the advantage of incorporating fewer motion was set at P < 0.05. 4 abdomen to hang free, minimizing epidural venous A non-parametric Spearman correlation test was activities . 17,18 segments in the fusion . but may lead to implant dilation and bleeding. Pedicle screw fixation and Results: conducted among Bridwell fusion grade, Final ODI There are standard classification systems based on failure and re-kyphosis (9-54%) and reduction were performed under C-arm guidance. There were 126 men and 20 women with male to and ASIA grading. There is a significant positive fracture pattern, mechanism of injury, neuro-deficit moderate-to-severe (50%) pain9,17. To prevent this Laminectomy to decompress spinal cord was carried female ratio were 6.3:1. Mean age was 31.5 years strong correlation between Bridwell fusion gradeand and posterior ligamentous complex (PLC) injury. and augment the anterior column, placement of body out at the involved level and bone was saved to be within the range of 31–45 years. Maximum 64 Final ODI exist (r= 0.694, p-value <0.05, n=146). Xrays are the main investigation while computed augmente,19 polymethylmethacrylate injection3, used as bone graft. Screws were 40 or 45 mm long, patients were manual worker. The majority of But final ASIA grading was not correlated with tomography (CT) scan delineates the extent on bony transpedicular bone grafting20, anterior depending on the level and size of the vertebra. At fractures were due to falls (106 cases). The Bridwell fusion grade (p-value=0.394). Also injury and magnetic resonance imaging (MRI) scan instrumentation and strut grafting12 or long-segment the10th and 11th thoracic levels, 5.5 or 6.5- remaining cases were due to car accidents (40 cases). magnitude of curve correction is not related with detects the spinal cord and soft tissue injury5. posterior fixation (LSPF)21 could be done. mmdiameter multiaxial screws and at the12th The fractured vertebra body level was L1, L2, and Bridwell fusion grade, Final ODI and ASIA grading

Maximum injuries were due to fall from height 106 showed thick fusion mass on one side i.e. bridwell 3. Ge CM, Wang YR, Jiang SD, Jiang LS. Neurosurg. 1995;83(6):977-83. https://doi.org/ 1976). 2004;29(18):382-7. https://doi.org/10.1097/ Allografts in the Thoracic and Lumbar Spine: Do 36. Lee GW, Jang SJ, Kim J Do, Son JH, Jang JH. The Fixation. Neurosurgery. 2003; https://doi.org/ REVIEW ARTICLES program by visual inspection with acetic acid (VIA), Programhas yet been started in Bangladesh and also the viral capsid. DNA containing approximately 8000 genes. The second is an early region (E), consisting (72.6%) in this study which was 92% and 59.25% grade II and 41% shows solid fusion in both sides Thoracolumbar burst fractures with a neurological 10.3171/jns.1995.83.6.0977, PMid:7490641 01.brs.0000139308.65813.70, PMid:15371717 They Work If Combined With Posterior Fusion and efficacy of percutaneous long-segmental posterior 10.1227/01.NEU.0000093200.74828.2F, which was considered to be a feasible method for no review has been done related to HPV Vaccination base pairs and harboring an average of 8 open reading of six ORFs: E1, E2, E4, E5, E6, and E7, which deficit treated with posterior decompression and Instrumentation in Adult Patients With Kyphosis or fixation of unstable thoracolumbar fracture with PMid:14633301 cases observed in some studies (31,36). But other (grade I). 12. Kaneda K, Taneichi H, Abumi K, Hashimoto T, Satoh 20. Daniaux H1, Seykora P, Genelin A, Lang T KA. screening cervical cancer in the present so far. Hence, this review has been conducted to frames (ORFs). In a functional point of view, the encodes no structural proteins involved in viral study showed road traffic accident is the common interlaminar fusion. Eur Spine J. 2011;20(12):2195- Anterior Column Defects? Available from: partial neurologic deficit. Asian Spine J. socio-economic context. It has been estimated that explore different aspects of HPV vaccines in depth HPV genome is divided into three regions. The first is replication and oncogenesis. The third is a late (L) Regarding the postoperative complication, bed sore S, Fujiya M. Anterior decompression and stabilization Application of posterior plating and modifications in 42. Jun DS, Yu CH, Ahn BG. Posterior direct Human Papilloma Virus Vaccine for Cervical 201. https://doi.org/ 10.1007/ s00586-011-1875-6, https://journals.lww.com/spinejournal/Abstract/1995/ 2013;7(2):81-90. https://doi.org/10.4184/asj.2013.7.2.81 only 5% of the women in developing countries have cause of injury (37). Maximum fractures were burst with the Kaneda device for thoracolumbar burst thoracolumbar spine injuries. Indication, techniques, decompression and fusion of the lower thoracic and which will help to recommend a National a long control region (LCR) that has regulatory region that encodes the L1 and L2 structural proteins. and wound infection was found in 9 (6.67%) patients 06020/Anterior_Fresh_Frozen_Structural_Allografts PMid:23741544 PMCid:PMC3669707 in nature 102 (70%) which were reported 44% and PMid:21688000 PMCid:PMC3229728 fractures associated with neurological deficits. J Bone lumbar fractures with neurological deficit. Asian Cancer Prevention been screened for cervical dysplasia compared with HPVvaccination Program for prevention of cervical function of the transcription of the E6 and E7 viral each who were responded to antibiotic later. But and results. Spine (Phila Pa 1976). 1991;16(supp. _in_the.14.aspx, https://doi.org/10.1097/00007632- 83.3%(31, 35) in other studies. Jt Surg - Ser A. 1997;79(1):69-83. https://doi.org/ 37. Payer M. Implantation of a distractible titanium cage Spine J. 2011;5(3):146-54. https://doi.org/10.4184/ a about 40% to 50% of women in developed cancer among Bangladeshi women by a low-cost Modi (47) reported 1 (3.22%) screw breakage, 2 4. Tian NF, Wu Y Sen, Zhang XL, Wu XL, Chi YL, Mao 3):s:125-133. https://doi.org/10.1097/00007632-1991 199506020-00014, PMid:7676341 CS SULTANA 10 10.2106/00004623-199701000-00008 after cervical corpectomy: Technical experience in 20 asj.2011.5.3.146, PMid:21892386 PMCid:PMC3159062 countries. bHPV vaccine. In our series, at final follow up1 grade improvement (6.45%) screw loosening and 1(3.22%) superficial FM. Fusion versus Nonfusion for Surgically Treated 03001-00018, PMid:2028327 PMid:9010188 28. Dai LY, Jiang LS, Jiang SD. Posterior short-segment consecutive cases. Acta Neurochir (Wien). occurred in 116(79.5%) patients and 2 grade wound infection. Thoracolumbar Burst Fractures: A Meta-Analysis. 43. Aly TA. Short segment versus long segment pedicle One of the greatest medical breakthroughs in the last Review of literature 21. Akbarnia, B A; Crandall, D G; Burkus, K; Matthews fixation with or without fusion for thoracolumbar 2006;148(11):1173-80. Abstract: of their national public health strategy to prevent improvement in 36 (20.5%). Butt et al., 2006 showed PLoS One. 2013;8(5):1-6. https://doi.org/ 10.1371/ 13. Roy-Camille R, Saillant G, Mazel C. Internal fixation screws fixation in management of thoracolumbar century is the development of HPV vaccine against Human papillomavirus (HPV) vaccine for preventing It was observed that, fusion rate was highest in T. Use of long rods and a short arthrodesis for burst burst fractures: A five to seven-year prospective https://doi.org/10.1007/s00701-006-0871-9 two grades of improvement in 40% (7/17) of the journal.pone.0063995,PMid:23704968 of the lumbar spine with pedicle screw plating. Clin burst fractures: Meta-analysis. Asian Spine J. HPV infection is estimated to be responsible for and control cervical cancer. Different studies cervical cancer by Professor Frazer and Dr Jian fractures of the thoracolumbar spine. A long-term randomized study. J Bone Jt Surg - Ser A. 11 HPV induced malignancy is a widely studied topic patients and one grade of improvement in 60%(38). minimally disabled group. There is a significant PMCid:PMC3660321 PMid:16927030 2017;11(1):150-60. https://doi.org/10.4184/asj.2017. about 5% of human cancers worldwide. Among all showed a drop in the prevalence of HPV associated Zhou. HPV related anogenital cancers can be Orthop Relat Res. 1986;NO. 203(September):7-17. follow-up study. JBJS [Internet]. 1994;76(11): 2009;91(5):1033-41. https://doi.org/10.2106/JBJS.H. for physicians. Different authors explained different positive strong correlation between Bridwell fusion https://doi.org/10.1097/00003086-198602000-00003 11.1.150, PMid:28243383 PMCid:PMC5326724 HPV-associated malignancies, cervical cancer is diseases in vaccinated populations. Sustained prevented using a prophylactic vaccine. The two The mean Cobb angle at pre-operative was 21.5 ±8.9 5. Rajasekaran S, Kanna RM, Shetty AP. Management 1629-35. Available from: https://journals.lww.com/ 00510, PMid:19411450 38. Butt MF, Farooq M, Mir B, Dhar AS, Hussain A, aspects of HPV, its malignant potential, its preventive grade and Final ODI exist (r= 0.694, p-value <0.05, Mumtaz M. Management of unstable thoracolumbar the most important cause of morbidity and mortality efficacy, immunogenicity, and safety of the bHPV prophylactic HPV vaccines, quadrivalent HPV type and at final follow-up was 11±4.57 in this study. of thoracolumbar spine trauma An overview. Indian J 14. Carl, Allen L., MD*; Tromanhauser, Scott G., MD†; jbjsjournal/Abstract/1994/11000/Use_of_long_rods_ 44. Azimi P, Shahzadi S, Mohammadi HR, Azhari S. measures through vaccination and HPV vaccines n=146). But final ASIA grading was not correlated 29. Denis F. Spinal instability as defined by the spinal injuries by posterior short segment spinal worldwide. Cervical cancer is the fourth most vaccine were observed in the final analysis of a 6/11/16/18 vaccine and bivalent HPV type 16/18 There was no correlation found between the final Orthop. 2015;49(1):72-82. https://doi.org/10.4103/ Roger, Douglas J. M. Pedicle Screw Instrumentation and_a_short_arthrodesis_for_burst.5.aspx Surgical outcomes and correlation ODI and ASIA immunogenicity, efficacy, safety etc through their with Bridwell fusion grade (p-value=0.394). Also three-column spine concept in acute spinal trauma. fixation. Int Orthop. 2007;31(2):259-64. common cancer in women worldwide and leading follow-up study up to 9.4 years postvaccination. vaccine, were licensed in 2006 and 2007 under the amount of Cobb angle and the degree of pain 0019-5413.143914,PMid:25593358 for Thoracolumbar Burst Fractures and Fracture- https://doi.org/10.2106/00004623-199411000-00005 Clin Orthop Relat Res. 1984;NO. 189:65-76. scores in patients with thoracolumbar and lumbar 12 own view. Articles related to Human papillomavirus magnitude of curve correction is not related with https://doi.org/10.1007/s00264-006-0161-4 cause of cancer death among females in less Cervical cancer is a major public health problem in names of Gardasil® and Cervarix® respectively. reported. Altay reported Cobb angle at preoperative PMCid:PMC4292328 Dislocations. Spine (Phila Pa 1976) [Internet]. PMid:7962022 https://doi.org/10.1097/00003086-198410000-00008 burst fractures. Int Clin Neurosci J. 2015;2(1):12-5. (HPV) vaccine were retrieved from different Bridwell fusion grade, Final ODI and ASIA grading PMid:16783550 PMCid:PMC2267576 Bangladesh. There has been little success with Recently nine-valent HPV type 6/11/16/18/31/33/45/52/58 and final follow up was 18.9 and 8.1 (39) which were 17(suppliment 8s):317-24. Available from: developed countries. Persistent HPV infection is a journals, web pages and books. From them 40 papers with a p-value of 0.150, 0.819 and 0.204 6. Zhang ZC, Li F, Sun TS. An expert consensus on the 22. Aligizakis A, Katonis P, Stergiopoulos K, Galanakis I, 30. Jr TW. Traumatic kyphosis of the thoracolumbar 45. Yang WE, Ng ZX, Miang K, Koh R. Percutaneous screening program against cervical cancer in vaccine with broader cancer coverage has also near about my result. Similar results 11.9±2.67 and https://journals.lww.com/spinejournal/Abstract/1992/ 39. Altay M, Ozkurt B, Aktekin CN, Ozturk AM, Dogan necessary cause of invasive cervical cancer with a were included to prepare this manuscript. respectively. evaluation and treatment of acute thoracolumbar spine Karabekios S, Hadjipavlou A. Functional outcome of spine. [Internet]. Clinical orthopaedics and related pedicle screw fixation for thoracolumbar burst Bangladesh. Therefore, a National HPV received the United States Food and Drug 11.4 at final follow up showed by some studies 08001/Pedicle_Screw_Instrumentation_for_Thoracol Ö, Tabak AY. Treatment of unstable thoracolumbar prevalence of 99.7% in cervical cancer and spinal cord injury in China. Neural Regen Res. burst fractures of the thoracolumbar spine managed research. 1977. Available from: http://ukpmc.ac.uk/ fracture : a Singapore experience. singapur Med J. Vaccination Program seems to be the window of Administration (US-FDA) approval in October 2016 Role of HPV in cancers: (40,41). But Sapkas, 2010 (15) showed preoperative Conclusion umbar.18.aspx, https://doi.org/ 10.1097/ 00007632- junction burst fractures with short- or long-segment worldwide.At least 70% of cervical cancers are 13 2013;8(33):3077-86. non-operatively, with early ambulation, evaluated abstract/MED/340100 2012;53(9):3-7. opportunity to reduce the mortality and morbidity of under the name of Gardasil9®. Different studies in The connection between persistent infection with Cobb angle was 17.5±6.8 which became 6.0±4.0 In countries like Bangladesh fractures of the 199208001-00018, PMid:1523519 posterior fixation in magerl type a fractures. Eur Spine caused by HPV 16 and HPV 18. HPV vaccination in using the load sharing classification. Acta Orthop cervical cancer in Bangladesh. USA, Australia and Scotland have begun to show a HPV and cervical cancer was first described by degree at final follow up. thoracolumbar spine are increasing in frequency. As 7. Bohlman HH. Treatment of fractures and dislocations 31. Raja RA. Management of thoracolumbar spine J. 2007 Aug;16(8):1145-55. https://doi.org/10.1007/ 46. Boos N, Webb JK. Pedicle screw fixation in spinal combination with regular screening offers the most 15. Sapkas G, Kateros K, Papadakis SA, Brilakis E, Belg. 2002;68(3):279-87. drop in the prevalence of HPV associated diseases of the thoracic and lumbar spine. J Bone Jt Surg Am injuries at a tertiary care hospital. J Ayub Med Coll disorders: A European view. Eur Spine J. Harald Zur Hausen in 1977. In 1983 & 1984 Zur 25 Gertzbein (2) noted that, more severe the canal seen from the result of this study, Long segment s00586-007-0310-5, PMid:17252216 PMCid:PMC2200786 effective way for women to be protected against Keywords: Cervical cancer, Human Papilloma both in vaccinated and non-vaccinated populations Life cycle of HPV : become persistently infected; which is the most [Internet]. 1985;67(1):165-9. Available from: Macheras G, Katonis P. Treatment of Unstable 23. McLain RF. The biomechanics of long versus short Abbottabad. 2010;22(1):171-5. 1997;6(1):2-18. https://doi.org/10.1007/BF01676569 Hausen and his collaborators identified role of HPV compromise and kyphotic deformity, worse the transpedicular screw fixation in unstable cervical cancer.The global burden of cervical Virus (HPV), HPV vaccine. indicating establishment, of herd immunity and also The viral life cycle refers mainly to high-risk important risk factor for the development of cervical http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd Thoracolumbar Burst Fractures by Indirect Reduction fixation for thoracolumbar spine fractures. Spine 40. Moon MS, Choi WT, Moon YW, Kim YS, Moon JL. https://doi.org/10.1007/BF00307823 16 & 18 in cervical cancer and in the course of the neurological deficit. But Mumford and Cantor thoracolumbar spine injury with incomplete 32. McCullen G, Vaccaro AR, Garfin SR. Thoracic and cancer falls heaviest on the developing countries (J Bangladesh Coll Phys Surg 2021; 39: 123-131) provide cross- protection.14-17 Khatun S et al18 mucosotropic HPVs and is commonly extrapolated to cancer. The most common clinically significant Retrieve&db=PubMed&dopt=Citation&list_uids=3 and Posterior Stabilization: Short-Segment Versus (Phila Pa 1976). 2006;31(11 SUPPL.):70-9. Stabilisation of fractured thoracic and lumbar spine PMCid:PMC3454634 next 12 years of research it has been recognized as a (33,34) stated that the relationship between these neurological deficit is an effective method of lumbar trauma: Rationale for selecting the appropriate which haven’t introduced the HPV vaccine as part DOI: https://doi.org/10.3329/jbcps.v39i2.52392 observed high immunogenicity and safety of the all HPVs. Activated cell divisionis necessary for viral manifestation of persistent genital HPV infection is 81446, https://doi.org/10.2106/00004623-198567010-00024 Long-Segment Stabilization. Open Orthop J. https://doi.org/10.1097/01.brs.0000218221.47230.dd with Cotrel-Dubousset instrument. J Orthop Surg. carcinogen influencing its development.21 This two is unclear. In this study the mean preoperative treatment. This method markedly reduce the hospital fusion technique. Orthop Clin North Am. 47. Modi HN, Chung KJ, Seo IW, Yoon HS, Hwang JH, bHPV vaccine among Bangladeshi adolescent girls at DNA access to the cell nucleus. Initial viral Cervical Intraepithelial Neoplasia (CIN). Within a 2010;4(1):7-13. https://doi.org/10.2174/ 187432500 PMid:16685240 2003;11(1):59-66. https://doi.org/10.1177/230949900 finding laid the ground for the idea of a vaccine stay and enhances neurological and functional 8. Hur J-W. A Comparative Analysis of the Efficacy of 1998;29(4):813-28. https://doi.org/10.1016/S0030-58 Kim HK, et al. Two levels above and one level below 7 months of vaccination.Sustained efficacy, replication in the basal cells requires E1 and E2 few years of infection, low-grade CIN(CIN 1) may kyphotic deformation of vertebral body was around 1004010007, PMid:20177428 PMCid:PMC2822149 301100113, PMid:12810974 Introduction: Human papillomavirus (HPV) is the virtually Short-Segment Pedicle Screw Fixation with that of 24. Kang S-K, Lee CW, Park NK, Kang T-W, Lim J-W, 98(05)70050-X pedicle screw fixation for the treatment of unstable against HPV infection and cervical cancer, and in proteins. The role of E6 and E7 in the basal layer is develop, which may spontaneously resolve and the 21.80and 14.50 at final follow-up. kyphotic recovery with an acceptable fusion rate. Cervical cancer is a major public health problem necessary cause of carcinoma cervix. HPVs causing immunogenicity, and safety of the bHPV vaccine Long-Segment Pedicle Screw Fixation for Unstable 16. Altay M, Ozkurt B, Aktekin CN, Ozturk AM, Dogan Cha KY, et al. Predictive Risk Factors for Refracture 41. Cho DY, Lee WY, Sheu PC, Sonntag VKH, Hitchon thoracolumbar fracture with partial or intact 1999 it finally became clear that persistent HPV uncertain; particularly for the low-risk HPVs. infection clear. Persistent HPV infection, may deformation was observed 200 pre-operatively and 33. Cantor, Jeffrey B., MD; Lebwohl, Nathan H., MD; worldwide. It is the 4th most frequently diagnosed not only the vast majority of cervical (99.7%), but were observed in the final analysis of a follow-up Funding: No funding sources Thoracolumbar Spinal Burst Fractures. Clin Med Res. after Percutaneous Vertebroplasty. Ann Rehabil Med. PW, Cooper PR, et al. Treatment of Thoracolumbar neurology. J Orthop Surg Res. 2009;4(1):1-6. 19 infection is a necessary cause of invasive cervical 30 at final follow-up (42). Mean beck index was Ö, Tabak AY. Treatment of unstable thoracolumbar Garvey, Timothy, MD; Eismont, Frank J. M. study up to 9.4 years postvaccination. Deregulation of E6/E7 expression is critical in progress directly to higher-grade CIN (CIN2 or Burst Fractures with Polymethyl Methacrylate cancer in women worldwide, with an estimated also a substantial proportion of other anogenital and 3 Conflict of interest: None declared 2015;4(1):1. https://doi.org/10.11648/j.cmr.20150401.11 junction burst fractures with short- or long-segment 2011;35(6):844. https://doi.org/10.5535/arm.2011.35. https://doi.org/10.1186/1749-799X-4-28 cancer. HPV infection is commonly found in the determining neoplastic grade. In high-risk HPVs, CIN3). High-grade abnormalities are at risk of found 0.68 pre operatively and 0.80 at final follow Nonoperative Management of Stable Thoracolumbar 570,000 new cases in 2018. It is also the 4th leading head and neck cancers.3,4 Among all HPV-associated HPV vaccine has introduced in Bangladesh by the 6.844, PMid:22506213 PMCid:PMC3309392 Vertebroplasty and Short-segment Pedicle Screw PMid:19635134 PMCid:PMC2724433 anogenital tract of men and women with and without E6/E7 mediates proliferation of the basal and progression to cancer. Some high-grade abnormalities up in this study. Sapkas (15) showed similar results References: 9. Alvine GF, Swain JM, Asher MA, Burton DC. posterior fixation in magerl type a fractures. Eur Spine Burst Fractures With Early Ambulation and Bracing. cause of cancer death, with an estimated 311,000 malignancies, cervical cancer is the most important Ministry of Health and Family Planning (MoHFP), with a p-value of 0.150, 0.819 and 0.204 thoracolumbar injuries sustain some degree of clinical lesions. The etiological role of HPV infection parabasal cells, facilitating lesion growth. HPV E6 spontaneously regress. If left, undetected and where preoperative Beck index was 0.60 and 0.92 at 1. Avanzi O, Landim E, Meves R, Caffaro MF, de Treatment of thoracolumbar burst fractures with J. 2007;16(8):1145-55. https://doi.org/10.1007/ s00586- 25. Vaccaro AR, Lehman RA, Hurlbert RJ, Anderson PA, Spine (Phila Pa 1976) [Internet]. 1993;18(8):971-6. deaths in 2018. Cervical cancer is the 2nd most cause of morbidity and mortality worldwide. with support from the Global Alliance for Vaccines respectively. neurological deficit. These types of injuries are best among women with cervical cancer is and E7 oncoproteins bind to and inactivate tumor untreated, years or decades later CIN2 or 3 can final follow up. Albuquerque Araujo Luyten F, Faria AA. variable screw placement or Isola instrumentation and 007-0310-5,PMid:17252216 PMCid:PMC2200786 Harris M, Hedlund R, et al. A New Classification of Available from: https://journals.lww.com/ spinejournal/ commonly diagnosed cancer and leading cause of Approximately 70% of cervical cancers worldwide and Immunizations (GAVI) for two years in Gazipur treated by vertebral column decompression and Abstract/1993/06150/Nonoperative_Management_of well-established, and there is growing evidence of its suppressor proteins p53 and pRb, respectively, progress to cervical cancer. The time lag between the During the follow-up hardware failure was detected According to functional outcome ODI was 67.68% Thoracolumbar Burst Fracture: Load Sharing arthrodesis: Case series and literature review. J Spinal 17. Alanay A, Acaroglu E, Yazici M, Oznur A, Surat A. Thoracolumbar Injuries. Spine (Phila Pa 1976). cancer death among females in less developed are associated with two high-risk HPV types (16/18), district and if it is successful, GAVI will provide stabilization (31). The management plans differ Disord Tech. 2004;17(4):251-64. https://doi.org/ 2005;30(20):2325-33. _Stable_Thoracolumbar.4.aspx 1 20 central role in other anogenital cancers (anus, vulva, leading to malignant transformation of infected cells. peak of HPV infection and the peak of cancer in 3 cases. There were 9 cases of superficial wound (Crippled) pre operatively which became 25.6% Classification and Posterior Instrumentation Failure. Short-Segment Pedicle Instrumentation of countries. Cervical cancer is the 2nd leading cause of while other high-risk HPV types 31, 33, 35, 45, 52 support for national introduction of HPV vaccine. among many of the researchers regarding operative 10.1097/01.bsd.0000095827.98982.88 https://doi.org/10.1097/01.brs.0000182986.43345.cb https://doi.org/10.1097/00007632-199306150-00004 5,6 vagina, penis), head and neck cancers. HPV is also incidence generally takes place over a period of 10 to infection and bed sore each which were responded to (moderately disabled) at final follow up Aly (43) Rev Bras Ortop (English Ed [Internet]. Thoracolumbar Burst Fractures. Spine (Phila Pa female cancer in incidence and 3rd leading cause of and 58 are responsible for approximately 20% case. There has been little success with screening program Transmission and natural history of HPV (32) and non-operative approaches (33,34). PMid:15280752 PMid:16227897 PMid:8367784 female cancer deaths among Bangladeshi women responsible for diseases e.g recurrent juvenile 26 20 years, making the initiating infections and conservative treatment. showed in a meta-analysis that Kim 2009, Canbeck 2010;45(3):236-40. Available from: http://dx.doi.org/ 1976). 2001;26(2):213-7. https://doi.org/10.1097/ HPV type 16/18 infection was detected in 40.42% of against cervical cancer, which is a major public infection : respiratory papillomatosis and genital warts, both precursor lesions of cervical cancer anappropriate 10.1016/S2255-4971(15)30363-3 26. Christensen FB, Laursen M, Gelineck J, Eiskjær SP, 34. Mumford, Joe, MD; Weinstein, James N., DO; Spratt, with an estimated 8,068 new cases and 5,214 deaths the women in Bangladesh with cervical epithelial cell health problem in Bangladesh. Therefore, a National HPV infection occurs at the basal epithelium during References: According to literature review the result of our study 2014 and Azmiri (44) found similar result which 10. Liu L, Gan Y, Zhou Q, Wang H, Dai F, Luo F, et al. 00007632-200101150-00017, PMid:11154543 2 22 in 2018. 7 mainly caused by HPV 6/11. target for screening and early detection. Some lesions Among all spinal injury thoracolumbar junction is is almost similar to internationally published studies. were 30%, 29% and 25% at last follow up https://doi.org/10.1016/S2255-4971(15)30363-3 Improved monosegment pedicle instrumentation for Thomsen K, Bünger CE. Interobserver and Kevin F., PhD; Goel, Vijay K. P. Thoracolumbar abnormality. HPV type 16 was detected in 81.82%, HPV Vaccination Program will reduce the mortality sexual intercourse. Although the incidence of 18. Knop C, Bastian L, Lange U, Oeser M, Zdichavsky become cancerous more rapidly, sometimes within 2 the commonest and comprises > 50% of the cases of It is observed that active age group was mostly respectively (moderately disabled). In this series, treatment of thoracolumbar incomplete burst Intraobserver Agreement of Radiograph Interpretation Burst Fractures: The Clinical Efficacy and Outcome type 18 in 9.09% and type 45 in 6.06% cases of and morbidity of cervical cancer in Bangladesh.The Structure23 and gene functions24 of HPV: infection is high, but most infections resolve 2. Gertzbein S.D., Court-brown, CM., Marks, P., Fazl, M., M, Blauth M. Complications in surgical treatment of a. Dr. Chowdhury Shamima Sultana, Assistant Professor, Department of years. Infection with one type of HPV does not all spinal fractures (28). affected with a male 126 (86.3%) dominancy. RA Mean Pre op VAS (pain intensity) was 57mm fractures. Biomed Res Int. 2015;2015. https://doi.org/ With and Without Pedicle Screw Implants. Spine of Nonoperative Management. Spine (Phila Pa 1976). cervical carcinoma in Bangladesh.8 objective of the review article is to evaluate the HPV is a relatively small non-enveloped double- spontaneously. Several studies have suggested that Schwartz, M., Jacobs RR. The Neurological Outcome thoracolumbar injuries. Eur Spine J. 2002;11(3):214-26. Gynaecological Oncology, National Institute of Cancer Research & Hospital prevent infection with another type. If persons raja, (31) showed 86% male patients in his series. In (moderate) and at final follow up it was 17 mm 10.1155/2015/357206,PMid:26097844 (Phila Pa 1976). 2001;26(5):538-43. https://doi.org/ 1993;18(8):955-70. (NICR&H), Dhaka. current status of the cervical cancer prevention stranded DNA virus in the family Papillomaviridae. most women successfully clear the HPV infection, Holdsworth, F. (1963) first described the burst following Surgery for Spinal Fractures. Spine (Phila https://doi.org/10.1007/s00586-001-0382-6, https://doi.org/10.1097/00007632-199306150-00003 In developed countries, incidence and mortality of infected with mucosal HPV, 5% to 30% are infected this study, most common level injured was L1 (mild) Pain intensity according to VAS was pre op PMCid:PMC4434173 10.1097/00007632-200103010-00018, Address of Correspondence: Dr. Chowdhury Shamima Sultana, Assistant Prof. achieved by HPV vaccination worldwide. It is associated with histone-like proteins and presumably through the action of a competent fracture (29). The existence of the unstable burst Pa 1976) [Internet]. 1988;6(13):641-4. Available PMid:12107790 PMCid:PMC3610522 cervical cancer has been lowered by effective with multiple types of the virus. 40mm post op 4 mm observed by Yang (45). PMid:11242382 35. Muralidhar BM, Hegde D, Hussain PSB. Department of Gynecological Oncology, National Institute of Cancer Research & immune system. Among the infected individuals, fracture, with complete disruption of the posterior (56.2%) and followed by D12 (27.4%). Altay (16) from:https://journals.lww.com/spinejournal/Abstract/ 11. Danisa OA, Shaffrey CI, Jane JA, Whitehill R, Wang Hospital (NICR&H), Dhaka. Mobile: +88 01711360651. Email: population-based screening program with Pap smear Rationale of the review protected by a capsid formed by two late proteins, L1 19. Chen HH, Wang WK, Li KC, Chen TH. Management of unstable thoracolumbar spinal 9 approximately, 90% of lesions regress spontaneously HPV prevalence: elements and increased potential for neural injury showed 51.6% involvement of L1 and 29% Fusion rate with pedicular fixation (99%) were 1988/06000/The_Neurological_Outcome_following_ GJ, Szabo TA, et al. Surgical approaches for the 27. Bridwell, Keith H., MD*; Lenke, Lawrence G., MD*; [email protected] and or HPV DNA testing. Government of National HPV vaccination programs have been and L2. Each virion contains 72 copies of the L1, the Biomechanical effects of the body augmenter for fractures by pedicle screws and rods fixation. J Clin without clinical signs or symptoms within 12 to 36 There have been many studies worldwide on the was described in whitesides, 1977(30). It is involvement of D12. Muralidhar (35) observed that significantly higher than those for anterior Surgery_for.7.aspx https://doi.org/10.1097/ 00007632- correction of unstable thoracolumbar burst fractures: McEnery, Kevin W., MD†; Baldus, Christy, LPN*; Postal address: 65/H, Azimpur Govt Colony, Dhaka-1205. Bangladesh with the support of UNFPA has taken implemented in many countries to prevent cervical major component of the capsid, and a variable reconstruction of the vertebral body. Spine (Phila Pa Diagnostic Res. 2014; months, a small proportion of infected persons proportion of cervical cancer, other anogenital estimated that approximately 75% of patients with 70% were at L1 level and 3 cases at D12 (10%). instrumentation (46) In this series, 48% of cases 198806000-00007, PMid:3175754 A retrospective analysis of treatment outcomes. J Blanke, Kathy R. Anterior Fresh Frozen Structural Received: 22 December, 2019 Accepted: 08 March, 2021 initiative to develop a cervical cancer screening cancer. But no National HPV Vaccination number of copies of L2, a secondary component of 123

cancers, high& low-grade squamous intraepithelial 81.82%followed by 18 in 9.09%& 45 in 6.06% cases • warnings about tobacco use • A quadrivalent vaccine (Gardasil®/Silgard®, Mechanism of vaccine related protection: were seroconverted for anti-HPV-16&18 antibodies developing countries which haven’t introduced the 2. Bruni L, Albero G, Serrano B, Mena M, Gómez D, ewjm.175.4.231. https://doi.org/10.1136/ ewjm. 18. Khatun S, HussainSMA, Chowdhury S, Ferdous J, 10.1016/j.vaccine.2013.10.003, PMid:24332295 PMid:19115209, DOI: 10.1002/ijc.24116, https://doi.org/ Muñoz J, et al. ICO/IARC Information Centre on 175.4.231, PMid:11577044 PMCid:PMC1071564 Hossain F, Begum SR, et al. Safety and PMCid:PMC7605442, DOI: 10.1016/j.vaccine.2013. lesions (HSIL and LSIL) due to different HPV of cervical carcinoma. Among precancerous cases, • male circumcision. produced by Merck & Co)–protects against HPV Systemic immunization with L1 VLPs generates at Month 7. At Month 48 of that study, all subjects HPV vaccine as part of their national public health 10.1002/ijc.24116, PMid:19115209 HPV and Cancer (HPV Information Centre). Human Immunogenicity Profile of Human Papillomavirus- 10.003, https://doi.org/10.1016/j.vaccine.2013.10.003 genotypes as well as prevalence of HPV in general only type 16 was detected. 16 & 18, 6 & 11 that causes anogenital warts antibody concentrations higher than in a natural were still seropositive for anti-HPV-16 antibodies strategy to prevent and control cervical cancer. 11. Zhao KN, Zhang L, Qu J. Dr. Jian Zhou: The great 33. Uterine cervical neoplasms - prevention and control. b) Secondary prevention through screening and Papillomavirus and Related Diseases in Bangladesh. 16/18 AS04 Adjuvant Cervical Cancer Vaccine: A PMid:24332295 PMCid:PMC7605442 population. also. infection. The HPV vaccines are highly and all but one subject in the 46–55 years age group inventor of cervical cancer vaccine. Protein Cell.2017; Comprehensive cervical cancer control: a guide to HPVprevalence in vulvar, vaginal and anal treatment of adult sexually active women for Bivalent HPV vaccine was registered in Bangladesh Summary Report 17 June 2019. [Date Accessed] Randomized Controlled Trial in Healthy Adolescent 27 immunogenic leading to seroconversion in virtually remained seropositive (99.4%) for anti-HPV-18 8(2): 79-82. DOI: 10.1007/s13238-016-0358-2 26. Human Papillomavirus. In: Centers for Disease Bruni L et al performed a meta-analysis of cervical intraepithelial neoplasia (VIN, VAIN, AIN) grades As of December 2014, the U.S.FDA approved Girls of Bangladesh. Jpn J Clin Oncol. 2011;42(1): essential practice. 2nd ed. World Health Organization. precancerous lesions, starting from 30 years of age. 100% of vaccinees. Antibody titers in blood reach 39 in 2009 while qHPV was registered in 2014.HPV 3. Walboomers JM, Jacobs MV, Manos MM, Bosch FX, https://doi.org/10.1007/s13238-016-0358-2 Control and Prevention. Epidemiology and Prevention HPV prevalence among women with normal 1-3 and carcinoma was conducted in 4 continents. antibodies. Roteli-Martins CM et al report the 36-41. https://doi.org/10.1093/jjco/hyr173, PMid:22194637 2014. ISBN 978 92 4 154895 3 Merck’s 9- valent HPV vaccine (GARDASIL 9®) vaccine has recently been introduced in Bangladesh Kummer JA, Shah KV, et al. Human papillomavirus is PMid:28108949 PMCid:PMC5291779 c)Tertiary prevention and palliative care for women peaks 2–3 log higher than in natural infections, long-term efficacy and immunogenicity of the PMCid:PMC3244935, DOI: 10.1093/jjco/hyr173 of Vaccine-Preventable Diseases. Hamborsky J, cytological findings. The estimated global HPV Overall HPV prevalence was 67.8%, 85.3% and which includes the additional five HPV 31, 33, 45, a necessary cause of invasive cervical cancer 34. Guide to introducing HPV vaccine into national affected by invasive cervical cancer include surgery, decrease gradually to levels several-fold lower than HPV-16/18 AS04-adjuvanted vaccine up to 8.4 y by the Ministry of Health and Family Planning 12. Markowitz LE, Dunne EF, Saraiya M, Chesson HW, https://doi.org/10.1093/jjco/hyr173 Kroger A, Wolfe S, eds. 13th ed., Supplement. prevalence was 11.7%. While based on the world 40.4% among VIN1, VIN2/3& vulvar carcinomas; 52& 58 compared to the quadrivalent vaccine. worldwide. J Pathol.1999;189(1): 12-19. https://doi.org/ immunization programmes. Immunization, Vaccines radiotherapy and chemotherapy. peak and then remain stable for years. The IgG is after the first vaccine dose. No new infection or (MoHFP), with support from the Global Alliance for Curtis CR, GEE J, et al. Human Papillomavirus PMid:22194637 PMCid:PMC3244935 Washington D.C. Public Health Foundation, 2017. regions Sub-Saharan Africa (24%), Eastern Europe 100%, 90.1% and 69.9% among VAIN1, VAIN2/3& 10.1002/(SICI)1096-9896(199909)189:1<12::AID-P and Biologicals. World Health Organization. 2016; Both vaccines are composed of type-specific HPV L1 exuded at the possible sites of infection (mucosa of Vaccines and Immunizations (GAVI). This new Vaccination: Recommendations of the Advisory p.175-186. (21.4%) and Latin America (16.1%) showed the vaginal carcinomas; and 91.5%, 93.9% and 84.3% HPV vaccines34: lesions associated with HPV-16/18 occurred in the ATH431>3.0.CO;2-F, DOI: 10.1002/(SICI)1096-9896 19. Naud PS, Roteli-Martins CM, De Carvalho NS, 1-90. ISBN: 978 92 4 154976 9 protein, the major capsid protein of HPV which is genital tract, oral cavity, etc.), neutralizes the virus 19 Committee on Immunization Practices (ACIP). highest prevalence’s. among AIN1, AIN2/3& anal carcinomas, vaccine group. NaudPSet al conducted a long-term vaccine introduction program ran for two years in (199909)189:1<12: AID-PATH431>3.0.CO;2-F Teixeira JC, De Borba PC, Sanchez N, et al. Sustained 27. Bruni L, Diaz M, Castellsagué X, Ferrer E, Bosch FX, The availability of prophylactic HPV vaccines has used as an antigen. Through Recombinant DNA and prevents its entry into the cells. The MMWR Recomm Rep. 2014; 63(RR-05): 35. Human papillomavirus vaccines: Weekly epidemiological respectively. HPV16 was found>75% and 18 <10% follow-up of an initial double-blind, randomized Gazipur district and if it is successful, GAVI will efficacy, immunogenicity, and safety of the De Sanjosé S. Cervical human papillomavirus Alemany L et al28 estimated the HPV type-specific provided a powerful tool for primary prevention of technology the L1 protein undergoes conformal vaccine-induced immune memory in the form of 4. Zur Hausen H. Papillomaviruses in the causation of 1-30.PMID: 25167164 record. WHO position paper.2017;92(19):241-268. in HPV positive vulvar, vaginal and anal carcinomas. (1:1), placebo-controlled study evaluating the provide support for national introduction of HPV HPV-16/18 AS04-adjuvanted vaccine: final analysis prevalence in 5 continents: Meta-analysis of 1 million distribution in a large series of invasive cervical cervical cancer and other HPV-associated diseases. human cancers-a brief historical account. Virology. ISSN 0049-8114 changes to self-assemble into 'virus-like' particles circulating plasma cells and memory B-cells allows 40 13. Meites E, Kempe A, Markowitz LE. Use of a 2-Dose of a long-term follow-up study up to 9.4 years women with normal cytological findings. J Infect Dis. Approximately 40% ofvulvar, 60% of vaginal and The vaccines are most effective when administered to efficacy against HPV16/18 infection and associated vaccine . WHO recommends that girls are 2009; 384(2): 260-265. https://doi.org/ 10.1016/ cancer (ICC) over 70 years from 11 countries in (VLPs). The VLPs are non-infective and non- generation and exudation of protecting IgG each time Schedule for Human Papillomavirus Vaccination - post-vaccination. Hum VaccinImmunother. 2014; 2010; 202(12): 1789-1799. https://doi.org/ 80% of anal carcinoma are responsible for a person prior to exposure to HPV. Two HPV cyto-histopathological abnormalities, persistence vaccinated with HPV vaccine between the ages of j.virol.2008.11.046, PMid:19135222, DOI: 10.1016/ 36. Harper DM, Franco EL, Wheeler CM, Moscick AB, Central-South America, Asia and Europe. Among pathogenic as these are devoid of the viral DNA the body is challenged by exposure to HPV infection. Updated Recommendations of the Advisory 10(8), 2147-2162. https://doi.org/10.4161/hv.29532 10.1086/657321, PMid:21067372, DOI: 10.1086/ HPV16/18.32 ofimmunogenicity, and safety of the HPV-16/18 j.virol.2008.11.046. https://doi.org/10.1016/j.virol. Romanowski B, Roteli-Martins CM, et al. Sustained 4,771 HPV DNA positive ICC cases, HPV16&18 vaccines are currently pre-qualified by WHO: essential to initiate the carcinogenic process. Bivalent 9-13 years. In line with this, the Government of Committee on Immunization Practices. MMWR Morb PMid:25424918 PMCid:PMC4896780, DOI: 657321, https://doi.org/10.1086/657321, PMid:21067372 Animal models suggest that very low antibody titers 2008.11.046, PMid:19135222 efficacy up to 4.5 years of a bivalent L1 virus-like AS04-adjuvanted vaccine. No new HPV 16/18- Bangladesh has decided to vaccinate 10-year-old Mortal Wkly Rep. 2016; 65(49):1405-1408. were the two most common HPVs in all the decades Co-factors associated with cervical cancer: • A bivalent vaccine (Cervarix®, produced by vaccinecontains a novel adjuvant AS04 and may still be protective. Partial cross-protection 10.4161/hv.29532, https://doi.org/10.4161/hv.29532 28. Alemany L, De Sanjosé S, Tous S, Quint W, Vallejos particle vaccine against human papillomavirus types 5 associated infections and cyto-histopathological girls in the primary school setting (Grade 5) with two 5. Mu˜noz N, Castellsagu' E X, De González AB, https://doi.org/10.15585/mmwr.mm6549a5 (HPV16-from 61.5 to 62.1%, and HPV18-from 6.9 to Muñoz N et al stated that although HPV is a GlaxoSmithKline)–protects against HPV 16 & quadrivalent vaccine VLPs are adsorbed on an against HPV31, HPV33 and HPV45 has been PMid:25424918 PMCid:PMC4896780 C, Shin HR.et al. Time trends of human 16 and 18: follow-up from a randomized control trial. 25 abnormalities occurred in the vaccine group. Gissmann L, Chapter 1: HPV in the etiology of human PMid:27977643, DOI: http://dx.doi.org/10.15585/ 7.2%). A meta-analysis update conducted by SmithJS necessary cause of cervical cancer, it is not a 18 that cause the majority of cervical cancers; aluminum-containing adjuvant to ensure robust and described. doses of bHPVvaccine, given 6 months apart. The 20. WORLD HEALTH ORGANIZATION. Country papillomavirus types in invasive cervical cancer, from Lancet.2006; 367(9518):1247-1255. https://doi.org/ 6 18 cancer. Vaccine. 2006; 24 (3): S1-S10. https://doi.org/ mmwr.mm6549a5external icon et al showed HPV type distribution in ICCand HSIL. sufficient cause. Epidemiologic studies indicate that long-lasting immunogenicity.12 Khatun S et al conducted a study to assess the target girls will mainly be reached through the office for Bangladesh. Human papillomavirus (HPV) 1940 to 2007.2014. Int J Cancer. 2014; 135(1):88-95. 10.1016/S0140-6736(06)68439-0, DOI: 10.1016/ and Recommended vaccination schedule: 10.1016/j.vaccine.2006.05.115, PMid:16949995, In ICC, HPV16 was the most common, and HPV18 the risk of contracting genital HPV infection and immunogenicity and safety profile of HPV16/18 14. Markowitz LE, Hariri S, Lin C, Dunne EF, Steinau M, vaccine introduced in Bangladesh.18 May 2016. https://doi.org/10.1002/ijc.28636, PMid:24382655, S0140-6736(06)68439-0, https://doi.org/10.1016/ The primary target group in most of the countries schoolbasedprogramme and girls who are out of DOI: 10.1016/ j.vaccine.2006.05.115, https://doi.org/ the second most common, type in all continents. The cervical cancer is influenced by a variety of factors. vaccines in healthy Bangladeshi girls aged between McquillanG, et al. Reduction in human News release DOI: 10.1002/ijc.28636, https://doi.org/10.1002/ S0140-6736(06)68439-0 recommending HPV vaccination is young adolescent school will receive the vaccine through the routine 10.1016/j.vaccine.2006.05.115, PMid:16949995 papillomavirus (HPV) prevalence among young next most common HPV types were HPV31, 33, 35, Thus, other cofactors are necessary for progression 9–13 years. They recommended that, bHPV vaccine EPI sites at the community level. 21. Morshed K, Polz-Gruszka D, Szymański M, ijc.28636, PMid:24382655 girls, aged 9-14.WHO has recommended the 6. Smith JS, Lindsay L, Hoots B, Keys J, Franceschi S, women following HPV vaccine introduction in the 37. De Carvalho N, Teixeira J, Roteli-Martins CM, Naud 45, 52 and 58. HPV18 was significantly more from cervical HPV infection to cancer. Long-term 35 was generally well tolerated, with no vaccine-related Polz-Dacewicz M. Human Papillomavirus (HPV) - following vaccination schedule . Winer R, et al. Human papillomavirus type United States, National Health and Nutrition 29. Nahar Q, Sultana F, Alam A, Islam JY, Rahman M, P, De Borba P, Zahaf T, et al. Sustained efficacy and prevalent in adeno/adenosquamous carcinoma than use of hormonal contraceptives, high parity, tobacco serious adverse effects. Conclusion: Structure, epidemiology and pathogenesis. Otolaryngol distribution in invasive cervical cancer and high-grade Examination Surveys, 2003-2010. J Infect Khatun F. et al. Genital human papillomavirus immunogenicity of the HPV-16/18 AS04-adjuvanted in squamous cell carcinoma. Among HSIL cases, smoking, and co-infection with HIV have been • Females <15 years at the time of first dose: a Immunization with the HPV vaccine induces Pol. 2014;68(5):213-219. https://doi.org/10.1016/ HPV prevalence, cross-protection and herd cervical lesions: A meta-analysis update. Int. J. Dis.2013;208(3):385-393. https://doi.org/10.1093/ infection among women in Bangladesh: findings from vaccine up to 7.3 years in young adult women. HPV16/18prevalence was 52%. WalboomersJM et identified as established cofactors; co-infection with sustained high levels of antibodies against high-risk j.otpol.2014.06.001, PMid:25283316, DOI: 10.1016/ 2-dose schedule (0, 6 months) is recommended. Cancer. 2007; 121(3): 621-632. https://doi.org/ infdis/jit192, PMid:23785124, DOI:10.1093/infdis/jit192. a Population-based survey. PLoS One. 2014; 9(10): Vaccine.2010; 28(38):6247-6255. https://doi.org/10.1016/ 3 immunity after vaccination: j.otpol.2014.06.001, https://doi.org/10.1016/j.otpol. al found that the worldwide HPV prevalence in Chlamydia trachomatis (CT) and herpes simplex HPV genotypes 16 and 18. The durable immune 10.1002/ijc.22527, PMid:17405118, DOI: 10.1002/ e107675. https://doi.org/10.1371/journal.pone.0107675 j.vaccine.2010.07.007, PMid:20643092, DOI: If the interval between doses is shorter than 5 months, A national HPV immunization program using a 15. Tabrizi SN, Brotherton JM, Kaldor JM, Skinner SR, 2014.06.001, PMid:25283316 cervical carcinomas is 99.7%. virus type-2 (HSV-2), immunosuppression, and response induced by the HPV vaccine in adolescent ijc.22527.https://doi.org/10.1002/ijc.22527 PMid:25271836 PMCid:PMC4182674, DOI: 10.1016/j.vaccine.2010.07.007, https://doi.org/ then a third dose should be given at least 6 months bHPV vaccine was implemented in Scotland in 2008, Liu B, Bateson D,et al. Assessment of herd immunity certain dietary deficiencies are other probable girls is predicted to provide long-term protection PMid:17405118 22. Bruni L, Albero G, Serrano B, Mena M, Gómez D, 10.1371/journal.pone.0107675, https://doi.org/10.1371/ 10.1016/j.vaccine.2010.07.007, PMid:20643092 Bangladesh had also different studies that focused on after the first dose. along with a national surveillance program designed and cross-protection after a human papillomavirus cofactors. against HPV infection and subsequent development Muñoz J, Bosch FX, de Sanjosé S. ICO/IARC journal.pone.0107675, PMid:25271836, PMCid:PMC4182674 HPV genotyping in different groups of females. to determine the longitudinal effects of vaccination 7. Banik U, Ahamad MSU, Bhattacharjee P, Adhikary vaccination programme in Australia: a repeat 38. Schwarz TF,Spaczynski M, Schneider A, Wysocki J, 29 • Information Centre on HPV and Cancer (HPV Nahar Q et al revealed prevalence of HPV infection Strategies for cervical cancer prevention and Females ≥15 years at the time of first dose & of high-grade cervical lesions and cancer. The AK, Rahman Z. cross-sectional study. Lancet Infect Dis.2014; 30. Sultana T, Huq M, Alam A, Mitra DK, Gomes DJ. Galaj A, Schulze K, et al. Persistence of immune on HPV infection at the population level. By linking Information Centre). Human Papillomavirus and was 7.7% with no significant difference between control33: immunocompromised and/or HIV-infected.: a 14(10):958-966.DOI: 10.1016/S1473-3099(14) 70841-2, Prevalence and genotyping of human papillomavirus vaccination, cervical screening, and HPV testing knowledge gained from this review is important for 8. High risk human papillomavirus type 16 and 18 Related Diseases in the World. Summary Report 17 response to HPV-16/18 AS04-adjuvanted cervical 3-dose schedule (0, 1-2, 6 months) is https://doi.org/10.1016/S1473-3099(14)70841-2 (HPV) in female with high-risk behaviour in Dhaka, urban and rural women. HR-HPV (High risk) WHO recommends a comprehensive approach to realizing the necessity of the use of a prophylactic infection in the cervical lesions of women with cancer vaccine in women aged 15-55 years. Hum recommended. data, over the study period they found a decline in June 2019. [Date Accessed] Bangladesh. Bangladesh J Microbiol. 2008; infections were more common (4.2%) than LR-HPV cervical cancer prevention and control. The HPV16/18 vaccine in Bangladeshi girls. There has epithelial cell abnormality in Pap smear: A 16. Kavanagh K, Pollock KG, Potts A, Love J, Cuschieri Vaccin.2011; 7(9): 958-965. https://doi.org/10.4161/ HPV 16 &18,significant decreases in HPV 31, 33& 23. FernandezJV and De Medeiros Fernandez TAA. 25(1):65-68. https://doi.org/10.3329/bjm.v25i1.4861, infections (3.4%). Most common HR genotypes were recommended set of actions includes following Evaluation of efficacy, immunogenicity and safety cytohistomorphologic association in Bangladeshi K, Cubie H, et al. Introduction and sustained high hv.7.9.15999, PMid:21892005 PMCid:PMC3225769, 45 (suggesting cross-protection). Among non- been little success with screening program against Chapter 1 Human Papillomavirus: Biology and DOI:https://doi.org/10.3329/bjm.v25i1.4861, HPV16,66,18,45,31&53. Sultana T et al30 noted the interventions. women. Cytojournal. 2013; 10: 14. DOI: 10.4103/ coverage of the HPV bivalent vaccine leads to DOI: 10.4161/hv.7.9.15999, https://doi.org/10.4161/ of HPV vaccine: vaccinated women, HPV 16 & 18 infections were cervical cancer in Bangladesh, an intervention that Pathogenesis. Human Papillomavirus and Related https://doi.org/10.3329/bjm.v25i1.4861 prevalence of genital HPV types in the sex workers 36 1742-6413.1150888. Borna NN, Tabassum S, Jahan areduction in prevalence of HPV 16/18 and closely hv.7.9.15999, PMid:21892005 PMCid:PMC3225769 a) Primary prevention begins with HPV vaccination HarperDM et al assessed the long-term efficacy, significantly lower in 2013 than in 2009 indicating has helped to significantly reduce cervical cancer in Diseases-From Bench to Bedside-A Clinical was as high as 75.8%, whereas for the high-risk types M, Munshi S, Unnesa A. Genotyping of High-Risk related HPV types. Br J Cancer.2014;110(11), 31. Khandker E, Khan M, Chowdhury AK. Human of girls aged 9-13 years, before they become sexually immunogenicity, and safety of a bivalent HPV-16/18 herd immunity and sustained effectiveness of the the developed world. Therefore, a National HPV Perspective, 2012. 1-40, Rijeka, Croatia: InTech. DOI: 39. Roteli-Martins CM, Naud P, De Borba P, TeixeiraJC, it was 49.8%. The highest prevalence rate was Human Papillomavirus (HPV) Among Cervical 2804-2811.DOI: 10.1038/bjc.2014.198. https://doi.org/ papillomavirus infection among Bangladeshi women active. Because HPV vaccines do not protect against L1 virus-like particle AS04 vaccine against incident bivalent vaccine onvirologic outcomes at the 10.5772/27154 https://doi.org/10.5772/27154 De Carvalho NS, Zahaf T, et al. Sustained observed for the genotype 16, 18 and 58. Khandker E Vaccination Program seems to be the window of Precancer and Cancer Patients. Acta MedicaInternational. 10.1038/bjc.2014.198,PMid:24736582 with cervical intraepithelial neoplasia and chronic all HPV types that cause cervical cancer, vaccine and persistent infection with HPV 16 & 18 and their 17 immunogenicity and efficacy of the HPV-16/18 31 population level. opportunity to reduce the mortality and morbidity of 2015;2(1):19-28.DOI: 10.5530/ami.2015.1.5, https://doi.org/ PMCid:PMC4037824 24. Gómez DT and Santos JL. Human papillomavirus cervicitis. IMC J Med Sci. 2016;10(1): 29-32. et al determine HPV infection rate was 43.1%. CIN associated cytological and histological outcomes. De AS04-adjuvanted vaccine: up to 8.4 years of introduction should be part of comprehensive 10.5530/ami.2015.1.5 infection and cervical cancer: pathogenesis and https://doi.org/10.3329/imcjms.v10i1.31103, DOI: cases had significantly high (p<0.01) HPV infection 37 Scenario of HPV vaccination in Bangladesh: HPV related cervical cancer in Bangladesh. 17. Cameron RL, Kavanagh K, Pan J, Love J, Cuschieri approach to cervical cancer control. Carvalhoa N et al report efficacy and epidemiology. Communicating Current Research and follow-up. Hum Vaccin. J Immunother.2012; 8(3): 9. Michael JC, Karen C. Cervical Cancer Screening and K, Robertson C, et al. Human Papillomavirus https://doi.org/10.3329/imcjms.v10i1.31103 (78.6%) compared to cases with chronic cervicitis immunogenicity of the HPV16/18 vaccine up to 7.3 WHO has developed guidelines on prevention and References : Educational Topics and Trends in Applied 390-397.https://doi.org/10.4161/hv.18865 7 Other recommended preventive interventions for Preinvasive Disease. In: Berek JS, Hacker NF Prevalence and Herd Immunity after Introduction of https://doi.org/10.3329/imcjms.v10i1.31103 (18.2%).BanikU et al find out the extent of HR HPV years post vaccination. No cases of infection or control of cervical cancer through vaccination and 1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre Microbiology. A Mendez Vilas (ed). Spain: Formatex; PMid:22327492,DOI:10.4161/hv.18865 (editors). Berek and Hacker's Gynecologic Oncology. Vaccination Program, Scotland, 2009-2013. Emerg type 16/18 infection in women with epithelial cell boys and girls are: cytohistological lesions associated with HPV 16/18 screening. By mid-2016, globally 65 countries, LA, Jemal A. Global Cancer Statistics 2018: 2007.p. 680-688. ISBN-13-9788461194223 32. De Vuyst H, Clifford GM, Nascimento MC, https://doi.org/10.4161/hv.18865 6th edition. Philadelphia: Wolters Kluwer; 2014. p. Infect Dis.2016; 22 (1), 56-64. https://doi.org/ abnormality in Pap smear. HPV type 16/18 infection mostly in high-income and upper-middle-income GLOBOCAN Estimates of Incidence and Mortality Madeleine MM, Franceschi S. Prevalence and type PMid:22327492 • education about safe sexual practices, delayed were observed in the vaccinee. Another follow up 242-325.ISBN-13-978-1-4511-9007-6. 10.3201/eid2201.150736,PMid:26692336 25. Bosch FX, Broker TR, Forman D, Moscicki AB, was detected in 40.42% of the patients. Borna NN et 38 Worldwide for 36 Cancers in 185 Countries.CA: distribution of human papillomavirus in carcinoma start of sexual activity study (up to 4 years) of SchwarzTF et al showed settings had introduced HPV vaccines into their PMCid:PMC4696690, DOI: 10.3201/eid2201.150736 Gillison ML, Doorbar J. et al. Comprehensive Control 40. World Health Organization. Country office for 8 33 Cancer J Clin. 2018; 68:394-424.DOI: 10.3322/ 10. Jacqueline S, Cristina H, Christopher E. Beyond Our and intraepithelial neoplasia of the vulva, vagina and al identify HR HPV genotype among women having persistence of immune response to HPV-16/18 national immunization programs . But the global https://doi.org/10.3201/eid2201.150736 of Human Papillomavirus Infections and Related • promotion and provision of condoms for those caac.21492.https://doi.org/10.3322/caac.21492 Borders Cervical cancer in the developing world. anus: a meta-analysis. Int J Cancer. 2009; Bangladesh. Human papillomavirus (HPV) vaccine CIN and carcinoma. HPV 16 was detected in vaccine in women aged 15–55 years. All subjects burden of cervical cancer fallsheaviest on the PMid:26692336 PMCid:PMC4696690 Diseases. Vaccine. 2013;31(7): H1-31. https://doi.org/ already engaged in sex PMid:30207593 West J Med. 2001; 175: 231-233. DOI: 10.1136/ 124(7):1626-1636. https://doi.org/10.1002/ijc.24116 introduced in Bangladesh. News release.2016. The assessment of neurological function is done by The use of transpedicular fixation two levels above thoracic level and caudally 6.5 mm diameter T12 in 82, 24, and 40 cases respectively. In this using the American Spinal Injury Association and below the fractured vertebra reduce the multiaxial screws were used. The instrumentation series maximum number of patients (92) operated (ASIA) method and graded according to the ASIA kyphosis, instrument failure and collapse of the was applied bilaterally. Fracture reduction and within 15 to 21 days (63%) and maximum fractures Impairment scale. Examination of anal sensation and vertebrae22. LSPF has gained popularity in the last indirect spinal canal decompression both could be were unstable burst in nature 102 (70%). decade as it has the aforementioned advantages as sphincter autonomic contraction should be accomplished by contouring the rod and applying All the patients were decompressed posteriorly and well as relieve pain sufficiently23. performed to identify complete or incomplete compression-distraction forces before tightening the long segment stabilization was done in each case by 6 neurological deficit as a standard protocol . Methods: screws. Long segment posterior fixation was done titanium pedicle screws and rods. Post-operative with autogenous bone grafting from the spinous The management of unstable thoracolumbar 146 patients (age range 15-60, mean 31.5±9.58 Xray showed good hardware position in all patients. process and lamina in all patients and applied fractures remains challenging. Effective correction years) with thoracolumbar fracture (T10– L2) with Adequate decompression was achieved in all the thoracolumbosacral orthosis (Taylor brace) of the deformity, neurological recovery, early incomplete neurological deficit from January2014 to cases. December 2018, studied in NITOR and private postoperatively for 3 months. Figure 1 shows Burst # mobilization and return to work are the fundamentals The mean duration of surgery was 150 ± 21 min settings were included in this study. Inclusions L2 in a 28 years’ male, fixed with LSPF. of the management, and also minimize complication. criteria were: a) single-level fracture; b) neurologic whereas the mean blood loss was 392.47 ml. The A fracture severity score was constructed using Absolute indication of early surgery is progressive function limited to ASIA Grades B, C, or D; c) mean length of hospital stay was 28 days and all the Thoracolumbar Injury Classification and Severity neurological deficit7. Other indication for surgical limited involvement of T10–L2; d) <3 weeks from patients were mobilized in the 1st or 2nd Score (TLICS). A comprehensive severity score of 3 intervention are incomplete neurological deficit, the time of injury, Exclusion criteria were: a) postoperative day. Radiological parameters are listed or less suggests a non-operative injury, while a score in Table-1. >25-300 angle of kyphotic deformity, >50% of loss Complete spinal cord injury (ASIA Grades A) b) of 5 or more suggests that surgical intervention may of vertebral body height, and >40-50% of canal Associated cervical spine & head injury; c) A paired sample T-test was conducted to compare 8 Pathological fracture of spine. This was a be considered. Injuries assigned a total score of 4 narrowing . 25 the means of radiological parameters which was prospective case series and cases were selected by might be handled conservatively or surgically . found statically significant (p-value <0.05) The surgical treatment of unstable fracture and purposive sampling. Correction loss was defined as progressive loss of fracture-dislocations of thoracolumber spine are still The mean Pre and post op VAS is 57.57±9.08 and Cobb angle in the latest follow-up radiographs in debate. Conservative treatment might be an Radiographic outcome was evaluated by measuring 16.4±8.9 (mild) respectively, 90% (131) of which compared to the initial post-operative radiographs. option, but surgery is the modern way of treatment. Cobb angle, kyphotic deformation and beck index end up with mild pain (p-value <0.05). The mean (24). Figure 2 shows measurement of Cobb Angle The fusion status of the patients was determined The goals of surgery are to restore the stability of the ODI at final follow up was 25.27 ± 8.49 which was and kyphotic deformation. Pain status was evaluated primarily with use of plain radiographs according to vertebral column and decompression of spinal canal 67.68±13.20 pre operatively with a p-value<0.05. by a 100-point VAS scale. The functional outcome the classification system of Christensen et al. 200126 (9). Posterior transpedicular fixation has been the Maximum patients (87) 59.6% end up with mild was assessed by Owestry Disability Index (ODI). by two independent observers and finally by choice for stabilizing acute unstable thoracolumbar disability at final follow-up. Neurological recovery was evaluated by ASIA Bridwell fusion grading27. The presence of screw fractures among all other methods10. In our series, pre-operative ASIA grade B was 30 grading. The investigation included X-ray, breakage, screw pullout, peri-implant loosening, and Introduction: 65% of thoracolumbar fractures occur due to motor (20.5 %), C was 48 (36.9%) and D was 68 (46.6%). Either anterior or posterior or both approaches can computed tomography (CT) scanning of the spine rod breakage were considered as criteria for implant Thoracolumbar fracture is the commonest injury of vehicle injuries and fall from height, with reminder After final follow up1 grade improvement occurred be used to stabilize and achieve fusion but the and magnetic resonance imaging (MRI). failure. the axial skeleton and accounts for around 90% ofall contributed by sports injury and violence2. in 116(79.5%) patients and 2 grade improvement in efficacy of either approach is somewhat similar11,12. spinal fractures. Due of the rigid costotransverse Informed written consent was taken from all the Data were collected concerning the age, sex, 36 (20.5%) patients. A cross-tab analysis was Due to the fulcrum of increased motion at Due to less extensile and hazardous approach, most joints of the dorsal spine, it acts as a fulcrum of patients mentioning the details of the procedure as localization, type of injury, presence of neurological conducted to see the significance of status in dorsolumbar junction, collapse of the vertebral body of the spine surgeons advocate posterior fusion as movement in dorsolumbar spine at the time of well as modalities of treatment. An expert deficits, pain, work status, complications and Pre-operative and Post-operative ASIA grading with with associated kyphotic deformity usually occurs. the treatment of choice13-15. injury1. technologist was responsible for gathering the radiologic parameters (Cobb angle, kyphotic grade impro vemen t . A Pe ar so n ch i-square v alu This vertebral collapse usually invades the spinal required information who is unaware of the Long-segment pedicle screw fixation (LSPF) usually deformation of vertebral body, vertebral height and e <0.05 indicates significant improvement in terms Thoracolumbar fractures are frequent in men and canal, which may cause neurological Deficit3. objectives and surgical procedures of this study. involves inserting eight screws: two level above & peak incidence is observed between 20 and 40 years. posterolateral fusion). Clinical and radiographic of neurology post-operatively. Long segment posterior fixation (LSPF) was done in Unstable fracture defined as failure of any two below the fracture. Short- segment pedicle fixation follow-up were done immediately after the operation 48% of cases (70) showed thick fusion mass on one every cases and performed by the same surgeon. column injury including middle column which (SSPF) involves inserting four screws: one level and at 2nd, 6th, 12th, 24th week & then 12 monthly. side i.e. bridwell grade II, 60 patients (41%) showed 16 Patients were placed in a prone position under account for 25%-50% of all fractures in this region. above & below the fracture . Statistical analysis was done using SPSS version grade I fusion and rest of patients’ had doubtful general anesthesia with modified kneeling with two They are very common in younger patients and 25.0 software. The level of statistical significance fusion with lucency. SSPF is the most common and simple treatment. It sand bags under each side of trunk which allowed the could have a great impact on their daily physical offers the advantage of incorporating fewer motion was set at P < 0.05. 4 abdomen to hang free, minimizing epidural venous A non-parametric Spearman correlation test was activities . 17,18 segments in the fusion . but may lead to implant dilation and bleeding. Pedicle screw fixation and Results: conducted among Bridwell fusion grade, Final ODI There are standard classification systems based on failure and re-kyphosis (9-54%) and reduction were performed under C-arm guidance. There were 126 men and 20 women with male to and ASIA grading. There is a significant positive fracture pattern, mechanism of injury, neuro-deficit moderate-to-severe (50%) pain9,17. To prevent this Laminectomy to decompress spinal cord was carried female ratio were 6.3:1. Mean age was 31.5 years strong correlation between Bridwell fusion gradeand and posterior ligamentous complex (PLC) injury. and augment the anterior column, placement of body out at the involved level and bone was saved to be within the range of 31–45 years. Maximum 64 Final ODI exist (r= 0.694, p-value <0.05, n=146). Xrays are the main investigation while computed augmente,19 polymethylmethacrylate injection3, used as bone graft. Screws were 40 or 45 mm long, patients were manual worker. The majority of But final ASIA grading was not correlated with tomography (CT) scan delineates the extent on bony transpedicular bone grafting20, anterior depending on the level and size of the vertebra. At fractures were due to falls (106 cases). The Bridwell fusion grade (p-value=0.394). Also injury and magnetic resonance imaging (MRI) scan instrumentation and strut grafting12 or long-segment the10th and 11th thoracic levels, 5.5 or 6.5- remaining cases were due to car accidents (40 cases). magnitude of curve correction is not related with detects the spinal cord and soft tissue injury5. posterior fixation (LSPF)21 could be done. mmdiameter multiaxial screws and at the12th The fractured vertebra body level was L1, L2, and Bridwell fusion grade, Final ODI and ASIA grading

Human Papilloma Virus Vaccinefor Cervical Cancer Prevention CS Sultana et al Maximum injuries were due to fall from height 106 showed thick fusion mass on one side i.e. bridwell 3. Ge CM, Wang YR, Jiang SD, Jiang LS. Neurosurg. 1995;83(6):977-83. https://doi.org/ 1976). 2004;29(18):382-7. https://doi.org/10.1097/ Allografts in the Thoracic and Lumbar Spine: Do 36. Lee GW, Jang SJ, Kim J Do, Son JH, Jang JH. The Fixation. Neurosurgery. 2003; https://doi.org/ program by visual inspection with acetic acid (VIA), Programhas yet been started in Bangladesh and also the viral capsid. DNA containing approximately 8000 genes. The second is an early region (E), consisting (72.6%) in this study which was 92% and 59.25% grade II and 41% shows solid fusion in both sides Thoracolumbar burst fractures with a neurological 10.3171/jns.1995.83.6.0977, PMid:7490641 01.brs.0000139308.65813.70, PMid:15371717 They Work If Combined With Posterior Fusion and efficacy of percutaneous long-segmental posterior 10.1227/01.NEU.0000093200.74828.2F, which was considered to be a feasible method for no review has been done related to HPV Vaccination base pairs and harboring an average of 8 open reading of six ORFs: E1, E2, E4, E5, E6, and E7, which deficit treated with posterior decompression and Instrumentation in Adult Patients With Kyphosis or fixation of unstable thoracolumbar fracture with PMid:14633301 cases observed in some studies (31,36). But other (grade I). 12. Kaneda K, Taneichi H, Abumi K, Hashimoto T, Satoh 20. Daniaux H1, Seykora P, Genelin A, Lang T KA. screening cervical cancer in the present so far. Hence, this review has been conducted to frames (ORFs). In a functional point of view, the encodes no structural proteins involved in viral study showed road traffic accident is the common interlaminar fusion. Eur Spine J. 2011;20(12):2195- Anterior Column Defects? Available from: partial neurologic deficit. Asian Spine J. socio-economic context. It has been estimated that explore different aspects of HPV vaccines in depth HPV genome is divided into three regions. The first is replication and oncogenesis. The third is a late (L) Regarding the postoperative complication, bed sore S, Fujiya M. Anterior decompression and stabilization Application of posterior plating and modifications in 42. Jun DS, Yu CH, Ahn BG. Posterior direct 201. https://doi.org/ 10.1007/ s00586-011-1875-6, https://journals.lww.com/spinejournal/Abstract/1995/ 2013;7(2):81-90. https://doi.org/10.4184/asj.2013.7.2.81 only 5% of the women in developing countries have cause of injury (37). Maximum fractures were burst with the Kaneda device for thoracolumbar burst thoracolumbar spine injuries. Indication, techniques, decompression and fusion of the lower thoracic and which will help to recommend a National a long control region (LCR) that has regulatory region that encodes the L1 and L2 structural proteins. and wound infection was found in 9 (6.67%) patients 06020/Anterior_Fresh_Frozen_Structural_Allografts PMid:23741544 PMCid:PMC3669707 in nature 102 (70%) which were reported 44% and PMid:21688000 PMCid:PMC3229728 fractures associated with neurological deficits. J Bone lumbar fractures with neurological deficit. Asian been screened for cervical dysplasia compared with HPVvaccination Program for prevention of cervical function of the transcription of the E6 and E7 viral each who were responded to antibiotic later. But and results. Spine (Phila Pa 1976). 1991;16(supp. _in_the.14.aspx, https://doi.org/10.1097/00007632- 83.3%(31, 35) in other studies. 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Pedicle Screw Instrumentation and_a_short_arthrodesis_for_burst.5.aspx Surgical outcomes and correlation ODI and ASIA immunogenicity, efficacy, safety etc through their with Bridwell fusion grade (p-value=0.394). Also three-column spine concept in acute spinal trauma. fixation. Int Orthop. 2007;31(2):259-64. vaccine, were licensed in 2006 and 2007 under the amount of Cobb angle and the degree of pain 0019-5413.143914,PMid:25593358 for Thoracolumbar Burst Fractures and Fracture- https://doi.org/10.2106/00004623-199411000-00005 Clin Orthop Relat Res. 1984;NO. 189:65-76. scores in patients with thoracolumbar and lumbar 12 own view. Articles related to Human papillomavirus magnitude of curve correction is not related with https://doi.org/10.1007/s00264-006-0161-4 names of Gardasil® and Cervarix® respectively. reported. Altay reported Cobb angle at preoperative PMCid:PMC4292328 Dislocations. Spine (Phila Pa 1976) [Internet]. 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But Sapkas, 2010 (15) showed preoperative Conclusion umbar.18.aspx, https://doi.org/ 10.1097/ 00007632- junction burst fractures with short- or long-segment 13 2013;8(33):3077-86. non-operatively, with early ambulation, evaluated abstract/MED/340100 2012;53(9):3-7. under the name of Gardasil9®. Different studies in The connection between persistent infection with Cobb angle was 17.5±6.8 which became 6.0±4.0 In countries like Bangladesh fractures of the 199208001-00018, PMid:1523519 posterior fixation in magerl type a fractures. Eur Spine using the load sharing classification. Acta Orthop USA, Australia and Scotland have begun to show a HPV and cervical cancer was first described by degree at final follow up. thoracolumbar spine are increasing in frequency. As 7. Bohlman HH. Treatment of fractures and dislocations 31. Raja RA. Management of thoracolumbar spine J. 2007 Aug;16(8):1145-55. https://doi.org/10.1007/ 46. Boos N, Webb JK. Pedicle screw fixation in spinal 15. Sapkas G, Kateros K, Papadakis SA, Brilakis E, Belg. 2002;68(3):279-87. drop in the prevalence of HPV associated diseases of the thoracic and lumbar spine. J Bone Jt Surg Am injuries at a tertiary care hospital. J Ayub Med Coll disorders: A European view. Eur Spine J. Harald Zur Hausen in 1977. In 1983 & 1984 Zur 25 Gertzbein (2) noted that, more severe the canal seen from the result of this study, Long segment s00586-007-0310-5, PMid:17252216 PMCid:PMC2200786 both in vaccinated and non-vaccinated populations Life cycle of HPV : become persistently infected; which is the most [Internet]. 1985;67(1):165-9. Available from: Macheras G, Katonis P. Treatment of Unstable 23. McLain RF. The biomechanics of long versus short Abbottabad. 2010;22(1):171-5. 1997;6(1):2-18. https://doi.org/10.1007/BF01676569 Hausen and his collaborators identified role of HPV compromise and kyphotic deformity, worse the transpedicular screw fixation in unstable indicating establishment, of herd immunity and also The viral life cycle refers mainly to high-risk important risk factor for the development of cervical http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd Thoracolumbar Burst Fractures by Indirect Reduction fixation for thoracolumbar spine fractures. Spine 40. Moon MS, Choi WT, Moon YW, Kim YS, Moon JL. https://doi.org/10.1007/BF00307823 16 & 18 in cervical cancer and in the course of the neurological deficit. But Mumford and Cantor thoracolumbar spine injury with incomplete 32. McCullen G, Vaccaro AR, Garfin SR. Thoracic and provide cross- protection.14-17 Khatun S et al18 mucosotropic HPVs and is commonly extrapolated to cancer. The most common clinically significant Retrieve&db=PubMed&dopt=Citation&list_uids=3 and Posterior Stabilization: Short-Segment Versus (Phila Pa 1976). 2006;31(11 SUPPL.):70-9. Stabilisation of fractured thoracic and lumbar spine PMCid:PMC3454634 next 12 years of research it has been recognized as a (33,34) stated that the relationship between these neurological deficit is an effective method of lumbar trauma: Rationale for selecting the appropriate observed high immunogenicity and safety of the all HPVs. Activated cell divisionis necessary for viral manifestation of persistent genital HPV infection is 81446, https://doi.org/10.2106/00004623-198567010-00024 Long-Segment Stabilization. Open Orthop J. https://doi.org/10.1097/01.brs.0000218221.47230.dd with Cotrel-Dubousset instrument. J Orthop Surg. carcinogen influencing its development.21 This two is unclear. In this study the mean preoperative treatment. This method markedly reduce the hospital fusion technique. Orthop Clin North Am. 47. Modi HN, Chung KJ, Seo IW, Yoon HS, Hwang JH, bHPV vaccine among Bangladeshi adolescent girls at DNA access to the cell nucleus. Initial viral Cervical Intraepithelial Neoplasia (CIN). Within a 2010;4(1):7-13. https://doi.org/10.2174/ 187432500 PMid:16685240 2003;11(1):59-66. https://doi.org/10.1177/230949900 finding laid the ground for the idea of a vaccine stay and enhances neurological and functional 8. Hur J-W. A Comparative Analysis of the Efficacy of 1998;29(4):813-28. https://doi.org/10.1016/S0030-58 Kim HK, et al. Two levels above and one level below 7 months of vaccination.Sustained efficacy, replication in the basal cells requires E1 and E2 few years of infection, low-grade CIN(CIN 1) may kyphotic deformation of vertebral body was around 1004010007, PMid:20177428 PMCid:PMC2822149 301100113, PMid:12810974 Introduction: Human papillomavirus (HPV) is the virtually Short-Segment Pedicle Screw Fixation with that of 24. Kang S-K, Lee CW, Park NK, Kang T-W, Lim J-W, 98(05)70050-X pedicle screw fixation for the treatment of unstable against HPV infection and cervical cancer, and in proteins. The role of E6 and E7 in the basal layer is develop, which may spontaneously resolve and the 21.80and 14.50 at final follow-up. kyphotic recovery with an acceptable fusion rate. Cervical cancer is a major public health problem necessary cause of carcinoma cervix. HPVs causing immunogenicity, and safety of the bHPV vaccine Long-Segment Pedicle Screw Fixation for Unstable 16. Altay M, Ozkurt B, Aktekin CN, Ozturk AM, Dogan Cha KY, et al. Predictive Risk Factors for Refracture 41. Cho DY, Lee WY, Sheu PC, Sonntag VKH, Hitchon thoracolumbar fracture with partial or intact 1999 it finally became clear that persistent HPV uncertain; particularly for the low-risk HPVs. infection clear. Persistent HPV infection, may deformation was observed 200 pre-operatively and 33. Cantor, Jeffrey B., MD; Lebwohl, Nathan H., MD; worldwide. It is the 4th most frequently diagnosed not only the vast majority of cervical (99.7%), but were observed in the final analysis of a follow-up Funding: No funding sources Thoracolumbar Spinal Burst Fractures. Clin Med Res. after Percutaneous Vertebroplasty. Ann Rehabil Med. PW, Cooper PR, et al. Treatment of Thoracolumbar neurology. J Orthop Surg Res. 2009;4(1):1-6. 19 infection is a necessary cause of invasive cervical 30 at final follow-up (42). Mean beck index was Ö, Tabak AY. Treatment of unstable thoracolumbar Garvey, Timothy, MD; Eismont, Frank J. M. study up to 9.4 years postvaccination. Deregulation of E6/E7 expression is critical in progress directly to higher-grade CIN (CIN2 or Burst Fractures with Polymethyl Methacrylate cancer in women worldwide, with an estimated also a substantial proportion of other anogenital and 3 Conflict of interest: None declared 2015;4(1):1. https://doi.org/10.11648/j.cmr.20150401.11 junction burst fractures with short- or long-segment 2011;35(6):844. https://doi.org/10.5535/arm.2011.35. https://doi.org/10.1186/1749-799X-4-28 cancer. HPV infection is commonly found in the determining neoplastic grade. In high-risk HPVs, CIN3). High-grade abnormalities are at risk of found 0.68 pre operatively and 0.80 at final follow Nonoperative Management of Stable Thoracolumbar 570,000 new cases in 2018. It is also the 4th leading head and neck cancers.3,4 Among all HPV-associated HPV vaccine has introduced in Bangladesh by the 6.844, PMid:22506213 PMCid:PMC3309392 Vertebroplasty and Short-segment Pedicle Screw PMid:19635134 PMCid:PMC2724433 anogenital tract of men and women with and without E6/E7 mediates proliferation of the basal and progression to cancer. Some high-grade abnormalities up in this study. Sapkas (15) showed similar results References: 9. Alvine GF, Swain JM, Asher MA, Burton DC. posterior fixation in magerl type a fractures. Eur Spine Burst Fractures With Early Ambulation and Bracing. cause of cancer death, with an estimated 311,000 malignancies, cervical cancer is the most important Ministry of Health and Family Planning (MoHFP), with a p-value of 0.150, 0.819 and 0.204 thoracolumbar injuries sustain some degree of clinical lesions. The etiological role of HPV infection parabasal cells, facilitating lesion growth. HPV E6 spontaneously regress. If left, undetected and where preoperative Beck index was 0.60 and 0.92 at 1. Avanzi O, Landim E, Meves R, Caffaro MF, de Treatment of thoracolumbar burst fractures with J. 2007;16(8):1145-55. https://doi.org/10.1007/ s00586- 25. Vaccaro AR, Lehman RA, Hurlbert RJ, Anderson PA, Spine (Phila Pa 1976) [Internet]. 1993;18(8):971-6. deaths in 2018. Cervical cancer is the 2nd most cause of morbidity and mortality worldwide. with support from the Global Alliance for Vaccines respectively. neurological deficit. These types of injuries are best among women with cervical cancer is and E7 oncoproteins bind to and inactivate tumor untreated, years or decades later CIN2 or 3 can final follow up. Albuquerque Araujo Luyten F, Faria AA. variable screw placement or Isola instrumentation and 007-0310-5,PMid:17252216 PMCid:PMC2200786 Harris M, Hedlund R, et al. A New Classification of Available from: https://journals.lww.com/ spinejournal/ commonly diagnosed cancer and leading cause of Approximately 70% of cervical cancers worldwide and Immunizations (GAVI) for two years in Gazipur treated by vertebral column decompression and Abstract/1993/06150/Nonoperative_Management_of well-established, and there is growing evidence of its suppressor proteins p53 and pRb, respectively, progress to cervical cancer. The time lag between the During the follow-up hardware failure was detected According to functional outcome ODI was 67.68% Thoracolumbar Burst Fracture: Load Sharing arthrodesis: Case series and literature review. J Spinal 17. Alanay A, Acaroglu E, Yazici M, Oznur A, Surat A. Thoracolumbar Injuries. Spine (Phila Pa 1976). cancer death among females in less developed are associated with two high-risk HPV types (16/18), district and if it is successful, GAVI will provide stabilization (31). The management plans differ Disord Tech. 2004;17(4):251-64. https://doi.org/ 2005;30(20):2325-33. _Stable_Thoracolumbar.4.aspx 1 20 central role in other anogenital cancers (anus, vulva, leading to malignant transformation of infected cells. peak of HPV infection and the peak of cancer in 3 cases. There were 9 cases of superficial wound (Crippled) pre operatively which became 25.6% Classification and Posterior Instrumentation Failure. Short-Segment Pedicle Instrumentation of countries. Cervical cancer is the 2nd leading cause of while other high-risk HPV types 31, 33, 35, 45, 52 support for national introduction of HPV vaccine. among many of the researchers regarding operative 10.1097/01.bsd.0000095827.98982.88 https://doi.org/10.1097/01.brs.0000182986.43345.cb https://doi.org/10.1097/00007632-199306150-00004 5,6 vagina, penis), head and neck cancers. HPV is also incidence generally takes place over a period of 10 to infection and bed sore each which were responded to (moderately disabled) at final follow up Aly (43) Rev Bras Ortop (English Ed [Internet]. Thoracolumbar Burst Fractures. Spine (Phila Pa female cancer in incidence and 3rd leading cause of and 58 are responsible for approximately 20% case. There has been little success with screening program Transmission and natural history of HPV (32) and non-operative approaches (33,34). PMid:15280752 PMid:16227897 PMid:8367784 female cancer deaths among Bangladeshi women responsible for diseases e.g recurrent juvenile 26 20 years, making the initiating infections and conservative treatment. showed in a meta-analysis that Kim 2009, Canbeck 2010;45(3):236-40. Available from: http://dx.doi.org/ 1976). 2001;26(2):213-7. https://doi.org/10.1097/ HPV type 16/18 infection was detected in 40.42% of against cervical cancer, which is a major public infection : respiratory papillomatosis and genital warts, both precursor lesions of cervical cancer anappropriate 10.1016/S2255-4971(15)30363-3 26. Christensen FB, Laursen M, Gelineck J, Eiskjær SP, 34. Mumford, Joe, MD; Weinstein, James N., DO; Spratt, with an estimated 8,068 new cases and 5,214 deaths the women in Bangladesh with cervical epithelial cell health problem in Bangladesh. Therefore, a National HPV infection occurs at the basal epithelium during References: According to literature review the result of our study 2014 and Azmiri (44) found similar result which 10. Liu L, Gan Y, Zhou Q, Wang H, Dai F, Luo F, et al. 00007632-200101150-00017, PMid:11154543 2 22 in 2018. 7 mainly caused by HPV 6/11. target for screening and early detection. Some lesions Among all spinal injury thoracolumbar junction is is almost similar to internationally published studies. were 30%, 29% and 25% at last follow up https://doi.org/10.1016/S2255-4971(15)30363-3 Improved monosegment pedicle instrumentation for Thomsen K, Bünger CE. Interobserver and Kevin F., PhD; Goel, Vijay K. P. Thoracolumbar abnormality. HPV type 16 was detected in 81.82%, HPV Vaccination Program will reduce the mortality sexual intercourse. Although the incidence of 18. Knop C, Bastian L, Lange U, Oeser M, Zdichavsky become cancerous more rapidly, sometimes within 2 the commonest and comprises > 50% of the cases of It is observed that active age group was mostly respectively (moderately disabled). In this series, treatment of thoracolumbar incomplete burst Intraobserver Agreement of Radiograph Interpretation Burst Fractures: The Clinical Efficacy and Outcome type 18 in 9.09% and type 45 in 6.06% cases of and morbidity of cervical cancer in Bangladesh.The Structure23 and gene functions24 of HPV: infection is high, but most infections resolve 2. Gertzbein S.D., Court-brown, CM., Marks, P., Fazl, M., M, Blauth M. Complications in surgical treatment of years. Infection with one type of HPV does not all spinal fractures (28). fractures. Biomed Res Int. 2015;2015. https://doi.org/ With and Without Pedicle Screw Implants. Spine of Nonoperative Management. Spine (Phila Pa 1976). cervical carcinoma in Bangladesh.8 objective of the review article is to evaluate the HPV is a relatively small non-enveloped double- spontaneously. Several studies have suggested that affected with a male 126 (86.3%) dominancy. RA Mean Pre op VAS (pain intensity) was 57mm Schwartz, M., Jacobs RR. The Neurological Outcome prevent infection with another type. If persons 10.1155/2015/357206,PMid:26097844 thoracolumbar injuries. Eur Spine J. 2002;11(3):214-26. (Phila Pa 1976). 2001;26(5):538-43. https://doi.org/ 1993;18(8):955-70. current status of the cervical cancer prevention most women successfully clear the HPV infection, Holdsworth, F. (1963) first described the burst raja, (31) showed 86% male patients in his series. In (moderate) and at final follow up it was 17 mm following Surgery for Spinal Fractures. Spine (Phila In developed countries, incidence and mortality of stranded DNA virus in the family Papillomaviridae. infected with mucosal HPV, 5% to 30% are infected PMCid:PMC4434173 https://doi.org/10.1007/s00586-001-0382-6, 10.1097/00007632-200103010-00018, https://doi.org/10.1097/00007632-199306150-00003 achieved by HPV vaccination worldwide. presumably through the action of a competent fracture (29). The existence of the unstable burst this study, most common level injured was L1 (mild) Pain intensity according to VAS was pre op Pa 1976) [Internet]. 1988;6(13):641-4. Available cervical cancer has been lowered by effective It is associated with histone-like proteins and with multiple types of the virus. PMid:12107790 PMCid:PMC3610522 PMid:11242382 immune system. Among the infected individuals, fracture, with complete disruption of the posterior (56.2%) and followed by D12 (27.4%). Altay (16) 40mm post op 4 mm observed by Yang (45). from:https://journals.lww.com/spinejournal/Abstract/ 11. Danisa OA, Shaffrey CI, Jane JA, Whitehill R, Wang 35. Muralidhar BM, Hegde D, Hussain PSB. population-based screening program with Pap smear Rationale of the review protected by a capsid formed by two late proteins, L1 19. Chen HH, Wang WK, Li KC, Chen TH. Management of unstable thoracolumbar spinal 9 approximately, 90% of lesions regress spontaneously HPV prevalence: elements and increased potential for neural injury showed 51.6% involvement of L1 and 29% Fusion rate with pedicular fixation (99%) were 1988/06000/The_Neurological_Outcome_following_ GJ, Szabo TA, et al. Surgical approaches for the 27. Bridwell, Keith H., MD*; Lenke, Lawrence G., MD*; and or HPV DNA testing. Government of National HPV vaccination programs have been and L2. Each virion contains 72 copies of the L1, the Biomechanical effects of the body augmenter for fractures by pedicle screws and rods fixation. J Clin without clinical signs or symptoms within 12 to 36 There have been many studies worldwide on the was described in whitesides, 1977(30). It is involvement of D12. Muralidhar (35) observed that significantly higher than those for anterior Surgery_for.7.aspx https://doi.org/10.1097/ 00007632- correction of unstable thoracolumbar burst fractures: McEnery, Kevin W., MD†; Baldus, Christy, LPN*; Bangladesh with the support of UNFPA has taken implemented in many countries to prevent cervical major component of the capsid, and a variable Diagnostic Res. 2014; months, a small proportion of infected persons proportion of cervical cancer, other anogenital estimated that approximately 75% of patients with 70% were at L1 level and 3 cases at D12 (10%). instrumentation (46) In this series, 48% of cases 198806000-00007, PMid:3175754 A retrospective analysis of treatment outcomes. J reconstruction of the vertebral body. Spine (Phila Pa Blanke, Kathy R. Anterior Fresh Frozen Structural initiative to develop a cervical cancer screening cancer. But no National HPV Vaccination number of copies of L2, a secondary component of 124

cancers, high& low-grade squamous intraepithelial 81.82%followed by 18 in 9.09%& 45 in 6.06% cases • warnings about tobacco use • A quadrivalent vaccine (Gardasil®/Silgard®, Mechanism of vaccine related protection: were seroconverted for anti-HPV-16&18 antibodies developing countries which haven’t introduced the 2. Bruni L, Albero G, Serrano B, Mena M, Gómez D, ewjm.175.4.231. https://doi.org/10.1136/ ewjm. 18. Khatun S, HussainSMA, Chowdhury S, Ferdous J, 10.1016/j.vaccine.2013.10.003, PMid:24332295 PMid:19115209, DOI: 10.1002/ijc.24116, https://doi.org/ Muñoz J, et al. ICO/IARC Information Centre on 175.4.231, PMid:11577044 PMCid:PMC1071564 Hossain F, Begum SR, et al. Safety and PMCid:PMC7605442, DOI: 10.1016/j.vaccine.2013. lesions (HSIL and LSIL) due to different HPV of cervical carcinoma. Among precancerous cases, • male circumcision. produced by Merck & Co)–protects against HPV Systemic immunization with L1 VLPs generates at Month 7. At Month 48 of that study, all subjects HPV vaccine as part of their national public health 10.1002/ijc.24116, PMid:19115209 HPV and Cancer (HPV Information Centre). Human Immunogenicity Profile of Human Papillomavirus- 10.003, https://doi.org/10.1016/j.vaccine.2013.10.003 genotypes as well as prevalence of HPV in general only type 16 was detected. 16 & 18, 6 & 11 that causes anogenital warts antibody concentrations higher than in a natural were still seropositive for anti-HPV-16 antibodies strategy to prevent and control cervical cancer. 11. Zhao KN, Zhang L, Qu J. Dr. Jian Zhou: The great 33. Uterine cervical neoplasms - prevention and control. b) Secondary prevention through screening and Papillomavirus and Related Diseases in Bangladesh. 16/18 AS04 Adjuvant Cervical Cancer Vaccine: A PMid:24332295 PMCid:PMC7605442 population. also. infection. The HPV vaccines are highly and all but one subject in the 46–55 years age group inventor of cervical cancer vaccine. Protein Cell.2017; Comprehensive cervical cancer control: a guide to HPVprevalence in vulvar, vaginal and anal treatment of adult sexually active women for Bivalent HPV vaccine was registered in Bangladesh Summary Report 17 June 2019. [Date Accessed] Randomized Controlled Trial in Healthy Adolescent 27 immunogenic leading to seroconversion in virtually remained seropositive (99.4%) for anti-HPV-18 8(2): 79-82. DOI: 10.1007/s13238-016-0358-2 26. Human Papillomavirus. In: Centers for Disease Bruni L et al performed a meta-analysis of cervical intraepithelial neoplasia (VIN, VAIN, AIN) grades As of December 2014, the U.S.FDA approved Girls of Bangladesh. Jpn J Clin Oncol. 2011;42(1): essential practice. 2nd ed. World Health Organization. precancerous lesions, starting from 30 years of age. 100% of vaccinees. Antibody titers in blood reach 39 in 2009 while qHPV was registered in 2014.HPV 3. Walboomers JM, Jacobs MV, Manos MM, Bosch FX, https://doi.org/10.1007/s13238-016-0358-2 Control and Prevention. Epidemiology and Prevention HPV prevalence among women with normal 1-3 and carcinoma was conducted in 4 continents. antibodies. Roteli-Martins CM et al report the 36-41. https://doi.org/10.1093/jjco/hyr173, PMid:22194637 2014. ISBN 978 92 4 154895 3 Merck’s 9- valent HPV vaccine (GARDASIL 9®) vaccine has recently been introduced in Bangladesh Kummer JA, Shah KV, et al. Human papillomavirus is PMid:28108949 PMCid:PMC5291779 c)Tertiary prevention and palliative care for women peaks 2–3 log higher than in natural infections, long-term efficacy and immunogenicity of the PMCid:PMC3244935, DOI: 10.1093/jjco/hyr173 of Vaccine-Preventable Diseases. Hamborsky J, cytological findings. The estimated global HPV Overall HPV prevalence was 67.8%, 85.3% and which includes the additional five HPV 31, 33, 45, a necessary cause of invasive cervical cancer 34. Guide to introducing HPV vaccine into national affected by invasive cervical cancer include surgery, decrease gradually to levels several-fold lower than HPV-16/18 AS04-adjuvanted vaccine up to 8.4 y by the Ministry of Health and Family Planning 12. Markowitz LE, Dunne EF, Saraiya M, Chesson HW, https://doi.org/10.1093/jjco/hyr173 Kroger A, Wolfe S, eds. 13th ed., Supplement. prevalence was 11.7%. While based on the world 40.4% among VIN1, VIN2/3& vulvar carcinomas; 52& 58 compared to the quadrivalent vaccine. worldwide. J Pathol.1999;189(1): 12-19. https://doi.org/ immunization programmes. Immunization, Vaccines radiotherapy and chemotherapy. peak and then remain stable for years. The IgG is after the first vaccine dose. No new infection or (MoHFP), with support from the Global Alliance for Curtis CR, GEE J, et al. Human Papillomavirus PMid:22194637 PMCid:PMC3244935 Washington D.C. Public Health Foundation, 2017. regions Sub-Saharan Africa (24%), Eastern Europe 100%, 90.1% and 69.9% among VAIN1, VAIN2/3& 10.1002/(SICI)1096-9896(199909)189:1<12::AID-P and Biologicals. World Health Organization. 2016; Both vaccines are composed of type-specific HPV L1 exuded at the possible sites of infection (mucosa of Vaccines and Immunizations (GAVI). This new Vaccination: Recommendations of the Advisory p.175-186. (21.4%) and Latin America (16.1%) showed the vaginal carcinomas; and 91.5%, 93.9% and 84.3% HPV vaccines34: lesions associated with HPV-16/18 occurred in the ATH431>3.0.CO;2-F, DOI: 10.1002/(SICI)1096-9896 19. Naud PS, Roteli-Martins CM, De Carvalho NS, 1-90. ISBN: 978 92 4 154976 9 protein, the major capsid protein of HPV which is genital tract, oral cavity, etc.), neutralizes the virus 19 Committee on Immunization Practices (ACIP). highest prevalence’s. among AIN1, AIN2/3& anal carcinomas, vaccine group. NaudPSet al conducted a long-term vaccine introduction program ran for two years in (199909)189:1<12: AID-PATH431>3.0.CO;2-F Teixeira JC, De Borba PC, Sanchez N, et al. Sustained 27. Bruni L, Diaz M, Castellsagué X, Ferrer E, Bosch FX, The availability of prophylactic HPV vaccines has used as an antigen. Through Recombinant DNA and prevents its entry into the cells. The MMWR Recomm Rep. 2014; 63(RR-05): 35. Human papillomavirus vaccines: Weekly epidemiological respectively. HPV16 was found>75% and 18 <10% follow-up of an initial double-blind, randomized Gazipur district and if it is successful, GAVI will efficacy, immunogenicity, and safety of the De Sanjosé S. Cervical human papillomavirus Alemany L et al28 estimated the HPV type-specific provided a powerful tool for primary prevention of technology the L1 protein undergoes conformal vaccine-induced immune memory in the form of 4. Zur Hausen H. Papillomaviruses in the causation of 1-30.PMID: 25167164 record. WHO position paper.2017;92(19):241-268. in HPV positive vulvar, vaginal and anal carcinomas. (1:1), placebo-controlled study evaluating the provide support for national introduction of HPV HPV-16/18 AS04-adjuvanted vaccine: final analysis prevalence in 5 continents: Meta-analysis of 1 million distribution in a large series of invasive cervical cervical cancer and other HPV-associated diseases. human cancers-a brief historical account. Virology. ISSN 0049-8114 changes to self-assemble into 'virus-like' particles circulating plasma cells and memory B-cells allows 40 13. Meites E, Kempe A, Markowitz LE. Use of a 2-Dose of a long-term follow-up study up to 9.4 years women with normal cytological findings. J Infect Dis. Approximately 40% ofvulvar, 60% of vaginal and The vaccines are most effective when administered to efficacy against HPV16/18 infection and associated vaccine . WHO recommends that girls are 2009; 384(2): 260-265. https://doi.org/ 10.1016/ cancer (ICC) over 70 years from 11 countries in (VLPs). The VLPs are non-infective and non- generation and exudation of protecting IgG each time Schedule for Human Papillomavirus Vaccination - post-vaccination. Hum VaccinImmunother. 2014; 2010; 202(12): 1789-1799. https://doi.org/ 80% of anal carcinoma are responsible for a person prior to exposure to HPV. Two HPV cyto-histopathological abnormalities, persistence vaccinated with HPV vaccine between the ages of j.virol.2008.11.046, PMid:19135222, DOI: 10.1016/ 36. Harper DM, Franco EL, Wheeler CM, Moscick AB, Central-South America, Asia and Europe. Among pathogenic as these are devoid of the viral DNA the body is challenged by exposure to HPV infection. Updated Recommendations of the Advisory 10(8), 2147-2162. https://doi.org/10.4161/hv.29532 10.1086/657321, PMid:21067372, DOI: 10.1086/ HPV16/18.32 ofimmunogenicity, and safety of the HPV-16/18 j.virol.2008.11.046. https://doi.org/10.1016/j.virol. Romanowski B, Roteli-Martins CM, et al. Sustained 4,771 HPV DNA positive ICC cases, HPV16&18 vaccines are currently pre-qualified by WHO: essential to initiate the carcinogenic process. Bivalent 9-13 years. In line with this, the Government of Committee on Immunization Practices. MMWR Morb PMid:25424918 PMCid:PMC4896780, DOI: 657321, https://doi.org/10.1086/657321, PMid:21067372 Animal models suggest that very low antibody titers 2008.11.046, PMid:19135222 efficacy up to 4.5 years of a bivalent L1 virus-like AS04-adjuvanted vaccine. No new HPV 16/18- Bangladesh has decided to vaccinate 10-year-old Mortal Wkly Rep. 2016; 65(49):1405-1408. were the two most common HPVs in all the decades Co-factors associated with cervical cancer: • A bivalent vaccine (Cervarix®, produced by vaccinecontains a novel adjuvant AS04 and may still be protective. Partial cross-protection 10.4161/hv.29532, https://doi.org/10.4161/hv.29532 28. Alemany L, De Sanjosé S, Tous S, Quint W, Vallejos particle vaccine against human papillomavirus types 5 associated infections and cyto-histopathological girls in the primary school setting (Grade 5) with two 5. Mu˜noz N, Castellsagu' E X, De González AB, https://doi.org/10.15585/mmwr.mm6549a5 (HPV16-from 61.5 to 62.1%, and HPV18-from 6.9 to Muñoz N et al stated that although HPV is a GlaxoSmithKline)–protects against HPV 16 & quadrivalent vaccine VLPs are adsorbed on an against HPV31, HPV33 and HPV45 has been PMid:25424918 PMCid:PMC4896780 C, Shin HR.et al. Time trends of human 16 and 18: follow-up from a randomized control trial. 25 abnormalities occurred in the vaccine group. Gissmann L, Chapter 1: HPV in the etiology of human PMid:27977643, DOI: http://dx.doi.org/10.15585/ 7.2%). A meta-analysis update conducted by SmithJS necessary cause of cervical cancer, it is not a 18 that cause the majority of cervical cancers; aluminum-containing adjuvant to ensure robust and described. doses of bHPVvaccine, given 6 months apart. The 20. WORLD HEALTH ORGANIZATION. Country papillomavirus types in invasive cervical cancer, from Lancet.2006; 367(9518):1247-1255. https://doi.org/ 6 18 cancer. Vaccine. 2006; 24 (3): S1-S10. https://doi.org/ mmwr.mm6549a5external icon et al showed HPV type distribution in ICCand HSIL. sufficient cause. Epidemiologic studies indicate that long-lasting immunogenicity.12 Khatun S et al conducted a study to assess the target girls will mainly be reached through the office for Bangladesh. Human papillomavirus (HPV) 1940 to 2007.2014. Int J Cancer. 2014; 135(1):88-95. 10.1016/S0140-6736(06)68439-0, DOI: 10.1016/ and Recommended vaccination schedule: 10.1016/j.vaccine.2006.05.115, PMid:16949995, In ICC, HPV16 was the most common, and HPV18 the risk of contracting genital HPV infection and immunogenicity and safety profile of HPV16/18 14. Markowitz LE, Hariri S, Lin C, Dunne EF, Steinau M, vaccine introduced in Bangladesh.18 May 2016. https://doi.org/10.1002/ijc.28636, PMid:24382655, S0140-6736(06)68439-0, https://doi.org/10.1016/ The primary target group in most of the countries schoolbasedprogramme and girls who are out of DOI: 10.1016/ j.vaccine.2006.05.115, https://doi.org/ the second most common, type in all continents. The cervical cancer is influenced by a variety of factors. vaccines in healthy Bangladeshi girls aged between McquillanG, et al. Reduction in human News release DOI: 10.1002/ijc.28636, https://doi.org/10.1002/ S0140-6736(06)68439-0 recommending HPV vaccination is young adolescent school will receive the vaccine through the routine 10.1016/j.vaccine.2006.05.115, PMid:16949995 papillomavirus (HPV) prevalence among young next most common HPV types were HPV31, 33, 35, Thus, other cofactors are necessary for progression 9–13 years. They recommended that, bHPV vaccine EPI sites at the community level. 21. Morshed K, Polz-Gruszka D, Szymański M, ijc.28636, PMid:24382655 girls, aged 9-14.WHO has recommended the 6. Smith JS, Lindsay L, Hoots B, Keys J, Franceschi S, women following HPV vaccine introduction in the 37. De Carvalho N, Teixeira J, Roteli-Martins CM, Naud 45, 52 and 58. HPV18 was significantly more from cervical HPV infection to cancer. Long-term 35 was generally well tolerated, with no vaccine-related Polz-Dacewicz M. Human Papillomavirus (HPV) - following vaccination schedule . Winer R, et al. Human papillomavirus type United States, National Health and Nutrition 29. Nahar Q, Sultana F, Alam A, Islam JY, Rahman M, P, De Borba P, Zahaf T, et al. Sustained efficacy and prevalent in adeno/adenosquamous carcinoma than use of hormonal contraceptives, high parity, tobacco serious adverse effects. Conclusion: Structure, epidemiology and pathogenesis. Otolaryngol distribution in invasive cervical cancer and high-grade Examination Surveys, 2003-2010. J Infect Khatun F. et al. Genital human papillomavirus immunogenicity of the HPV-16/18 AS04-adjuvanted in squamous cell carcinoma. Among HSIL cases, smoking, and co-infection with HIV have been • Females <15 years at the time of first dose: a Immunization with the HPV vaccine induces Pol. 2014;68(5):213-219. https://doi.org/10.1016/ HPV prevalence, cross-protection and herd cervical lesions: A meta-analysis update. Int. J. Dis.2013;208(3):385-393. https://doi.org/10.1093/ infection among women in Bangladesh: findings from vaccine up to 7.3 years in young adult women. HPV16/18prevalence was 52%. WalboomersJM et identified as established cofactors; co-infection with sustained high levels of antibodies against high-risk j.otpol.2014.06.001, PMid:25283316, DOI: 10.1016/ 2-dose schedule (0, 6 months) is recommended. Cancer. 2007; 121(3): 621-632. https://doi.org/ infdis/jit192, PMid:23785124, DOI:10.1093/infdis/jit192. a Population-based survey. PLoS One. 2014; 9(10): Vaccine.2010; 28(38):6247-6255. https://doi.org/10.1016/ 3 immunity after vaccination: j.otpol.2014.06.001, https://doi.org/10.1016/j.otpol. al found that the worldwide HPV prevalence in Chlamydia trachomatis (CT) and herpes simplex HPV genotypes 16 and 18. The durable immune 10.1002/ijc.22527, PMid:17405118, DOI: 10.1002/ e107675. https://doi.org/10.1371/journal.pone.0107675 j.vaccine.2010.07.007, PMid:20643092, DOI: If the interval between doses is shorter than 5 months, A national HPV immunization program using a 15. Tabrizi SN, Brotherton JM, Kaldor JM, Skinner SR, 2014.06.001, PMid:25283316 cervical carcinomas is 99.7%. virus type-2 (HSV-2), immunosuppression, and response induced by the HPV vaccine in adolescent ijc.22527.https://doi.org/10.1002/ijc.22527 PMid:25271836 PMCid:PMC4182674, DOI: 10.1016/j.vaccine.2010.07.007, https://doi.org/ then a third dose should be given at least 6 months bHPV vaccine was implemented in Scotland in 2008, Liu B, Bateson D,et al. Assessment of herd immunity certain dietary deficiencies are other probable girls is predicted to provide long-term protection PMid:17405118 22. Bruni L, Albero G, Serrano B, Mena M, Gómez D, 10.1371/journal.pone.0107675, https://doi.org/10.1371/ 10.1016/j.vaccine.2010.07.007, PMid:20643092 Bangladesh had also different studies that focused on after the first dose. along with a national surveillance program designed and cross-protection after a human papillomavirus cofactors. against HPV infection and subsequent development Muñoz J, Bosch FX, de Sanjosé S. ICO/IARC journal.pone.0107675, PMid:25271836, PMCid:PMC4182674 HPV genotyping in different groups of females. to determine the longitudinal effects of vaccination 7. Banik U, Ahamad MSU, Bhattacharjee P, Adhikary vaccination programme in Australia: a repeat 38. Schwarz TF,Spaczynski M, Schneider A, Wysocki J, 29 • Information Centre on HPV and Cancer (HPV Nahar Q et al revealed prevalence of HPV infection Strategies for cervical cancer prevention and Females ≥15 years at the time of first dose & of high-grade cervical lesions and cancer. The AK, Rahman Z. cross-sectional study. Lancet Infect Dis.2014; 30. Sultana T, Huq M, Alam A, Mitra DK, Gomes DJ. Galaj A, Schulze K, et al. Persistence of immune on HPV infection at the population level. By linking Information Centre). Human Papillomavirus and was 7.7% with no significant difference between control33: immunocompromised and/or HIV-infected.: a 14(10):958-966.DOI: 10.1016/S1473-3099(14) 70841-2, Prevalence and genotyping of human papillomavirus vaccination, cervical screening, and HPV testing knowledge gained from this review is important for 8. High risk human papillomavirus type 16 and 18 Related Diseases in the World. Summary Report 17 response to HPV-16/18 AS04-adjuvanted cervical 3-dose schedule (0, 1-2, 6 months) is https://doi.org/10.1016/S1473-3099(14)70841-2 (HPV) in female with high-risk behaviour in Dhaka, urban and rural women. HR-HPV (High risk) WHO recommends a comprehensive approach to realizing the necessity of the use of a prophylactic infection in the cervical lesions of women with cancer vaccine in women aged 15-55 years. Hum recommended. data, over the study period they found a decline in June 2019. [Date Accessed] Bangladesh. Bangladesh J Microbiol. 2008; infections were more common (4.2%) than LR-HPV cervical cancer prevention and control. The HPV16/18 vaccine in Bangladeshi girls. There has epithelial cell abnormality in Pap smear: A 16. Kavanagh K, Pollock KG, Potts A, Love J, Cuschieri Vaccin.2011; 7(9): 958-965. https://doi.org/10.4161/ HPV 16 &18,significant decreases in HPV 31, 33& 23. FernandezJV and De Medeiros Fernandez TAA. 25(1):65-68. https://doi.org/10.3329/bjm.v25i1.4861, infections (3.4%). Most common HR genotypes were recommended set of actions includes following Evaluation of efficacy, immunogenicity and safety cytohistomorphologic association in Bangladeshi K, Cubie H, et al. Introduction and sustained high hv.7.9.15999, PMid:21892005 PMCid:PMC3225769, 45 (suggesting cross-protection). Among non- been little success with screening program against Chapter 1 Human Papillomavirus: Biology and DOI:https://doi.org/10.3329/bjm.v25i1.4861, HPV16,66,18,45,31&53. Sultana T et al30 noted the interventions. women. Cytojournal. 2013; 10: 14. DOI: 10.4103/ coverage of the HPV bivalent vaccine leads to DOI: 10.4161/hv.7.9.15999, https://doi.org/10.4161/ of HPV vaccine: vaccinated women, HPV 16 & 18 infections were cervical cancer in Bangladesh, an intervention that Pathogenesis. Human Papillomavirus and Related https://doi.org/10.3329/bjm.v25i1.4861 prevalence of genital HPV types in the sex workers 36 1742-6413.1150888. Borna NN, Tabassum S, Jahan areduction in prevalence of HPV 16/18 and closely hv.7.9.15999, PMid:21892005 PMCid:PMC3225769 a) Primary prevention begins with HPV vaccination HarperDM et al assessed the long-term efficacy, significantly lower in 2013 than in 2009 indicating has helped to significantly reduce cervical cancer in Diseases-From Bench to Bedside-A Clinical was as high as 75.8%, whereas for the high-risk types M, Munshi S, Unnesa A. Genotyping of High-Risk related HPV types. Br J Cancer.2014;110(11), 31. Khandker E, Khan M, Chowdhury AK. Human of girls aged 9-13 years, before they become sexually immunogenicity, and safety of a bivalent HPV-16/18 herd immunity and sustained effectiveness of the the developed world. Therefore, a National HPV Perspective, 2012. 1-40, Rijeka, Croatia: InTech. DOI: 39. Roteli-Martins CM, Naud P, De Borba P, TeixeiraJC, it was 49.8%. The highest prevalence rate was Human Papillomavirus (HPV) Among Cervical 2804-2811.DOI: 10.1038/bjc.2014.198. https://doi.org/ papillomavirus infection among Bangladeshi women active. Because HPV vaccines do not protect against L1 virus-like particle AS04 vaccine against incident bivalent vaccine onvirologic outcomes at the 10.5772/27154 https://doi.org/10.5772/27154 De Carvalho NS, Zahaf T, et al. Sustained observed for the genotype 16, 18 and 58. Khandker E Vaccination Program seems to be the window of Precancer and Cancer Patients. Acta MedicaInternational. 10.1038/bjc.2014.198,PMid:24736582 with cervical intraepithelial neoplasia and chronic all HPV types that cause cervical cancer, vaccine and persistent infection with HPV 16 & 18 and their 17 immunogenicity and efficacy of the HPV-16/18 31 population level. opportunity to reduce the mortality and morbidity of 2015;2(1):19-28.DOI: 10.5530/ami.2015.1.5, https://doi.org/ PMCid:PMC4037824 24. Gómez DT and Santos JL. Human papillomavirus cervicitis. IMC J Med Sci. 2016;10(1): 29-32. et al determine HPV infection rate was 43.1%. CIN associated cytological and histological outcomes. De AS04-adjuvanted vaccine: up to 8.4 years of introduction should be part of comprehensive 10.5530/ami.2015.1.5 infection and cervical cancer: pathogenesis and https://doi.org/10.3329/imcjms.v10i1.31103, DOI: cases had significantly high (p<0.01) HPV infection 37 Scenario of HPV vaccination in Bangladesh: HPV related cervical cancer in Bangladesh. 17. Cameron RL, Kavanagh K, Pan J, Love J, Cuschieri approach to cervical cancer control. Carvalhoa N et al report efficacy and epidemiology. Communicating Current Research and follow-up. Hum Vaccin. J Immunother.2012; 8(3): 9. Michael JC, Karen C. Cervical Cancer Screening and K, Robertson C, et al. Human Papillomavirus https://doi.org/10.3329/imcjms.v10i1.31103 (78.6%) compared to cases with chronic cervicitis immunogenicity of the HPV16/18 vaccine up to 7.3 WHO has developed guidelines on prevention and References : Educational Topics and Trends in Applied 390-397.https://doi.org/10.4161/hv.18865 7 Other recommended preventive interventions for Preinvasive Disease. In: Berek JS, Hacker NF Prevalence and Herd Immunity after Introduction of https://doi.org/10.3329/imcjms.v10i1.31103 (18.2%).BanikU et al find out the extent of HR HPV years post vaccination. No cases of infection or control of cervical cancer through vaccination and 1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre Microbiology. A Mendez Vilas (ed). Spain: Formatex; PMid:22327492,DOI:10.4161/hv.18865 (editors). Berek and Hacker's Gynecologic Oncology. Vaccination Program, Scotland, 2009-2013. Emerg type 16/18 infection in women with epithelial cell boys and girls are: cytohistological lesions associated with HPV 16/18 screening. By mid-2016, globally 65 countries, LA, Jemal A. Global Cancer Statistics 2018: 2007.p. 680-688. ISBN-13-9788461194223 32. De Vuyst H, Clifford GM, Nascimento MC, https://doi.org/10.4161/hv.18865 6th edition. Philadelphia: Wolters Kluwer; 2014. p. Infect Dis.2016; 22 (1), 56-64. https://doi.org/ abnormality in Pap smear. HPV type 16/18 infection mostly in high-income and upper-middle-income GLOBOCAN Estimates of Incidence and Mortality Madeleine MM, Franceschi S. Prevalence and type PMid:22327492 • education about safe sexual practices, delayed were observed in the vaccinee. Another follow up 242-325.ISBN-13-978-1-4511-9007-6. 10.3201/eid2201.150736,PMid:26692336 25. Bosch FX, Broker TR, Forman D, Moscicki AB, was detected in 40.42% of the patients. Borna NN et 38 Worldwide for 36 Cancers in 185 Countries.CA: distribution of human papillomavirus in carcinoma start of sexual activity study (up to 4 years) of SchwarzTF et al showed settings had introduced HPV vaccines into their PMCid:PMC4696690, DOI: 10.3201/eid2201.150736 Gillison ML, Doorbar J. et al. Comprehensive Control 40. World Health Organization. Country office for 8 33 Cancer J Clin. 2018; 68:394-424.DOI: 10.3322/ 10. Jacqueline S, Cristina H, Christopher E. Beyond Our and intraepithelial neoplasia of the vulva, vagina and al identify HR HPV genotype among women having persistence of immune response to HPV-16/18 national immunization programs . But the global https://doi.org/10.3201/eid2201.150736 of Human Papillomavirus Infections and Related • promotion and provision of condoms for those caac.21492.https://doi.org/10.3322/caac.21492 Borders Cervical cancer in the developing world. anus: a meta-analysis. Int J Cancer. 2009; Bangladesh. Human papillomavirus (HPV) vaccine CIN and carcinoma. HPV 16 was detected in vaccine in women aged 15–55 years. All subjects burden of cervical cancer fallsheaviest on the PMid:26692336 PMCid:PMC4696690 Diseases. Vaccine. 2013;31(7): H1-31. https://doi.org/ already engaged in sex PMid:30207593 West J Med. 2001; 175: 231-233. DOI: 10.1136/ 124(7):1626-1636. https://doi.org/10.1002/ijc.24116 introduced in Bangladesh. News release.2016. Journal of Bangladesh College of Physicians and Surgeons Vol. 39, No. 2, April 2021 program by visual inspection with acetic acid (VIA), Programhas yet been started in Bangladesh and also the viral capsid. DNA containing approximately 8000 genes. The second is an early region (E), consisting which was considered to be a feasible method for no review has been done related to HPV Vaccination base pairs and harboring an average of 8 open reading of six ORFs: E1, E2, E4, E5, E6, and E7, which screening cervical cancer in the present so far. Hence, this review has been conducted to frames (ORFs). In a functional point of view, the encodes no structural proteins involved in viral socio-economic context. It has been estimated that explore different aspects of HPV vaccines in depth HPV genome is divided into three regions. The first is replication and oncogenesis. The third is a late (L) only 5% of the women in developing countries have which will help to recommend a National a long control region (LCR) that has regulatory region that encodes the L1 and L2 structural proteins. been screened for cervical dysplasia compared with HPVvaccination Program for prevention of cervical function of the transcription of the E6 and E7 viral about 40% to 50% of women in developed cancer among Bangladeshi women by a low-cost 10 countries. bHPV vaccine. Table1 different human papillomavirus gene functions24 One of the greatest medical breakthroughs in the last Review of literature Gene Category Gene Function century is the development of HPV vaccine against Human papillomavirus (HPV) vaccine for preventing E1 Viral replication cervical cancer by Professor Frazer and Dr Jian HPV induced malignancy is a widely studied topic Zhou.11 HPV related anogenital cancers can be E2 Modulation of transcription and replication for physicians. Different authors explained different prevented using a prophylactic vaccine. The two aspects of HPV, its malignant potential, its preventive E3 Unknown prophylactic HPV vaccines, quadrivalent HPV type measures through vaccination and HPV vaccines E4 Productive viral infections 6/11/16/18 vaccine and bivalent HPV type 16/18 E5 Transforming properties vaccine, were licensed in 2006 and 2007 under the immunogenicity, efficacy, safety etc through their names of Gardasil® and Cervarix® respectively.12 own view. Articles related to Human papillomavirus E6 Oncoprotein; interaction with p53 protein Recently nine-valent HPV type 6/11/16/18/31/33/45/52/58 (HPV) vaccine were retrieved from different E7 Oncoprotein; interaction with pRb protein vaccine with broader cancer coverage has also journals, web pages and books. From them 40 papers Early genes E8 Unknown were included to prepare this manuscript. received the United States Food and Drug L1 Major capsid protein Administration (US-FDA) approval in October 2016 Role of HPV in cancers: 13 L2 Major capsid protein under the name of Gardasil9®. Different studies in The connection between persistent infection with Late genes USA, Australia and Scotland have begun to show a HPV and cervical cancer was first described by drop in the prevalence of HPV associated diseases Harald Zur Hausen in 1977. In 1983 & 1984 Zur Life cycle of HPV25: become persistently infected; which is the most both in vaccinated and non-vaccinated populations Hausen and his collaborators identified role of HPV indicating establishment, of herd immunity and also The viral life cycle refers mainly to high-risk important risk factor for the development of cervical 16 & 18 in cervical cancer and in the course of the provide cross- protection.14-17 Khatun S et al18 mucosotropic HPVs and is commonly extrapolated to cancer. The most common clinically significant next 12 years of research it has been recognized as a observed high immunogenicity and safety of the all HPVs. Activated cell divisionis necessary for viral manifestation of persistent genital HPV infection is carcinogen influencing its development.21 This bHPV vaccine among Bangladeshi adolescent girls at DNA access to the cell nucleus. Initial viral Cervical Intraepithelial Neoplasia (CIN). Within a finding laid the ground for the idea of a vaccine 7 months of vaccination.Sustained efficacy, replication in the basal cells requires E1 and E2 few years of infection, low-grade CIN(CIN 1) may Introduction: Human papillomavirus (HPV) is the virtually against HPV infection and cervical cancer, and in proteins. The role of E6 and E7 in the basal layer is develop, which may spontaneously resolve and the Cervical cancer is a major public health problem necessary cause of carcinoma cervix. HPVs causing immunogenicity, and safety of the bHPV vaccine 1999 it finally became clear that persistent HPV uncertain; particularly for the low-risk HPVs. infection clear. Persistent HPV infection, may worldwide. It is the 4th most frequently diagnosed not only the vast majority of cervical (99.7%), but were observed in the final analysis of a follow-up study up to 9.4 years postvaccination.19 infection is a necessary cause of invasive cervical Deregulation of E6/E7 expression is critical in progress directly to higher-grade CIN (CIN2 or cancer in women worldwide, with an estimated also a substantial proportion of other anogenital and 3 cancer. HPV infection is commonly found in the determining neoplastic grade. In high-risk HPVs, CIN3). High-grade abnormalities are at risk of 570,000 new cases in 2018. It is also the 4th leading head and neck cancers.3,4 Among all HPV-associated HPV vaccine has introduced in Bangladesh by the anogenital tract of men and women with and without E6/E7 mediates proliferation of the basal and progression to cancer. Some high-grade abnormalities cause of cancer death, with an estimated 311,000 malignancies, cervical cancer is the most important Ministry of Health and Family Planning (MoHFP), clinical lesions. The etiological role of HPV infection parabasal cells, facilitating lesion growth. HPV E6 spontaneously regress. If left, undetected and deaths in 2018. Cervical cancer is the 2nd most cause of morbidity and mortality worldwide. with support from the Global Alliance for Vaccines among women with cervical cancer is and E7 oncoproteins bind to and inactivate tumor untreated, years or decades later CIN2 or 3 can commonly diagnosed cancer and leading cause of Approximately 70% of cervical cancers worldwide and Immunizations (GAVI) for two years in Gazipur well-established, and there is growing evidence of its suppressor proteins p53 and pRb, respectively, progress to cervical cancer. The time lag between the cancer death among females in less developed are associated with two high-risk HPV types (16/18), district and if it is successful, GAVI will provide 1 central role in other anogenital cancers (anus, vulva, leading to malignant transformation of infected cells. peak of HPV infection and the peak of cancer countries. Cervical cancer is the 2nd leading cause of while other high-risk HPV types 31, 33, 35, 45, 52 support for national introduction of HPV vaccine.20 vagina, penis), head and neck cancers. HPV is also incidence generally takes place over a period of 10 to female cancer in incidence and 3rd leading cause of and 58 are responsible for approximately 20% case.5,6 There has been little success with screening program Transmission and natural history of HPV responsible for diseases e.g recurrent juvenile 20 years, making the initiating infections and female cancer deaths among Bangladeshi women HPV type 16/18 infection was detected in 40.42% of against cervical cancer, which is a major public infection26: precursor lesions of cervical cancer anappropriate with an estimated 8,068 new cases and 5,214 deaths the women in Bangladesh with cervical epithelial cell health problem in Bangladesh. Therefore, a National respiratory papillomatosis and genital warts, both HPV infection occurs at the basal epithelium during 2 22 target for screening and early detection. Some lesions in 2018. abnormality.7 HPV type 16 was detected in 81.82%, HPV Vaccination Program will reduce the mortality mainly caused by HPV 6/11. sexual intercourse. Although the incidence of become cancerous more rapidly, sometimes within 2 type 18 in 9.09% and type 45 in 6.06% cases of and morbidity of cervical cancer in Bangladesh.The Structure23 and gene functions24 of HPV: infection is high, but most infections resolve years. Infection with one type of HPV does not cervical carcinoma in Bangladesh.8 objective of the review article is to evaluate the HPV is a relatively small non-enveloped double- spontaneously. Several studies have suggested that prevent infection with another type. If persons current status of the cervical cancer prevention most women successfully clear the HPV infection, In developed countries, incidence and mortality of stranded DNA virus in the family Papillomaviridae. infected with mucosal HPV, 5% to 30% are infected achieved by HPV vaccination worldwide. presumably through the action of a competent cervical cancer has been lowered by effective It is associated with histone-like proteins and with multiple types of the virus. immune system. Among the infected individuals, population-based screening program with Pap smear Rationale of the review protected by a capsid formed by two late proteins, L1 approximately, 90% of lesions regress spontaneously HPV prevalence: and or HPV DNA testing.9 Government of National HPV vaccination programs have been and L2. Each virion contains 72 copies of the L1, the without clinical signs or symptoms within 12 to 36 There have been many studies worldwide on the Bangladesh with the support of UNFPA has taken implemented in many countries to prevent cervical major component of the capsid, and a variable months, a small proportion of infected persons proportion of cervical cancer, other anogenital initiative to develop a cervical cancer screening cancer. But no National HPV Vaccination number of copies of L2, a secondary component of

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cancers, high& low-grade squamous intraepithelial 81.82%followed by 18 in 9.09%& 45 in 6.06% cases • warnings about tobacco use • A quadrivalent vaccine (Gardasil®/Silgard®, Mechanism of vaccine related protection: were seroconverted for anti-HPV-16&18 antibodies developing countries which haven’t introduced the 2. Bruni L, Albero G, Serrano B, Mena M, Gómez D, ewjm.175.4.231. https://doi.org/10.1136/ ewjm. 18. Khatun S, HussainSMA, Chowdhury S, Ferdous J, 10.1016/j.vaccine.2013.10.003, PMid:24332295 PMid:19115209, DOI: 10.1002/ijc.24116, https://doi.org/ Muñoz J, et al. ICO/IARC Information Centre on 175.4.231, PMid:11577044 PMCid:PMC1071564 Hossain F, Begum SR, et al. Safety and PMCid:PMC7605442, DOI: 10.1016/j.vaccine.2013. lesions (HSIL and LSIL) due to different HPV of cervical carcinoma. Among precancerous cases, • male circumcision. produced by Merck & Co)–protects against HPV Systemic immunization with L1 VLPs generates at Month 7. At Month 48 of that study, all subjects HPV vaccine as part of their national public health 10.1002/ijc.24116, PMid:19115209 HPV and Cancer (HPV Information Centre). Human Immunogenicity Profile of Human Papillomavirus- 10.003, https://doi.org/10.1016/j.vaccine.2013.10.003 genotypes as well as prevalence of HPV in general only type 16 was detected. 16 & 18, 6 & 11 that causes anogenital warts antibody concentrations higher than in a natural were still seropositive for anti-HPV-16 antibodies strategy to prevent and control cervical cancer. 11. Zhao KN, Zhang L, Qu J. Dr. Jian Zhou: The great 33. Uterine cervical neoplasms - prevention and control. b) Secondary prevention through screening and Papillomavirus and Related Diseases in Bangladesh. 16/18 AS04 Adjuvant Cervical Cancer Vaccine: A PMid:24332295 PMCid:PMC7605442 population. also. infection. The HPV vaccines are highly and all but one subject in the 46–55 years age group inventor of cervical cancer vaccine. Protein Cell.2017; Comprehensive cervical cancer control: a guide to HPVprevalence in vulvar, vaginal and anal treatment of adult sexually active women for Bivalent HPV vaccine was registered in Bangladesh Summary Report 17 June 2019. [Date Accessed] Randomized Controlled Trial in Healthy Adolescent 27 immunogenic leading to seroconversion in virtually remained seropositive (99.4%) for anti-HPV-18 8(2): 79-82. DOI: 10.1007/s13238-016-0358-2 26. Human Papillomavirus. In: Centers for Disease Bruni L et al performed a meta-analysis of cervical intraepithelial neoplasia (VIN, VAIN, AIN) grades As of December 2014, the U.S.FDA approved Girls of Bangladesh. Jpn J Clin Oncol. 2011;42(1): essential practice. 2nd ed. World Health Organization. precancerous lesions, starting from 30 years of age. 100% of vaccinees. Antibody titers in blood reach 39 in 2009 while qHPV was registered in 2014.HPV 3. Walboomers JM, Jacobs MV, Manos MM, Bosch FX, https://doi.org/10.1007/s13238-016-0358-2 Control and Prevention. Epidemiology and Prevention HPV prevalence among women with normal 1-3 and carcinoma was conducted in 4 continents. antibodies. Roteli-Martins CM et al report the 36-41. https://doi.org/10.1093/jjco/hyr173, PMid:22194637 2014. ISBN 978 92 4 154895 3 Merck’s 9- valent HPV vaccine (GARDASIL 9®) vaccine has recently been introduced in Bangladesh Kummer JA, Shah KV, et al. Human papillomavirus is PMid:28108949 PMCid:PMC5291779 c)Tertiary prevention and palliative care for women peaks 2–3 log higher than in natural infections, long-term efficacy and immunogenicity of the PMCid:PMC3244935, DOI: 10.1093/jjco/hyr173 of Vaccine-Preventable Diseases. Hamborsky J, cytological findings. The estimated global HPV Overall HPV prevalence was 67.8%, 85.3% and which includes the additional five HPV 31, 33, 45, a necessary cause of invasive cervical cancer 34. Guide to introducing HPV vaccine into national affected by invasive cervical cancer include surgery, decrease gradually to levels several-fold lower than HPV-16/18 AS04-adjuvanted vaccine up to 8.4 y by the Ministry of Health and Family Planning 12. Markowitz LE, Dunne EF, Saraiya M, Chesson HW, https://doi.org/10.1093/jjco/hyr173 Kroger A, Wolfe S, eds. 13th ed., Supplement. prevalence was 11.7%. While based on the world 40.4% among VIN1, VIN2/3& vulvar carcinomas; 52& 58 compared to the quadrivalent vaccine. worldwide. J Pathol.1999;189(1): 12-19. https://doi.org/ immunization programmes. Immunization, Vaccines radiotherapy and chemotherapy. peak and then remain stable for years. The IgG is after the first vaccine dose. No new infection or (MoHFP), with support from the Global Alliance for Curtis CR, GEE J, et al. Human Papillomavirus PMid:22194637 PMCid:PMC3244935 Washington D.C. Public Health Foundation, 2017. regions Sub-Saharan Africa (24%), Eastern Europe 100%, 90.1% and 69.9% among VAIN1, VAIN2/3& 10.1002/(SICI)1096-9896(199909)189:1<12::AID-P and Biologicals. World Health Organization. 2016; Both vaccines are composed of type-specific HPV L1 exuded at the possible sites of infection (mucosa of Vaccines and Immunizations (GAVI). This new Vaccination: Recommendations of the Advisory p.175-186. (21.4%) and Latin America (16.1%) showed the vaginal carcinomas; and 91.5%, 93.9% and 84.3% HPV vaccines34: lesions associated with HPV-16/18 occurred in the ATH431>3.0.CO;2-F, DOI: 10.1002/(SICI)1096-9896 19. Naud PS, Roteli-Martins CM, De Carvalho NS, 1-90. ISBN: 978 92 4 154976 9 protein, the major capsid protein of HPV which is genital tract, oral cavity, etc.), neutralizes the virus 19 Committee on Immunization Practices (ACIP). highest prevalence’s. among AIN1, AIN2/3& anal carcinomas, vaccine group. NaudPSet al conducted a long-term vaccine introduction program ran for two years in (199909)189:1<12: AID-PATH431>3.0.CO;2-F Teixeira JC, De Borba PC, Sanchez N, et al. Sustained 27. Bruni L, Diaz M, Castellsagué X, Ferrer E, Bosch FX, The availability of prophylactic HPV vaccines has used as an antigen. Through Recombinant DNA and prevents its entry into the cells. The MMWR Recomm Rep. 2014; 63(RR-05): 35. Human papillomavirus vaccines: Weekly epidemiological respectively. HPV16 was found>75% and 18 <10% follow-up of an initial double-blind, randomized Gazipur district and if it is successful, GAVI will efficacy, immunogenicity, and safety of the De Sanjosé S. Cervical human papillomavirus Alemany L et al28 estimated the HPV type-specific provided a powerful tool for primary prevention of technology the L1 protein undergoes conformal vaccine-induced immune memory in the form of 4. Zur Hausen H. Papillomaviruses in the causation of 1-30.PMID: 25167164 record. WHO position paper.2017;92(19):241-268. in HPV positive vulvar, vaginal and anal carcinomas. (1:1), placebo-controlled study evaluating the provide support for national introduction of HPV HPV-16/18 AS04-adjuvanted vaccine: final analysis prevalence in 5 continents: Meta-analysis of 1 million distribution in a large series of invasive cervical cervical cancer and other HPV-associated diseases. human cancers-a brief historical account. Virology. ISSN 0049-8114 changes to self-assemble into 'virus-like' particles circulating plasma cells and memory B-cells allows 40 13. Meites E, Kempe A, Markowitz LE. Use of a 2-Dose of a long-term follow-up study up to 9.4 years women with normal cytological findings. J Infect Dis. Approximately 40% ofvulvar, 60% of vaginal and The vaccines are most effective when administered to efficacy against HPV16/18 infection and associated vaccine . WHO recommends that girls are 2009; 384(2): 260-265. https://doi.org/ 10.1016/ cancer (ICC) over 70 years from 11 countries in (VLPs). The VLPs are non-infective and non- generation and exudation of protecting IgG each time Schedule for Human Papillomavirus Vaccination - post-vaccination. Hum VaccinImmunother. 2014; 2010; 202(12): 1789-1799. https://doi.org/ 80% of anal carcinoma are responsible for a person prior to exposure to HPV. Two HPV cyto-histopathological abnormalities, persistence vaccinated with HPV vaccine between the ages of j.virol.2008.11.046, PMid:19135222, DOI: 10.1016/ 36. Harper DM, Franco EL, Wheeler CM, Moscick AB, Central-South America, Asia and Europe. Among pathogenic as these are devoid of the viral DNA the body is challenged by exposure to HPV infection. Updated Recommendations of the Advisory 10(8), 2147-2162. https://doi.org/10.4161/hv.29532 10.1086/657321, PMid:21067372, DOI: 10.1086/ HPV16/18.32 ofimmunogenicity, and safety of the HPV-16/18 j.virol.2008.11.046. https://doi.org/10.1016/j.virol. Romanowski B, Roteli-Martins CM, et al. Sustained 4,771 HPV DNA positive ICC cases, HPV16&18 vaccines are currently pre-qualified by WHO: essential to initiate the carcinogenic process. Bivalent 9-13 years. In line with this, the Government of Committee on Immunization Practices. MMWR Morb PMid:25424918 PMCid:PMC4896780, DOI: 657321, https://doi.org/10.1086/657321, PMid:21067372 Animal models suggest that very low antibody titers 2008.11.046, PMid:19135222 efficacy up to 4.5 years of a bivalent L1 virus-like AS04-adjuvanted vaccine. No new HPV 16/18- Bangladesh has decided to vaccinate 10-year-old Mortal Wkly Rep. 2016; 65(49):1405-1408. were the two most common HPVs in all the decades Co-factors associated with cervical cancer: • A bivalent vaccine (Cervarix®, produced by vaccinecontains a novel adjuvant AS04 and may still be protective. Partial cross-protection 10.4161/hv.29532, https://doi.org/10.4161/hv.29532 28. Alemany L, De Sanjosé S, Tous S, Quint W, Vallejos particle vaccine against human papillomavirus types 5 associated infections and cyto-histopathological girls in the primary school setting (Grade 5) with two 5. Mu˜noz N, Castellsagu' E X, De González AB, https://doi.org/10.15585/mmwr.mm6549a5 (HPV16-from 61.5 to 62.1%, and HPV18-from 6.9 to Muñoz N et al stated that although HPV is a GlaxoSmithKline)–protects against HPV 16 & quadrivalent vaccine VLPs are adsorbed on an against HPV31, HPV33 and HPV45 has been PMid:25424918 PMCid:PMC4896780 C, Shin HR.et al. Time trends of human 16 and 18: follow-up from a randomized control trial. 25 abnormalities occurred in the vaccine group. Gissmann L, Chapter 1: HPV in the etiology of human PMid:27977643, DOI: http://dx.doi.org/10.15585/ 7.2%). A meta-analysis update conducted by SmithJS necessary cause of cervical cancer, it is not a 18 that cause the majority of cervical cancers; aluminum-containing adjuvant to ensure robust and described. doses of bHPVvaccine, given 6 months apart. The 20. WORLD HEALTH ORGANIZATION. Country papillomavirus types in invasive cervical cancer, from Lancet.2006; 367(9518):1247-1255. https://doi.org/ 6 18 cancer. Vaccine. 2006; 24 (3): S1-S10. https://doi.org/ mmwr.mm6549a5external icon et al showed HPV type distribution in ICCand HSIL. sufficient cause. Epidemiologic studies indicate that long-lasting immunogenicity.12 Khatun S et al conducted a study to assess the target girls will mainly be reached through the office for Bangladesh. Human papillomavirus (HPV) 1940 to 2007.2014. Int J Cancer. 2014; 135(1):88-95. 10.1016/S0140-6736(06)68439-0, DOI: 10.1016/ and Recommended vaccination schedule: 10.1016/j.vaccine.2006.05.115, PMid:16949995, In ICC, HPV16 was the most common, and HPV18 the risk of contracting genital HPV infection and immunogenicity and safety profile of HPV16/18 14. Markowitz LE, Hariri S, Lin C, Dunne EF, Steinau M, vaccine introduced in Bangladesh.18 May 2016. https://doi.org/10.1002/ijc.28636, PMid:24382655, S0140-6736(06)68439-0, https://doi.org/10.1016/ The primary target group in most of the countries schoolbasedprogramme and girls who are out of DOI: 10.1016/ j.vaccine.2006.05.115, https://doi.org/ the second most common, type in all continents. The cervical cancer is influenced by a variety of factors. vaccines in healthy Bangladeshi girls aged between McquillanG, et al. Reduction in human News release DOI: 10.1002/ijc.28636, https://doi.org/10.1002/ S0140-6736(06)68439-0 recommending HPV vaccination is young adolescent school will receive the vaccine through the routine 10.1016/j.vaccine.2006.05.115, PMid:16949995 papillomavirus (HPV) prevalence among young next most common HPV types were HPV31, 33, 35, Thus, other cofactors are necessary for progression 9–13 years. They recommended that, bHPV vaccine EPI sites at the community level. 21. Morshed K, Polz-Gruszka D, Szymański M, ijc.28636, PMid:24382655 girls, aged 9-14.WHO has recommended the 6. Smith JS, Lindsay L, Hoots B, Keys J, Franceschi S, women following HPV vaccine introduction in the 37. De Carvalho N, Teixeira J, Roteli-Martins CM, Naud 45, 52 and 58. HPV18 was significantly more from cervical HPV infection to cancer. Long-term 35 was generally well tolerated, with no vaccine-related Polz-Dacewicz M. Human Papillomavirus (HPV) - following vaccination schedule . Winer R, et al. Human papillomavirus type United States, National Health and Nutrition 29. Nahar Q, Sultana F, Alam A, Islam JY, Rahman M, P, De Borba P, Zahaf T, et al. Sustained efficacy and prevalent in adeno/adenosquamous carcinoma than use of hormonal contraceptives, high parity, tobacco serious adverse effects. Conclusion: Structure, epidemiology and pathogenesis. Otolaryngol distribution in invasive cervical cancer and high-grade Examination Surveys, 2003-2010. J Infect Khatun F. et al. Genital human papillomavirus immunogenicity of the HPV-16/18 AS04-adjuvanted in squamous cell carcinoma. Among HSIL cases, smoking, and co-infection with HIV have been • Females <15 years at the time of first dose: a Immunization with the HPV vaccine induces Pol. 2014;68(5):213-219. https://doi.org/10.1016/ HPV prevalence, cross-protection and herd cervical lesions: A meta-analysis update. Int. J. Dis.2013;208(3):385-393. https://doi.org/10.1093/ infection among women in Bangladesh: findings from vaccine up to 7.3 years in young adult women. HPV16/18prevalence was 52%. WalboomersJM et identified as established cofactors; co-infection with sustained high levels of antibodies against high-risk j.otpol.2014.06.001, PMid:25283316, DOI: 10.1016/ 2-dose schedule (0, 6 months) is recommended. Cancer. 2007; 121(3): 621-632. https://doi.org/ infdis/jit192, PMid:23785124, DOI:10.1093/infdis/jit192. a Population-based survey. PLoS One. 2014; 9(10): Vaccine.2010; 28(38):6247-6255. https://doi.org/10.1016/ 3 immunity after vaccination: j.otpol.2014.06.001, https://doi.org/10.1016/j.otpol. al found that the worldwide HPV prevalence in Chlamydia trachomatis (CT) and herpes simplex HPV genotypes 16 and 18. The durable immune 10.1002/ijc.22527, PMid:17405118, DOI: 10.1002/ e107675. https://doi.org/10.1371/journal.pone.0107675 j.vaccine.2010.07.007, PMid:20643092, DOI: If the interval between doses is shorter than 5 months, A national HPV immunization program using a 15. Tabrizi SN, Brotherton JM, Kaldor JM, Skinner SR, 2014.06.001, PMid:25283316 cervical carcinomas is 99.7%. virus type-2 (HSV-2), immunosuppression, and response induced by the HPV vaccine in adolescent ijc.22527.https://doi.org/10.1002/ijc.22527 PMid:25271836 PMCid:PMC4182674, DOI: 10.1016/j.vaccine.2010.07.007, https://doi.org/ then a third dose should be given at least 6 months bHPV vaccine was implemented in Scotland in 2008, Liu B, Bateson D,et al. Assessment of herd immunity certain dietary deficiencies are other probable girls is predicted to provide long-term protection PMid:17405118 22. Bruni L, Albero G, Serrano B, Mena M, Gómez D, 10.1371/journal.pone.0107675, https://doi.org/10.1371/ 10.1016/j.vaccine.2010.07.007, PMid:20643092 Bangladesh had also different studies that focused on after the first dose. along with a national surveillance program designed and cross-protection after a human papillomavirus cofactors. against HPV infection and subsequent development Muñoz J, Bosch FX, de Sanjosé S. ICO/IARC journal.pone.0107675, PMid:25271836, PMCid:PMC4182674 HPV genotyping in different groups of females. to determine the longitudinal effects of vaccination 7. Banik U, Ahamad MSU, Bhattacharjee P, Adhikary vaccination programme in Australia: a repeat 38. Schwarz TF,Spaczynski M, Schneider A, Wysocki J, 29 • Information Centre on HPV and Cancer (HPV Nahar Q et al revealed prevalence of HPV infection Strategies for cervical cancer prevention and Females ≥15 years at the time of first dose & of high-grade cervical lesions and cancer. The AK, Rahman Z. cross-sectional study. Lancet Infect Dis.2014; 30. Sultana T, Huq M, Alam A, Mitra DK, Gomes DJ. Galaj A, Schulze K, et al. Persistence of immune on HPV infection at the population level. By linking Information Centre). Human Papillomavirus and was 7.7% with no significant difference between control33: immunocompromised and/or HIV-infected.: a 14(10):958-966.DOI: 10.1016/S1473-3099(14) 70841-2, Prevalence and genotyping of human papillomavirus vaccination, cervical screening, and HPV testing knowledge gained from this review is important for 8. High risk human papillomavirus type 16 and 18 Related Diseases in the World. Summary Report 17 response to HPV-16/18 AS04-adjuvanted cervical 3-dose schedule (0, 1-2, 6 months) is https://doi.org/10.1016/S1473-3099(14)70841-2 (HPV) in female with high-risk behaviour in Dhaka, urban and rural women. HR-HPV (High risk) WHO recommends a comprehensive approach to realizing the necessity of the use of a prophylactic infection in the cervical lesions of women with cancer vaccine in women aged 15-55 years. Hum recommended. data, over the study period they found a decline in June 2019. [Date Accessed] Bangladesh. Bangladesh J Microbiol. 2008; infections were more common (4.2%) than LR-HPV cervical cancer prevention and control. The HPV16/18 vaccine in Bangladeshi girls. There has epithelial cell abnormality in Pap smear: A 16. Kavanagh K, Pollock KG, Potts A, Love J, Cuschieri Vaccin.2011; 7(9): 958-965. https://doi.org/10.4161/ HPV 16 &18,significant decreases in HPV 31, 33& 23. FernandezJV and De Medeiros Fernandez TAA. 25(1):65-68. https://doi.org/10.3329/bjm.v25i1.4861, infections (3.4%). Most common HR genotypes were recommended set of actions includes following Evaluation of efficacy, immunogenicity and safety cytohistomorphologic association in Bangladeshi K, Cubie H, et al. Introduction and sustained high hv.7.9.15999, PMid:21892005 PMCid:PMC3225769, 45 (suggesting cross-protection). Among non- been little success with screening program against Chapter 1 Human Papillomavirus: Biology and DOI:https://doi.org/10.3329/bjm.v25i1.4861, HPV16,66,18,45,31&53. Sultana T et al30 noted the interventions. women. Cytojournal. 2013; 10: 14. DOI: 10.4103/ coverage of the HPV bivalent vaccine leads to DOI: 10.4161/hv.7.9.15999, https://doi.org/10.4161/ of HPV vaccine: vaccinated women, HPV 16 & 18 infections were cervical cancer in Bangladesh, an intervention that Pathogenesis. Human Papillomavirus and Related https://doi.org/10.3329/bjm.v25i1.4861 prevalence of genital HPV types in the sex workers 36 1742-6413.1150888. Borna NN, Tabassum S, Jahan areduction in prevalence of HPV 16/18 and closely hv.7.9.15999, PMid:21892005 PMCid:PMC3225769 a) Primary prevention begins with HPV vaccination HarperDM et al assessed the long-term efficacy, significantly lower in 2013 than in 2009 indicating has helped to significantly reduce cervical cancer in Diseases-From Bench to Bedside-A Clinical was as high as 75.8%, whereas for the high-risk types M, Munshi S, Unnesa A. Genotyping of High-Risk related HPV types. Br J Cancer.2014;110(11), 31. Khandker E, Khan M, Chowdhury AK. Human of girls aged 9-13 years, before they become sexually immunogenicity, and safety of a bivalent HPV-16/18 herd immunity and sustained effectiveness of the the developed world. Therefore, a National HPV Perspective, 2012. 1-40, Rijeka, Croatia: InTech. DOI: 39. Roteli-Martins CM, Naud P, De Borba P, TeixeiraJC, it was 49.8%. The highest prevalence rate was Human Papillomavirus (HPV) Among Cervical 2804-2811.DOI: 10.1038/bjc.2014.198. https://doi.org/ papillomavirus infection among Bangladeshi women active. Because HPV vaccines do not protect against L1 virus-like particle AS04 vaccine against incident bivalent vaccine onvirologic outcomes at the 10.5772/27154 https://doi.org/10.5772/27154 De Carvalho NS, Zahaf T, et al. Sustained observed for the genotype 16, 18 and 58. Khandker E Vaccination Program seems to be the window of Precancer and Cancer Patients. Acta MedicaInternational. 10.1038/bjc.2014.198,PMid:24736582 with cervical intraepithelial neoplasia and chronic all HPV types that cause cervical cancer, vaccine and persistent infection with HPV 16 & 18 and their 17 immunogenicity and efficacy of the HPV-16/18 31 population level. opportunity to reduce the mortality and morbidity of 2015;2(1):19-28.DOI: 10.5530/ami.2015.1.5, https://doi.org/ PMCid:PMC4037824 24. Gómez DT and Santos JL. Human papillomavirus cervicitis. IMC J Med Sci. 2016;10(1): 29-32. et al determine HPV infection rate was 43.1%. CIN associated cytological and histological outcomes. De AS04-adjuvanted vaccine: up to 8.4 years of introduction should be part of comprehensive 10.5530/ami.2015.1.5 infection and cervical cancer: pathogenesis and https://doi.org/10.3329/imcjms.v10i1.31103, DOI: cases had significantly high (p<0.01) HPV infection 37 Scenario of HPV vaccination in Bangladesh: HPV related cervical cancer in Bangladesh. 17. Cameron RL, Kavanagh K, Pan J, Love J, Cuschieri approach to cervical cancer control. Carvalhoa N et al report efficacy and epidemiology. Communicating Current Research and follow-up. Hum Vaccin. J Immunother.2012; 8(3): 9. Michael JC, Karen C. Cervical Cancer Screening and K, Robertson C, et al. Human Papillomavirus https://doi.org/10.3329/imcjms.v10i1.31103 (78.6%) compared to cases with chronic cervicitis immunogenicity of the HPV16/18 vaccine up to 7.3 WHO has developed guidelines on prevention and References : Educational Topics and Trends in Applied 390-397.https://doi.org/10.4161/hv.18865 7 Other recommended preventive interventions for Preinvasive Disease. In: Berek JS, Hacker NF Prevalence and Herd Immunity after Introduction of https://doi.org/10.3329/imcjms.v10i1.31103 (18.2%).BanikU et al find out the extent of HR HPV years post vaccination. No cases of infection or control of cervical cancer through vaccination and 1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre Microbiology. A Mendez Vilas (ed). Spain: Formatex; PMid:22327492,DOI:10.4161/hv.18865 (editors). Berek and Hacker's Gynecologic Oncology. Vaccination Program, Scotland, 2009-2013. Emerg type 16/18 infection in women with epithelial cell boys and girls are: cytohistological lesions associated with HPV 16/18 screening. By mid-2016, globally 65 countries, LA, Jemal A. Global Cancer Statistics 2018: 2007.p. 680-688. ISBN-13-9788461194223 32. De Vuyst H, Clifford GM, Nascimento MC, https://doi.org/10.4161/hv.18865 6th edition. Philadelphia: Wolters Kluwer; 2014. p. Infect Dis.2016; 22 (1), 56-64. https://doi.org/ abnormality in Pap smear. HPV type 16/18 infection mostly in high-income and upper-middle-income GLOBOCAN Estimates of Incidence and Mortality Madeleine MM, Franceschi S. Prevalence and type PMid:22327492 • education about safe sexual practices, delayed were observed in the vaccinee. Another follow up 242-325.ISBN-13-978-1-4511-9007-6. 10.3201/eid2201.150736,PMid:26692336 25. Bosch FX, Broker TR, Forman D, Moscicki AB, was detected in 40.42% of the patients. Borna NN et 38 Worldwide for 36 Cancers in 185 Countries.CA: distribution of human papillomavirus in carcinoma start of sexual activity study (up to 4 years) of SchwarzTF et al showed settings had introduced HPV vaccines into their PMCid:PMC4696690, DOI: 10.3201/eid2201.150736 Gillison ML, Doorbar J. et al. Comprehensive Control 40. World Health Organization. Country office for 8 33 Cancer J Clin. 2018; 68:394-424.DOI: 10.3322/ 10. Jacqueline S, Cristina H, Christopher E. Beyond Our and intraepithelial neoplasia of the vulva, vagina and al identify HR HPV genotype among women having persistence of immune response to HPV-16/18 national immunization programs . But the global https://doi.org/10.3201/eid2201.150736 of Human Papillomavirus Infections and Related • promotion and provision of condoms for those caac.21492.https://doi.org/10.3322/caac.21492 Borders Cervical cancer in the developing world. anus: a meta-analysis. Int J Cancer. 2009; Bangladesh. Human papillomavirus (HPV) vaccine CIN and carcinoma. HPV 16 was detected in vaccine in women aged 15–55 years. All subjects burden of cervical cancer fallsheaviest on the PMid:26692336 PMCid:PMC4696690 Diseases. Vaccine. 2013;31(7): H1-31. https://doi.org/ already engaged in sex PMid:30207593 West J Med. 2001; 175: 231-233. DOI: 10.1136/ 124(7):1626-1636. https://doi.org/10.1002/ijc.24116 introduced in Bangladesh. News release.2016. program by visual inspection with acetic acid (VIA), Programhas yet been started in Bangladesh and also the viral capsid. DNA containing approximately 8000 genes. The second is an early region (E), consisting which was considered to be a feasible method for no review has been done related to HPV Vaccination base pairs and harboring an average of 8 open reading of six ORFs: E1, E2, E4, E5, E6, and E7, which screening cervical cancer in the present so far. Hence, this review has been conducted to frames (ORFs). In a functional point of view, the encodes no structural proteins involved in viral socio-economic context. It has been estimated that explore different aspects of HPV vaccines in depth HPV genome is divided into three regions. The first is replication and oncogenesis. The third is a late (L) only 5% of the women in developing countries have which will help to recommend a National a long control region (LCR) that has regulatory region that encodes the L1 and L2 structural proteins. been screened for cervical dysplasia compared with HPVvaccination Program for prevention of cervical function of the transcription of the E6 and E7 viral about 40% to 50% of women in developed cancer among Bangladeshi women by a low-cost 10 countries. bHPV vaccine. One of the greatest medical breakthroughs in the last Review of literature century is the development of HPV vaccine against Human papillomavirus (HPV) vaccine for preventing cervical cancer by Professor Frazer and Dr Jian HPV induced malignancy is a widely studied topic Zhou.11 HPV related anogenital cancers can be for physicians. Different authors explained different prevented using a prophylactic vaccine. The two aspects of HPV, its malignant potential, its preventive prophylactic HPV vaccines, quadrivalent HPV type measures through vaccination and HPV vaccines 6/11/16/18 vaccine and bivalent HPV type 16/18 vaccine, were licensed in 2006 and 2007 under the immunogenicity, efficacy, safety etc through their names of Gardasil® and Cervarix® respectively.12 own view. Articles related to Human papillomavirus Recently nine-valent HPV type 6/11/16/18/31/33/45/52/58 (HPV) vaccine were retrieved from different vaccine with broader cancer coverage has also journals, web pages and books. From them 40 papers received the United States Food and Drug were included to prepare this manuscript. Administration (US-FDA) approval in October 2016 Role of HPV in cancers: 13 under the name of Gardasil9®. Different studies in The connection between persistent infection with USA, Australia and Scotland have begun to show a HPV and cervical cancer was first described by drop in the prevalence of HPV associated diseases Harald Zur Hausen in 1977. In 1983 & 1984 Zur Life cycle of HPV25: become persistently infected; which is the most both in vaccinated and non-vaccinated populations Hausen and his collaborators identified role of HPV indicating establishment, of herd immunity and also The viral life cycle refers mainly to high-risk important risk factor for the development of cervical 16 & 18 in cervical cancer and in the course of the provide cross- protection.14-17 Khatun S et al18 mucosotropic HPVs and is commonly extrapolated to cancer. The most common clinically significant next 12 years of research it has been recognized as a observed high immunogenicity and safety of the all HPVs. Activated cell divisionis necessary for viral manifestation of persistent genital HPV infection is carcinogen influencing its development.21 This bHPV vaccine among Bangladeshi adolescent girls at DNA access to the cell nucleus. Initial viral Cervical Intraepithelial Neoplasia (CIN). Within a finding laid the ground for the idea of a vaccine 7 months of vaccination.Sustained efficacy, replication in the basal cells requires E1 and E2 few years of infection, low-grade CIN(CIN 1) may Introduction: Human papillomavirus (HPV) is the virtually against HPV infection and cervical cancer, and in proteins. The role of E6 and E7 in the basal layer is develop, which may spontaneously resolve and the Cervical cancer is a major public health problem necessary cause of carcinoma cervix. HPVs causing immunogenicity, and safety of the bHPV vaccine 1999 it finally became clear that persistent HPV uncertain; particularly for the low-risk HPVs. infection clear. Persistent HPV infection, may worldwide. It is the 4th most frequently diagnosed not only the vast majority of cervical (99.7%), but were observed in the final analysis of a follow-up study up to 9.4 years postvaccination.19 infection is a necessary cause of invasive cervical Deregulation of E6/E7 expression is critical in progress directly to higher-grade CIN (CIN2 or cancer in women worldwide, with an estimated also a substantial proportion of other anogenital and 3 cancer. HPV infection is commonly found in the determining neoplastic grade. In high-risk HPVs, CIN3). High-grade abnormalities are at risk of 570,000 new cases in 2018. It is also the 4th leading head and neck cancers.3,4 Among all HPV-associated HPV vaccine has introduced in Bangladesh by the anogenital tract of men and women with and without E6/E7 mediates proliferation of the basal and progression to cancer. Some high-grade abnormalities cause of cancer death, with an estimated 311,000 malignancies, cervical cancer is the most important Ministry of Health and Family Planning (MoHFP), clinical lesions. The etiological role of HPV infection parabasal cells, facilitating lesion growth. HPV E6 spontaneously regress. If left, undetected and deaths in 2018. Cervical cancer is the 2nd most cause of morbidity and mortality worldwide. with support from the Global Alliance for Vaccines among women with cervical cancer is and E7 oncoproteins bind to and inactivate tumor untreated, years or decades later CIN2 or 3 can commonly diagnosed cancer and leading cause of Approximately 70% of cervical cancers worldwide and Immunizations (GAVI) for two years in Gazipur well-established, and there is growing evidence of its suppressor proteins p53 and pRb, respectively, progress to cervical cancer. The time lag between the cancer death among females in less developed are associated with two high-risk HPV types (16/18), district and if it is successful, GAVI will provide 1 central role in other anogenital cancers (anus, vulva, leading to malignant transformation of infected cells. peak of HPV infection and the peak of cancer countries. Cervical cancer is the 2nd leading cause of while other high-risk HPV types 31, 33, 35, 45, 52 support for national introduction of HPV vaccine.20 vagina, penis), head and neck cancers. HPV is also incidence generally takes place over a period of 10 to female cancer in incidence and 3rd leading cause of and 58 are responsible for approximately 20% case.5,6 There has been little success with screening program Transmission and natural history of HPV responsible for diseases e.g recurrent juvenile 20 years, making the initiating infections and female cancer deaths among Bangladeshi women HPV type 16/18 infection was detected in 40.42% of against cervical cancer, which is a major public infection26: precursor lesions of cervical cancer anappropriate with an estimated 8,068 new cases and 5,214 deaths the women in Bangladesh with cervical epithelial cell health problem in Bangladesh. Therefore, a National respiratory papillomatosis and genital warts, both HPV infection occurs at the basal epithelium during 2 22 target for screening and early detection. Some lesions in 2018. abnormality.7 HPV type 16 was detected in 81.82%, HPV Vaccination Program will reduce the mortality mainly caused by HPV 6/11. sexual intercourse. Although the incidence of become cancerous more rapidly, sometimes within 2 type 18 in 9.09% and type 45 in 6.06% cases of and morbidity of cervical cancer in Bangladesh.The Structure23 and gene functions24 of HPV: infection is high, but most infections resolve years. Infection with one type of HPV does not cervical carcinoma in Bangladesh.8 objective of the review article is to evaluate the HPV is a relatively small non-enveloped double- spontaneously. Several studies have suggested that current status of the cervical cancer prevention most women successfully clear the HPV infection, prevent infection with another type. If persons In developed countries, incidence and mortality of stranded DNA virus in the family Papillomaviridae. achieved by HPV vaccination worldwide. presumably through the action of a competent infected with mucosal HPV, 5% to 30% are infected cervical cancer has been lowered by effective It is associated with histone-like proteins and immune system. Among the infected individuals, with multiple types of the virus. population-based screening program with Pap smear Rationale of the review protected by a capsid formed by two late proteins, L1 approximately, 90% of lesions regress spontaneously HPV prevalence: and or HPV DNA testing.9 Government of National HPV vaccination programs have been and L2. Each virion contains 72 copies of the L1, the without clinical signs or symptoms within 12 to 36 There have been many studies worldwide on the Bangladesh with the support of UNFPA has taken implemented in many countries to prevent cervical major component of the capsid, and a variable months, a small proportion of infected persons proportion of cervical cancer, other anogenital initiative to develop a cervical cancer screening cancer. But no National HPV Vaccination number of copies of L2, a secondary component of

Human Papilloma Virus Vaccinefor Cervical Cancer Prevention CS Sultana et al cancers, high& low-grade squamous intraepithelial 81.82%followed by 18 in 9.09%& 45 in 6.06% cases • warnings about tobacco use • A quadrivalent vaccine (Gardasil®/Silgard®, Mechanism of vaccine related protection: were seroconverted for anti-HPV-16&18 antibodies developing countries which haven’t introduced the 2. Bruni L, Albero G, Serrano B, Mena M, Gómez D, ewjm.175.4.231. https://doi.org/10.1136/ ewjm. 18. Khatun S, HussainSMA, Chowdhury S, Ferdous J, 10.1016/j.vaccine.2013.10.003, PMid:24332295 PMid:19115209, DOI: 10.1002/ijc.24116, https://doi.org/ Muñoz J, et al. ICO/IARC Information Centre on 175.4.231, PMid:11577044 PMCid:PMC1071564 Hossain F, Begum SR, et al. Safety and PMCid:PMC7605442, DOI: 10.1016/j.vaccine.2013. lesions (HSIL and LSIL) due to different HPV of cervical carcinoma. Among precancerous cases, • male circumcision. produced by Merck & Co)–protects against HPV Systemic immunization with L1 VLPs generates at Month 7. At Month 48 of that study, all subjects HPV vaccine as part of their national public health 10.1002/ijc.24116, PMid:19115209 HPV and Cancer (HPV Information Centre). Human Immunogenicity Profile of Human Papillomavirus- 10.003, https://doi.org/10.1016/j.vaccine.2013.10.003 genotypes as well as prevalence of HPV in general only type 16 was detected. 16 & 18, 6 & 11 that causes anogenital warts antibody concentrations higher than in a natural were still seropositive for anti-HPV-16 antibodies strategy to prevent and control cervical cancer. 11. Zhao KN, Zhang L, Qu J. Dr. Jian Zhou: The great 33. Uterine cervical neoplasms - prevention and control. b) Secondary prevention through screening and Papillomavirus and Related Diseases in Bangladesh. 16/18 AS04 Adjuvant Cervical Cancer Vaccine: A PMid:24332295 PMCid:PMC7605442 population. also. infection. The HPV vaccines are highly and all but one subject in the 46–55 years age group inventor of cervical cancer vaccine. Protein Cell.2017; Comprehensive cervical cancer control: a guide to HPVprevalence in vulvar, vaginal and anal treatment of adult sexually active women for Bivalent HPV vaccine was registered in Bangladesh Summary Report 17 June 2019. [Date Accessed] Randomized Controlled Trial in Healthy Adolescent 27 immunogenic leading to seroconversion in virtually remained seropositive (99.4%) for anti-HPV-18 8(2): 79-82. DOI: 10.1007/s13238-016-0358-2 26. Human Papillomavirus. In: Centers for Disease Bruni L et al performed a meta-analysis of cervical intraepithelial neoplasia (VIN, VAIN, AIN) grades As of December 2014, the U.S.FDA approved Girls of Bangladesh. Jpn J Clin Oncol. 2011;42(1): essential practice. 2nd ed. World Health Organization. precancerous lesions, starting from 30 years of age. 100% of vaccinees. Antibody titers in blood reach 39 in 2009 while qHPV was registered in 2014.HPV 3. Walboomers JM, Jacobs MV, Manos MM, Bosch FX, https://doi.org/10.1007/s13238-016-0358-2 Control and Prevention. Epidemiology and Prevention HPV prevalence among women with normal 1-3 and carcinoma was conducted in 4 continents. antibodies. Roteli-Martins CM et al report the 36-41. https://doi.org/10.1093/jjco/hyr173, PMid:22194637 2014. ISBN 978 92 4 154895 3 Merck’s 9- valent HPV vaccine (GARDASIL 9®) vaccine has recently been introduced in Bangladesh Kummer JA, Shah KV, et al. Human papillomavirus is PMid:28108949 PMCid:PMC5291779 c)Tertiary prevention and palliative care for women peaks 2–3 log higher than in natural infections, long-term efficacy and immunogenicity of the PMCid:PMC3244935, DOI: 10.1093/jjco/hyr173 of Vaccine-Preventable Diseases. Hamborsky J, cytological findings. The estimated global HPV Overall HPV prevalence was 67.8%, 85.3% and which includes the additional five HPV 31, 33, 45, a necessary cause of invasive cervical cancer 34. Guide to introducing HPV vaccine into national affected by invasive cervical cancer include surgery, decrease gradually to levels several-fold lower than HPV-16/18 AS04-adjuvanted vaccine up to 8.4 y by the Ministry of Health and Family Planning 12. Markowitz LE, Dunne EF, Saraiya M, Chesson HW, https://doi.org/10.1093/jjco/hyr173 Kroger A, Wolfe S, eds. 13th ed., Supplement. prevalence was 11.7%. While based on the world 40.4% among VIN1, VIN2/3& vulvar carcinomas; 52& 58 compared to the quadrivalent vaccine. worldwide. J Pathol.1999;189(1): 12-19. https://doi.org/ immunization programmes. Immunization, Vaccines radiotherapy and chemotherapy. peak and then remain stable for years. The IgG is after the first vaccine dose. No new infection or (MoHFP), with support from the Global Alliance for Curtis CR, GEE J, et al. Human Papillomavirus PMid:22194637 PMCid:PMC3244935 Washington D.C. Public Health Foundation, 2017. regions Sub-Saharan Africa (24%), Eastern Europe 100%, 90.1% and 69.9% among VAIN1, VAIN2/3& 10.1002/(SICI)1096-9896(199909)189:1<12::AID-P and Biologicals. World Health Organization. 2016; Both vaccines are composed of type-specific HPV L1 exuded at the possible sites of infection (mucosa of Vaccines and Immunizations (GAVI). This new Vaccination: Recommendations of the Advisory p.175-186. (21.4%) and Latin America (16.1%) showed the vaginal carcinomas; and 91.5%, 93.9% and 84.3% HPV vaccines34: lesions associated with HPV-16/18 occurred in the ATH431>3.0.CO;2-F, DOI: 10.1002/(SICI)1096-9896 19. Naud PS, Roteli-Martins CM, De Carvalho NS, 1-90. ISBN: 978 92 4 154976 9 protein, the major capsid protein of HPV which is genital tract, oral cavity, etc.), neutralizes the virus 19 Committee on Immunization Practices (ACIP). highest prevalence’s. among AIN1, AIN2/3& anal carcinomas, vaccine group. NaudPSet al conducted a long-term vaccine introduction program ran for two years in (199909)189:1<12: AID-PATH431>3.0.CO;2-F Teixeira JC, De Borba PC, Sanchez N, et al. Sustained 27. Bruni L, Diaz M, Castellsagué X, Ferrer E, Bosch FX, The availability of prophylactic HPV vaccines has used as an antigen. Through Recombinant DNA and prevents its entry into the cells. The MMWR Recomm Rep. 2014; 63(RR-05): 35. Human papillomavirus vaccines: Weekly epidemiological respectively. HPV16 was found>75% and 18 <10% follow-up of an initial double-blind, randomized Gazipur district and if it is successful, GAVI will efficacy, immunogenicity, and safety of the De Sanjosé S. Cervical human papillomavirus Alemany L et al28 estimated the HPV type-specific provided a powerful tool for primary prevention of technology the L1 protein undergoes conformal vaccine-induced immune memory in the form of 4. Zur Hausen H. Papillomaviruses in the causation of 1-30.PMID: 25167164 record. WHO position paper.2017;92(19):241-268. in HPV positive vulvar, vaginal and anal carcinomas. (1:1), placebo-controlled study evaluating the provide support for national introduction of HPV HPV-16/18 AS04-adjuvanted vaccine: final analysis prevalence in 5 continents: Meta-analysis of 1 million distribution in a large series of invasive cervical cervical cancer and other HPV-associated diseases. human cancers-a brief historical account. Virology. ISSN 0049-8114 changes to self-assemble into 'virus-like' particles circulating plasma cells and memory B-cells allows 40 13. Meites E, Kempe A, Markowitz LE. Use of a 2-Dose of a long-term follow-up study up to 9.4 years women with normal cytological findings. J Infect Dis. Approximately 40% ofvulvar, 60% of vaginal and The vaccines are most effective when administered to efficacy against HPV16/18 infection and associated vaccine . WHO recommends that girls are 2009; 384(2): 260-265. https://doi.org/ 10.1016/ cancer (ICC) over 70 years from 11 countries in (VLPs). The VLPs are non-infective and non- generation and exudation of protecting IgG each time Schedule for Human Papillomavirus Vaccination - post-vaccination. Hum VaccinImmunother. 2014; 2010; 202(12): 1789-1799. https://doi.org/ 80% of anal carcinoma are responsible for a person prior to exposure to HPV. Two HPV cyto-histopathological abnormalities, persistence vaccinated with HPV vaccine between the ages of j.virol.2008.11.046, PMid:19135222, DOI: 10.1016/ 36. Harper DM, Franco EL, Wheeler CM, Moscick AB, Central-South America, Asia and Europe. Among pathogenic as these are devoid of the viral DNA the body is challenged by exposure to HPV infection. Updated Recommendations of the Advisory 10(8), 2147-2162. https://doi.org/10.4161/hv.29532 10.1086/657321, PMid:21067372, DOI: 10.1086/ HPV16/18.32 ofimmunogenicity, and safety of the HPV-16/18 j.virol.2008.11.046. https://doi.org/10.1016/j.virol. Romanowski B, Roteli-Martins CM, et al. Sustained 4,771 HPV DNA positive ICC cases, HPV16&18 vaccines are currently pre-qualified by WHO: essential to initiate the carcinogenic process. Bivalent 9-13 years. In line with this, the Government of Committee on Immunization Practices. MMWR Morb PMid:25424918 PMCid:PMC4896780, DOI: 657321, https://doi.org/10.1086/657321, PMid:21067372 Animal models suggest that very low antibody titers 2008.11.046, PMid:19135222 efficacy up to 4.5 years of a bivalent L1 virus-like AS04-adjuvanted vaccine. No new HPV 16/18- Bangladesh has decided to vaccinate 10-year-old Mortal Wkly Rep. 2016; 65(49):1405-1408. were the two most common HPVs in all the decades Co-factors associated with cervical cancer: • A bivalent vaccine (Cervarix®, produced by vaccinecontains a novel adjuvant AS04 and may still be protective. Partial cross-protection 10.4161/hv.29532, https://doi.org/10.4161/hv.29532 28. Alemany L, De Sanjosé S, Tous S, Quint W, Vallejos particle vaccine against human papillomavirus types 5 associated infections and cyto-histopathological girls in the primary school setting (Grade 5) with two 5. Mu˜noz N, Castellsagu' E X, De González AB, https://doi.org/10.15585/mmwr.mm6549a5 (HPV16-from 61.5 to 62.1%, and HPV18-from 6.9 to Muñoz N et al stated that although HPV is a GlaxoSmithKline)–protects against HPV 16 & quadrivalent vaccine VLPs are adsorbed on an against HPV31, HPV33 and HPV45 has been PMid:25424918 PMCid:PMC4896780 C, Shin HR.et al. Time trends of human 16 and 18: follow-up from a randomized control trial. 25 abnormalities occurred in the vaccine group. Gissmann L, Chapter 1: HPV in the etiology of human PMid:27977643, DOI: http://dx.doi.org/10.15585/ 7.2%). A meta-analysis update conducted by SmithJS necessary cause of cervical cancer, it is not a 18 that cause the majority of cervical cancers; aluminum-containing adjuvant to ensure robust and described. doses of bHPVvaccine, given 6 months apart. The 20. WORLD HEALTH ORGANIZATION. Country papillomavirus types in invasive cervical cancer, from Lancet.2006; 367(9518):1247-1255. https://doi.org/ 6 18 cancer. Vaccine. 2006; 24 (3): S1-S10. https://doi.org/ mmwr.mm6549a5external icon et al showed HPV type distribution in ICCand HSIL. sufficient cause. Epidemiologic studies indicate that long-lasting immunogenicity.12 Khatun S et al conducted a study to assess the target girls will mainly be reached through the office for Bangladesh. Human papillomavirus (HPV) 1940 to 2007.2014. Int J Cancer. 2014; 135(1):88-95. 10.1016/S0140-6736(06)68439-0, DOI: 10.1016/ and Recommended vaccination schedule: 10.1016/j.vaccine.2006.05.115, PMid:16949995, In ICC, HPV16 was the most common, and HPV18 the risk of contracting genital HPV infection and immunogenicity and safety profile of HPV16/18 14. Markowitz LE, Hariri S, Lin C, Dunne EF, Steinau M, vaccine introduced in Bangladesh.18 May 2016. https://doi.org/10.1002/ijc.28636, PMid:24382655, S0140-6736(06)68439-0, https://doi.org/10.1016/ The primary target group in most of the countries schoolbasedprogramme and girls who are out of DOI: 10.1016/ j.vaccine.2006.05.115, https://doi.org/ the second most common, type in all continents. The cervical cancer is influenced by a variety of factors. vaccines in healthy Bangladeshi girls aged between McquillanG, et al. Reduction in human News release DOI: 10.1002/ijc.28636, https://doi.org/10.1002/ S0140-6736(06)68439-0 recommending HPV vaccination is young adolescent school will receive the vaccine through the routine 10.1016/j.vaccine.2006.05.115, PMid:16949995 papillomavirus (HPV) prevalence among young next most common HPV types were HPV31, 33, 35, Thus, other cofactors are necessary for progression 9–13 years. They recommended that, bHPV vaccine EPI sites at the community level. 21. Morshed K, Polz-Gruszka D, Szymański M, ijc.28636, PMid:24382655 girls, aged 9-14.WHO has recommended the 6. Smith JS, Lindsay L, Hoots B, Keys J, Franceschi S, women following HPV vaccine introduction in the 37. De Carvalho N, Teixeira J, Roteli-Martins CM, Naud 45, 52 and 58. HPV18 was significantly more from cervical HPV infection to cancer. Long-term 35 was generally well tolerated, with no vaccine-related Polz-Dacewicz M. Human Papillomavirus (HPV) - following vaccination schedule . Winer R, et al. Human papillomavirus type United States, National Health and Nutrition 29. Nahar Q, Sultana F, Alam A, Islam JY, Rahman M, P, De Borba P, Zahaf T, et al. Sustained efficacy and prevalent in adeno/adenosquamous carcinoma than use of hormonal contraceptives, high parity, tobacco serious adverse effects. Conclusion: Structure, epidemiology and pathogenesis. Otolaryngol distribution in invasive cervical cancer and high-grade Examination Surveys, 2003-2010. J Infect Khatun F. et al. Genital human papillomavirus immunogenicity of the HPV-16/18 AS04-adjuvanted in squamous cell carcinoma. Among HSIL cases, smoking, and co-infection with HIV have been • Females <15 years at the time of first dose: a Immunization with the HPV vaccine induces Pol. 2014;68(5):213-219. https://doi.org/10.1016/ HPV prevalence, cross-protection and herd cervical lesions: A meta-analysis update. Int. J. Dis.2013;208(3):385-393. https://doi.org/10.1093/ infection among women in Bangladesh: findings from vaccine up to 7.3 years in young adult women. HPV16/18prevalence was 52%. WalboomersJM et identified as established cofactors; co-infection with sustained high levels of antibodies against high-risk j.otpol.2014.06.001, PMid:25283316, DOI: 10.1016/ 2-dose schedule (0, 6 months) is recommended. Cancer. 2007; 121(3): 621-632. https://doi.org/ infdis/jit192, PMid:23785124, DOI:10.1093/infdis/jit192. a Population-based survey. PLoS One. 2014; 9(10): Vaccine.2010; 28(38):6247-6255. https://doi.org/10.1016/ 3 immunity after vaccination: j.otpol.2014.06.001, https://doi.org/10.1016/j.otpol. al found that the worldwide HPV prevalence in Chlamydia trachomatis (CT) and herpes simplex HPV genotypes 16 and 18. The durable immune 10.1002/ijc.22527, PMid:17405118, DOI: 10.1002/ e107675. https://doi.org/10.1371/journal.pone.0107675 j.vaccine.2010.07.007, PMid:20643092, DOI: If the interval between doses is shorter than 5 months, A national HPV immunization program using a 15. Tabrizi SN, Brotherton JM, Kaldor JM, Skinner SR, 2014.06.001, PMid:25283316 cervical carcinomas is 99.7%. virus type-2 (HSV-2), immunosuppression, and response induced by the HPV vaccine in adolescent ijc.22527.https://doi.org/10.1002/ijc.22527 PMid:25271836 PMCid:PMC4182674, DOI: 10.1016/j.vaccine.2010.07.007, https://doi.org/ then a third dose should be given at least 6 months bHPV vaccine was implemented in Scotland in 2008, Liu B, Bateson D,et al. Assessment of herd immunity certain dietary deficiencies are other probable girls is predicted to provide long-term protection PMid:17405118 22. Bruni L, Albero G, Serrano B, Mena M, Gómez D, 10.1371/journal.pone.0107675, https://doi.org/10.1371/ 10.1016/j.vaccine.2010.07.007, PMid:20643092 Bangladesh had also different studies that focused on after the first dose. along with a national surveillance program designed and cross-protection after a human papillomavirus cofactors. against HPV infection and subsequent development Muñoz J, Bosch FX, de Sanjosé S. ICO/IARC journal.pone.0107675, PMid:25271836, PMCid:PMC4182674 HPV genotyping in different groups of females. to determine the longitudinal effects of vaccination 7. Banik U, Ahamad MSU, Bhattacharjee P, Adhikary vaccination programme in Australia: a repeat 38. Schwarz TF,Spaczynski M, Schneider A, Wysocki J, 29 • Information Centre on HPV and Cancer (HPV Nahar Q et al revealed prevalence of HPV infection Strategies for cervical cancer prevention and Females ≥15 years at the time of first dose & of high-grade cervical lesions and cancer. The AK, Rahman Z. cross-sectional study. Lancet Infect Dis.2014; 30. Sultana T, Huq M, Alam A, Mitra DK, Gomes DJ. Galaj A, Schulze K, et al. Persistence of immune on HPV infection at the population level. By linking Information Centre). Human Papillomavirus and was 7.7% with no significant difference between control33: immunocompromised and/or HIV-infected.: a 14(10):958-966.DOI: 10.1016/S1473-3099(14) 70841-2, Prevalence and genotyping of human papillomavirus vaccination, cervical screening, and HPV testing knowledge gained from this review is important for 8. High risk human papillomavirus type 16 and 18 Related Diseases in the World. Summary Report 17 response to HPV-16/18 AS04-adjuvanted cervical 3-dose schedule (0, 1-2, 6 months) is https://doi.org/10.1016/S1473-3099(14)70841-2 (HPV) in female with high-risk behaviour in Dhaka, urban and rural women. HR-HPV (High risk) WHO recommends a comprehensive approach to realizing the necessity of the use of a prophylactic infection in the cervical lesions of women with cancer vaccine in women aged 15-55 years. Hum recommended. data, over the study period they found a decline in June 2019. [Date Accessed] Bangladesh. Bangladesh J Microbiol. 2008; infections were more common (4.2%) than LR-HPV cervical cancer prevention and control. The HPV16/18 vaccine in Bangladeshi girls. There has epithelial cell abnormality in Pap smear: A 16. Kavanagh K, Pollock KG, Potts A, Love J, Cuschieri Vaccin.2011; 7(9): 958-965. https://doi.org/10.4161/ HPV 16 &18,significant decreases in HPV 31, 33& 23. FernandezJV and De Medeiros Fernandez TAA. 25(1):65-68. https://doi.org/10.3329/bjm.v25i1.4861, infections (3.4%). Most common HR genotypes were recommended set of actions includes following Evaluation of efficacy, immunogenicity and safety cytohistomorphologic association in Bangladeshi K, Cubie H, et al. Introduction and sustained high hv.7.9.15999, PMid:21892005 PMCid:PMC3225769, 45 (suggesting cross-protection). Among non- been little success with screening program against Chapter 1 Human Papillomavirus: Biology and DOI:https://doi.org/10.3329/bjm.v25i1.4861, HPV16,66,18,45,31&53. Sultana T et al30 noted the interventions. women. Cytojournal. 2013; 10: 14. DOI: 10.4103/ coverage of the HPV bivalent vaccine leads to DOI: 10.4161/hv.7.9.15999, https://doi.org/10.4161/ of HPV vaccine: vaccinated women, HPV 16 & 18 infections were cervical cancer in Bangladesh, an intervention that Pathogenesis. Human Papillomavirus and Related https://doi.org/10.3329/bjm.v25i1.4861 prevalence of genital HPV types in the sex workers 36 1742-6413.1150888. Borna NN, Tabassum S, Jahan areduction in prevalence of HPV 16/18 and closely hv.7.9.15999, PMid:21892005 PMCid:PMC3225769 a) Primary prevention begins with HPV vaccination HarperDM et al assessed the long-term efficacy, significantly lower in 2013 than in 2009 indicating has helped to significantly reduce cervical cancer in Diseases-From Bench to Bedside-A Clinical was as high as 75.8%, whereas for the high-risk types M, Munshi S, Unnesa A. Genotyping of High-Risk related HPV types. Br J Cancer.2014;110(11), 31. Khandker E, Khan M, Chowdhury AK. Human of girls aged 9-13 years, before they become sexually immunogenicity, and safety of a bivalent HPV-16/18 herd immunity and sustained effectiveness of the the developed world. Therefore, a National HPV Perspective, 2012. 1-40, Rijeka, Croatia: InTech. DOI: 39. Roteli-Martins CM, Naud P, De Borba P, TeixeiraJC, it was 49.8%. The highest prevalence rate was Human Papillomavirus (HPV) Among Cervical 2804-2811.DOI: 10.1038/bjc.2014.198. https://doi.org/ papillomavirus infection among Bangladeshi women active. Because HPV vaccines do not protect against L1 virus-like particle AS04 vaccine against incident bivalent vaccine onvirologic outcomes at the 10.5772/27154 https://doi.org/10.5772/27154 De Carvalho NS, Zahaf T, et al. Sustained observed for the genotype 16, 18 and 58. Khandker E Vaccination Program seems to be the window of Precancer and Cancer Patients. Acta MedicaInternational. 10.1038/bjc.2014.198,PMid:24736582 with cervical intraepithelial neoplasia and chronic all HPV types that cause cervical cancer, vaccine and persistent infection with HPV 16 & 18 and their 17 immunogenicity and efficacy of the HPV-16/18 31 population level. opportunity to reduce the mortality and morbidity of 2015;2(1):19-28.DOI: 10.5530/ami.2015.1.5, https://doi.org/ PMCid:PMC4037824 24. Gómez DT and Santos JL. Human papillomavirus cervicitis. IMC J Med Sci. 2016;10(1): 29-32. et al determine HPV infection rate was 43.1%. CIN associated cytological and histological outcomes. De AS04-adjuvanted vaccine: up to 8.4 years of introduction should be part of comprehensive 10.5530/ami.2015.1.5 infection and cervical cancer: pathogenesis and https://doi.org/10.3329/imcjms.v10i1.31103, DOI: cases had significantly high (p<0.01) HPV infection 37 Scenario of HPV vaccination in Bangladesh: HPV related cervical cancer in Bangladesh. 17. Cameron RL, Kavanagh K, Pan J, Love J, Cuschieri approach to cervical cancer control. Carvalhoa N et al report efficacy and epidemiology. Communicating Current Research and follow-up. Hum Vaccin. J Immunother.2012; 8(3): 9. Michael JC, Karen C. Cervical Cancer Screening and K, Robertson C, et al. Human Papillomavirus https://doi.org/10.3329/imcjms.v10i1.31103 (78.6%) compared to cases with chronic cervicitis immunogenicity of the HPV16/18 vaccine up to 7.3 WHO has developed guidelines on prevention and References : Educational Topics and Trends in Applied 390-397.https://doi.org/10.4161/hv.18865 7 Other recommended preventive interventions for Preinvasive Disease. In: Berek JS, Hacker NF Prevalence and Herd Immunity after Introduction of https://doi.org/10.3329/imcjms.v10i1.31103 (18.2%).BanikU et al find out the extent of HR HPV years post vaccination. No cases of infection or control of cervical cancer through vaccination and 1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre Microbiology. A Mendez Vilas (ed). Spain: Formatex; PMid:22327492,DOI:10.4161/hv.18865 (editors). Berek and Hacker's Gynecologic Oncology. Vaccination Program, Scotland, 2009-2013. Emerg type 16/18 infection in women with epithelial cell boys and girls are: cytohistological lesions associated with HPV 16/18 screening. By mid-2016, globally 65 countries, LA, Jemal A. Global Cancer Statistics 2018: 2007.p. 680-688. ISBN-13-9788461194223 32. De Vuyst H, Clifford GM, Nascimento MC, https://doi.org/10.4161/hv.18865 6th edition. Philadelphia: Wolters Kluwer; 2014. p. Infect Dis.2016; 22 (1), 56-64. https://doi.org/ abnormality in Pap smear. HPV type 16/18 infection mostly in high-income and upper-middle-income GLOBOCAN Estimates of Incidence and Mortality Madeleine MM, Franceschi S. Prevalence and type PMid:22327492 • education about safe sexual practices, delayed were observed in the vaccinee. Another follow up 242-325.ISBN-13-978-1-4511-9007-6. 10.3201/eid2201.150736,PMid:26692336 25. Bosch FX, Broker TR, Forman D, Moscicki AB, was detected in 40.42% of the patients. 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126 program by visual inspection with acetic acid (VIA), Programhas yet been started in Bangladesh and also the viral capsid. DNA containing approximately 8000 genes. The second is an early region (E), consisting which was considered to be a feasible method for no review has been done related to HPV Vaccination base pairs and harboring an average of 8 open reading of six ORFs: E1, E2, E4, E5, E6, and E7, which screening cervical cancer in the present so far. Hence, this review has been conducted to frames (ORFs). In a functional point of view, the encodes no structural proteins involved in viral socio-economic context. It has been estimated that explore different aspects of HPV vaccines in depth HPV genome is divided into three regions. The first is replication and oncogenesis. The third is a late (L) only 5% of the women in developing countries have which will help to recommend a National a long control region (LCR) that has regulatory region that encodes the L1 and L2 structural proteins. been screened for cervical dysplasia compared with HPVvaccination Program for prevention of cervical function of the transcription of the E6 and E7 viral about 40% to 50% of women in developed cancer among Bangladeshi women by a low-cost 10 countries. bHPV vaccine. One of the greatest medical breakthroughs in the last Review of literature century is the development of HPV vaccine against Human papillomavirus (HPV) vaccine for preventing cervical cancer by Professor Frazer and Dr Jian HPV induced malignancy is a widely studied topic Zhou.11 HPV related anogenital cancers can be for physicians. Different authors explained different prevented using a prophylactic vaccine. The two aspects of HPV, its malignant potential, its preventive prophylactic HPV vaccines, quadrivalent HPV type measures through vaccination and HPV vaccines 6/11/16/18 vaccine and bivalent HPV type 16/18 vaccine, were licensed in 2006 and 2007 under the immunogenicity, efficacy, safety etc through their names of Gardasil® and Cervarix® respectively.12 own view. Articles related to Human papillomavirus Recently nine-valent HPV type 6/11/16/18/31/33/45/52/58 (HPV) vaccine were retrieved from different vaccine with broader cancer coverage has also journals, web pages and books. From them 40 papers received the United States Food and Drug were included to prepare this manuscript. Administration (US-FDA) approval in October 2016 Role of HPV in cancers: 13 under the name of Gardasil9®. Different studies in The connection between persistent infection with USA, Australia and Scotland have begun to show a HPV and cervical cancer was first described by drop in the prevalence of HPV associated diseases Harald Zur Hausen in 1977. In 1983 & 1984 Zur Life cycle of HPV25: become persistently infected; which is the most both in vaccinated and non-vaccinated populations Hausen and his collaborators identified role of HPV indicating establishment, of herd immunity and also The viral life cycle refers mainly to high-risk important risk factor for the development of cervical 16 & 18 in cervical cancer and in the course of the provide cross- protection.14-17 Khatun S et al18 mucosotropic HPVs and is commonly extrapolated to cancer. The most common clinically significant next 12 years of research it has been recognized as a observed high immunogenicity and safety of the all HPVs. Activated cell divisionis necessary for viral manifestation of persistent genital HPV infection is carcinogen influencing its development.21 This bHPV vaccine among Bangladeshi adolescent girls at DNA access to the cell nucleus. Initial viral Cervical Intraepithelial Neoplasia (CIN). Within a finding laid the ground for the idea of a vaccine 7 months of vaccination.Sustained efficacy, replication in the basal cells requires E1 and E2 few years of infection, low-grade CIN(CIN 1) may Introduction: Human papillomavirus (HPV) is the virtually against HPV infection and cervical cancer, and in proteins. The role of E6 and E7 in the basal layer is develop, which may spontaneously resolve and the Cervical cancer is a major public health problem necessary cause of carcinoma cervix. HPVs causing immunogenicity, and safety of the bHPV vaccine 1999 it finally became clear that persistent HPV uncertain; particularly for the low-risk HPVs. infection clear. Persistent HPV infection, may worldwide. It is the 4th most frequently diagnosed not only the vast majority of cervical (99.7%), but were observed in the final analysis of a follow-up study up to 9.4 years postvaccination.19 infection is a necessary cause of invasive cervical Deregulation of E6/E7 expression is critical in progress directly to higher-grade CIN (CIN2 or cancer in women worldwide, with an estimated also a substantial proportion of other anogenital and 3 cancer. HPV infection is commonly found in the determining neoplastic grade. In high-risk HPVs, CIN3). High-grade abnormalities are at risk of 570,000 new cases in 2018. It is also the 4th leading head and neck cancers.3,4 Among all HPV-associated HPV vaccine has introduced in Bangladesh by the anogenital tract of men and women with and without E6/E7 mediates proliferation of the basal and progression to cancer. Some high-grade abnormalities cause of cancer death, with an estimated 311,000 malignancies, cervical cancer is the most important Ministry of Health and Family Planning (MoHFP), clinical lesions. The etiological role of HPV infection parabasal cells, facilitating lesion growth. HPV E6 spontaneously regress. If left, undetected and deaths in 2018. Cervical cancer is the 2nd most cause of morbidity and mortality worldwide. with support from the Global Alliance for Vaccines among women with cervical cancer is and E7 oncoproteins bind to and inactivate tumor untreated, years or decades later CIN2 or 3 can commonly diagnosed cancer and leading cause of Approximately 70% of cervical cancers worldwide and Immunizations (GAVI) for two years in Gazipur well-established, and there is growing evidence of its suppressor proteins p53 and pRb, respectively, progress to cervical cancer. The time lag between the cancer death among females in less developed are associated with two high-risk HPV types (16/18), district and if it is successful, GAVI will provide 1 central role in other anogenital cancers (anus, vulva, leading to malignant transformation of infected cells. peak of HPV infection and the peak of cancer countries. Cervical cancer is the 2nd leading cause of while other high-risk HPV types 31, 33, 35, 45, 52 support for national introduction of HPV vaccine.20 vagina, penis), head and neck cancers. HPV is also incidence generally takes place over a period of 10 to female cancer in incidence and 3rd leading cause of and 58 are responsible for approximately 20% case.5,6 There has been little success with screening program Transmission and natural history of HPV responsible for diseases e.g recurrent juvenile 20 years, making the initiating infections and female cancer deaths among Bangladeshi women HPV type 16/18 infection was detected in 40.42% of against cervical cancer, which is a major public infection26: precursor lesions of cervical cancer anappropriate with an estimated 8,068 new cases and 5,214 deaths the women in Bangladesh with cervical epithelial cell health problem in Bangladesh. Therefore, a National respiratory papillomatosis and genital warts, both HPV infection occurs at the basal epithelium during 2 22 target for screening and early detection. Some lesions in 2018. abnormality.7 HPV type 16 was detected in 81.82%, HPV Vaccination Program will reduce the mortality mainly caused by HPV 6/11. sexual intercourse. Although the incidence of become cancerous more rapidly, sometimes within 2 type 18 in 9.09% and type 45 in 6.06% cases of and morbidity of cervical cancer in Bangladesh.The Structure23 and gene functions24 of HPV: infection is high, but most infections resolve years. Infection with one type of HPV does not cervical carcinoma in Bangladesh.8 objective of the review article is to evaluate the HPV is a relatively small non-enveloped double- spontaneously. Several studies have suggested that current status of the cervical cancer prevention most women successfully clear the HPV infection, prevent infection with another type. If persons In developed countries, incidence and mortality of stranded DNA virus in the family Papillomaviridae. achieved by HPV vaccination worldwide. presumably through the action of a competent infected with mucosal HPV, 5% to 30% are infected cervical cancer has been lowered by effective It is associated with histone-like proteins and immune system. Among the infected individuals, with multiple types of the virus. population-based screening program with Pap smear Rationale of the review protected by a capsid formed by two late proteins, L1 approximately, 90% of lesions regress spontaneously HPV prevalence: and or HPV DNA testing.9 Government of National HPV vaccination programs have been and L2. Each virion contains 72 copies of the L1, the without clinical signs or symptoms within 12 to 36 There have been many studies worldwide on the Bangladesh with the support of UNFPA has taken implemented in many countries to prevent cervical major component of the capsid, and a variable months, a small proportion of infected persons proportion of cervical cancer, other anogenital initiative to develop a cervical cancer screening cancer. But no National HPV Vaccination number of copies of L2, a secondary component of

Journal of Bangladesh College of Physicians and Surgeons Vol. 39, No. 2, April 2021 cancers, high& low-grade squamous intraepithelial 81.82%followed by 18 in 9.09%& 45 in 6.06% cases • warnings about tobacco use • A quadrivalent vaccine (Gardasil®/Silgard®, Mechanism of vaccine related protection: were seroconverted for anti-HPV-16&18 antibodies developing countries which haven’t introduced the 2. Bruni L, Albero G, Serrano B, Mena M, Gómez D, ewjm.175.4.231. https://doi.org/10.1136/ ewjm. 18. Khatun S, HussainSMA, Chowdhury S, Ferdous J, 10.1016/j.vaccine.2013.10.003, PMid:24332295 PMid:19115209, DOI: 10.1002/ijc.24116, https://doi.org/ Muñoz J, et al. ICO/IARC Information Centre on 175.4.231, PMid:11577044 PMCid:PMC1071564 Hossain F, Begum SR, et al. Safety and PMCid:PMC7605442, DOI: 10.1016/j.vaccine.2013. lesions (HSIL and LSIL) due to different HPV of cervical carcinoma. Among precancerous cases, • male circumcision. produced by Merck & Co)–protects against HPV Systemic immunization with L1 VLPs generates at Month 7. At Month 48 of that study, all subjects HPV vaccine as part of their national public health 10.1002/ijc.24116, PMid:19115209 HPV and Cancer (HPV Information Centre). Human Immunogenicity Profile of Human Papillomavirus- 10.003, https://doi.org/10.1016/j.vaccine.2013.10.003 genotypes as well as prevalence of HPV in general only type 16 was detected. 16 & 18, 6 & 11 that causes anogenital warts antibody concentrations higher than in a natural were still seropositive for anti-HPV-16 antibodies strategy to prevent and control cervical cancer. 11. Zhao KN, Zhang L, Qu J. Dr. Jian Zhou: The great 33. Uterine cervical neoplasms - prevention and control. b) Secondary prevention through screening and Papillomavirus and Related Diseases in Bangladesh. 16/18 AS04 Adjuvant Cervical Cancer Vaccine: A PMid:24332295 PMCid:PMC7605442 population. also. infection. The HPV vaccines are highly and all but one subject in the 46–55 years age group inventor of cervical cancer vaccine. Protein Cell.2017; Comprehensive cervical cancer control: a guide to HPVprevalence in vulvar, vaginal and anal treatment of adult sexually active women for Bivalent HPV vaccine was registered in Bangladesh Summary Report 17 June 2019. [Date Accessed] Randomized Controlled Trial in Healthy Adolescent 27 immunogenic leading to seroconversion in virtually remained seropositive (99.4%) for anti-HPV-18 8(2): 79-82. DOI: 10.1007/s13238-016-0358-2 26. Human Papillomavirus. In: Centers for Disease Bruni L et al performed a meta-analysis of cervical intraepithelial neoplasia (VIN, VAIN, AIN) grades As of December 2014, the U.S.FDA approved Girls of Bangladesh. Jpn J Clin Oncol. 2011;42(1): essential practice. 2nd ed. World Health Organization. precancerous lesions, starting from 30 years of age. 100% of vaccinees. Antibody titers in blood reach 39 in 2009 while qHPV was registered in 2014.HPV 3. Walboomers JM, Jacobs MV, Manos MM, Bosch FX, https://doi.org/10.1007/s13238-016-0358-2 Control and Prevention. Epidemiology and Prevention HPV prevalence among women with normal 1-3 and carcinoma was conducted in 4 continents. antibodies. Roteli-Martins CM et al report the 36-41. https://doi.org/10.1093/jjco/hyr173, PMid:22194637 2014. ISBN 978 92 4 154895 3 Merck’s 9- valent HPV vaccine (GARDASIL 9®) vaccine has recently been introduced in Bangladesh Kummer JA, Shah KV, et al. Human papillomavirus is PMid:28108949 PMCid:PMC5291779 c)Tertiary prevention and palliative care for women peaks 2–3 log higher than in natural infections, long-term efficacy and immunogenicity of the PMCid:PMC3244935, DOI: 10.1093/jjco/hyr173 of Vaccine-Preventable Diseases. Hamborsky J, cytological findings. The estimated global HPV Overall HPV prevalence was 67.8%, 85.3% and which includes the additional five HPV 31, 33, 45, a necessary cause of invasive cervical cancer 34. Guide to introducing HPV vaccine into national affected by invasive cervical cancer include surgery, decrease gradually to levels several-fold lower than HPV-16/18 AS04-adjuvanted vaccine up to 8.4 y by the Ministry of Health and Family Planning 12. Markowitz LE, Dunne EF, Saraiya M, Chesson HW, https://doi.org/10.1093/jjco/hyr173 Kroger A, Wolfe S, eds. 13th ed., Supplement. prevalence was 11.7%. While based on the world 40.4% among VIN1, VIN2/3& vulvar carcinomas; 52& 58 compared to the quadrivalent vaccine. worldwide. J Pathol.1999;189(1): 12-19. https://doi.org/ immunization programmes. Immunization, Vaccines radiotherapy and chemotherapy. peak and then remain stable for years. The IgG is after the first vaccine dose. No new infection or (MoHFP), with support from the Global Alliance for Curtis CR, GEE J, et al. Human Papillomavirus PMid:22194637 PMCid:PMC3244935 Washington D.C. Public Health Foundation, 2017. regions Sub-Saharan Africa (24%), Eastern Europe 100%, 90.1% and 69.9% among VAIN1, VAIN2/3& 10.1002/(SICI)1096-9896(199909)189:1<12::AID-P and Biologicals. World Health Organization. 2016; Both vaccines are composed of type-specific HPV L1 exuded at the possible sites of infection (mucosa of Vaccines and Immunizations (GAVI). This new Vaccination: Recommendations of the Advisory p.175-186. (21.4%) and Latin America (16.1%) showed the vaginal carcinomas; and 91.5%, 93.9% and 84.3% HPV vaccines34: lesions associated with HPV-16/18 occurred in the ATH431>3.0.CO;2-F, DOI: 10.1002/(SICI)1096-9896 19. Naud PS, Roteli-Martins CM, De Carvalho NS, 1-90. ISBN: 978 92 4 154976 9 protein, the major capsid protein of HPV which is genital tract, oral cavity, etc.), neutralizes the virus 19 Committee on Immunization Practices (ACIP). highest prevalence’s. among AIN1, AIN2/3& anal carcinomas, vaccine group. NaudPSet al conducted a long-term vaccine introduction program ran for two years in (199909)189:1<12: AID-PATH431>3.0.CO;2-F Teixeira JC, De Borba PC, Sanchez N, et al. Sustained 27. Bruni L, Diaz M, Castellsagué X, Ferrer E, Bosch FX, The availability of prophylactic HPV vaccines has used as an antigen. Through Recombinant DNA and prevents its entry into the cells. The MMWR Recomm Rep. 2014; 63(RR-05): 35. Human papillomavirus vaccines: Weekly epidemiological respectively. HPV16 was found>75% and 18 <10% follow-up of an initial double-blind, randomized Gazipur district and if it is successful, GAVI will efficacy, immunogenicity, and safety of the De Sanjosé S. Cervical human papillomavirus Alemany L et al28 estimated the HPV type-specific provided a powerful tool for primary prevention of technology the L1 protein undergoes conformal vaccine-induced immune memory in the form of 4. Zur Hausen H. Papillomaviruses in the causation of 1-30.PMID: 25167164 record. WHO position paper.2017;92(19):241-268. in HPV positive vulvar, vaginal and anal carcinomas. (1:1), placebo-controlled study evaluating the provide support for national introduction of HPV HPV-16/18 AS04-adjuvanted vaccine: final analysis prevalence in 5 continents: Meta-analysis of 1 million distribution in a large series of invasive cervical cervical cancer and other HPV-associated diseases. human cancers-a brief historical account. Virology. ISSN 0049-8114 changes to self-assemble into 'virus-like' particles circulating plasma cells and memory B-cells allows 40 13. Meites E, Kempe A, Markowitz LE. Use of a 2-Dose of a long-term follow-up study up to 9.4 years women with normal cytological findings. J Infect Dis. Approximately 40% ofvulvar, 60% of vaginal and The vaccines are most effective when administered to efficacy against HPV16/18 infection and associated vaccine . WHO recommends that girls are 2009; 384(2): 260-265. https://doi.org/ 10.1016/ cancer (ICC) over 70 years from 11 countries in (VLPs). The VLPs are non-infective and non- generation and exudation of protecting IgG each time Schedule for Human Papillomavirus Vaccination - post-vaccination. Hum VaccinImmunother. 2014; 2010; 202(12): 1789-1799. https://doi.org/ 80% of anal carcinoma are responsible for a person prior to exposure to HPV. Two HPV cyto-histopathological abnormalities, persistence vaccinated with HPV vaccine between the ages of j.virol.2008.11.046, PMid:19135222, DOI: 10.1016/ 36. Harper DM, Franco EL, Wheeler CM, Moscick AB, Central-South America, Asia and Europe. Among pathogenic as these are devoid of the viral DNA the body is challenged by exposure to HPV infection. Updated Recommendations of the Advisory 10(8), 2147-2162. https://doi.org/10.4161/hv.29532 10.1086/657321, PMid:21067372, DOI: 10.1086/ HPV16/18.32 ofimmunogenicity, and safety of the HPV-16/18 j.virol.2008.11.046. https://doi.org/10.1016/j.virol. Romanowski B, Roteli-Martins CM, et al. Sustained 4,771 HPV DNA positive ICC cases, HPV16&18 vaccines are currently pre-qualified by WHO: essential to initiate the carcinogenic process. Bivalent 9-13 years. In line with this, the Government of Committee on Immunization Practices. MMWR Morb PMid:25424918 PMCid:PMC4896780, DOI: 657321, https://doi.org/10.1086/657321, PMid:21067372 Animal models suggest that very low antibody titers 2008.11.046, PMid:19135222 efficacy up to 4.5 years of a bivalent L1 virus-like AS04-adjuvanted vaccine. No new HPV 16/18- Bangladesh has decided to vaccinate 10-year-old Mortal Wkly Rep. 2016; 65(49):1405-1408. were the two most common HPVs in all the decades Co-factors associated with cervical cancer: • A bivalent vaccine (Cervarix®, produced by vaccinecontains a novel adjuvant AS04 and may still be protective. Partial cross-protection 10.4161/hv.29532, https://doi.org/10.4161/hv.29532 28. Alemany L, De Sanjosé S, Tous S, Quint W, Vallejos particle vaccine against human papillomavirus types 5 associated infections and cyto-histopathological girls in the primary school setting (Grade 5) with two 5. Mu˜noz N, Castellsagu' E X, De González AB, https://doi.org/10.15585/mmwr.mm6549a5 (HPV16-from 61.5 to 62.1%, and HPV18-from 6.9 to Muñoz N et al stated that although HPV is a GlaxoSmithKline)–protects against HPV 16 & quadrivalent vaccine VLPs are adsorbed on an against HPV31, HPV33 and HPV45 has been PMid:25424918 PMCid:PMC4896780 C, Shin HR.et al. Time trends of human 16 and 18: follow-up from a randomized control trial. 25 abnormalities occurred in the vaccine group. Gissmann L, Chapter 1: HPV in the etiology of human PMid:27977643, DOI: http://dx.doi.org/10.15585/ 7.2%). A meta-analysis update conducted by SmithJS necessary cause of cervical cancer, it is not a 18 that cause the majority of cervical cancers; aluminum-containing adjuvant to ensure robust and described. doses of bHPVvaccine, given 6 months apart. The 20. WORLD HEALTH ORGANIZATION. Country papillomavirus types in invasive cervical cancer, from Lancet.2006; 367(9518):1247-1255. https://doi.org/ 6 18 cancer. Vaccine. 2006; 24 (3): S1-S10. https://doi.org/ mmwr.mm6549a5external icon et al showed HPV type distribution in ICCand HSIL. sufficient cause. Epidemiologic studies indicate that long-lasting immunogenicity.12 Khatun S et al conducted a study to assess the target girls will mainly be reached through the office for Bangladesh. Human papillomavirus (HPV) 1940 to 2007.2014. Int J Cancer. 2014; 135(1):88-95. 10.1016/S0140-6736(06)68439-0, DOI: 10.1016/ and Recommended vaccination schedule: 10.1016/j.vaccine.2006.05.115, PMid:16949995, In ICC, HPV16 was the most common, and HPV18 the risk of contracting genital HPV infection and immunogenicity and safety profile of HPV16/18 14. Markowitz LE, Hariri S, Lin C, Dunne EF, Steinau M, vaccine introduced in Bangladesh.18 May 2016. https://doi.org/10.1002/ijc.28636, PMid:24382655, S0140-6736(06)68439-0, https://doi.org/10.1016/ The primary target group in most of the countries schoolbasedprogramme and girls who are out of DOI: 10.1016/ j.vaccine.2006.05.115, https://doi.org/ the second most common, type in all continents. The cervical cancer is influenced by a variety of factors. Table2 Summary of HPV vaccine characteristics vaccines in healthy Bangladeshi girls aged between McquillanG, et al. Reduction in human News release DOI: 10.1002/ijc.28636, https://doi.org/10.1002/ S0140-6736(06)68439-0 recommending HPV vaccination is young adolescent school will receive the vaccine through the routine 10.1016/j.vaccine.2006.05.115, PMid:16949995 papillomavirus (HPV) prevalence among young next most common HPV types were HPV31, 33, 35, Thus, other cofactors are necessary for progression Attributes Bivalent Quadrivalent 9-valent 9–13 years. They recommended that, bHPV vaccine EPI sites at the community level. 21. Morshed K, Polz-Gruszka D, Szymański M, ijc.28636, PMid:24382655 girls, aged 9-14.WHO has recommended the 6. Smith JS, Lindsay L, Hoots B, Keys J, Franceschi S, women following HPV vaccine introduction in the 37. De Carvalho N, Teixeira J, Roteli-Martins CM, Naud 45, 52 and 58. HPV18 was significantly more from cervical HPV infection to cancer. Long-term (Cervarix®) (Gardasil®/Silgard®) (Gardasil 9®) 35 was generally well tolerated, with no vaccine-related Polz-Dacewicz M. Human Papillomavirus (HPV) - following vaccination schedule . Winer R, et al. Human papillomavirus type United States, National Health and Nutrition 29. Nahar Q, Sultana F, Alam A, Islam JY, Rahman M, P, De Borba P, Zahaf T, et al. Sustained efficacy and prevalent in adeno/adenosquamous carcinoma than use of hormonal contraceptives, high parity, tobacco Vaccine type Recombinant L1-capsid Recombinant L1-capsid Recombinant L1-capsid virus- serious adverse effects. Conclusion: Structure, epidemiology and pathogenesis. Otolaryngol distribution in invasive cervical cancer and high-grade Examination Surveys, 2003-2010. J Infect Khatun F. et al. Genital human papillomavirus immunogenicity of the HPV-16/18 AS04-adjuvanted in squamous cell carcinoma. Among HSIL cases, smoking, and co-infection with HIV have been virus-like particles (VLP) virus-like particles (VLP) like particles (VLP) • Females <15 years at the time of first dose: a Immunization with the HPV vaccine induces Pol. 2014;68(5):213-219. https://doi.org/10.1016/ HPV prevalence, cross-protection and herd cervical lesions: A meta-analysis update. Int. J. Dis.2013;208(3):385-393. https://doi.org/10.1093/ infection among women in Bangladesh: findings from vaccine up to 7.3 years in young adult women. HPV16/18prevalence was 52%. WalboomersJM et identified as established cofactors; co-infection with HPV types in vaccine 16,18 6,11,16,18 6,11,16,18,31,33,45,52,58 sustained high levels of antibodies against high-risk j.otpol.2014.06.001, PMid:25283316, DOI: 10.1016/ 2-dose schedule (0, 6 months) is recommended. Cancer. 2007; 121(3): 621-632. https://doi.org/ infdis/jit192, PMid:23785124, DOI:10.1093/infdis/jit192. a Population-based survey. PLoS One. 2014; 9(10): Vaccine.2010; 28(38):6247-6255. https://doi.org/10.1016/ 3 Disease protection Cervical cancer (and Cervical cancer (and Cervical cancer (and immunity after vaccination: j.otpol.2014.06.001, https://doi.org/10.1016/j.otpol. al found that the worldwide HPV prevalence in Chlamydia trachomatis (CT) and herpes simplex HPV genotypes 16 and 18. The durable immune 10.1002/ijc.22527, PMid:17405118, DOI: 10.1002/ e107675. https://doi.org/10.1371/journal.pone.0107675 j.vaccine.2010.07.007, PMid:20643092, DOI: premalignant genital lesions premalignant genital premalignant genital lesions of If the interval between doses is shorter than 5 months, A national HPV immunization program using a 15. Tabrizi SN, Brotherton JM, Kaldor JM, Skinner SR, 2014.06.001, PMid:25283316 cervical carcinomas is 99.7%. virus type-2 (HSV-2), immunosuppression, and response induced by the HPV vaccine in adolescent ijc.22527.https://doi.org/10.1002/ijc.22527 PMid:25271836 PMCid:PMC4182674, DOI: 10.1016/j.vaccine.2010.07.007, https://doi.org/ of cervix, vulva and vagina) lesions of cervix, vulva cervix, vulva and vagina) then a third dose should be given at least 6 months bHPV vaccine was implemented in Scotland in 2008, Liu B, Bateson D,et al. Assessment of herd immunity certain dietary deficiencies are other probable PMid:17405118 22. Bruni L, Albero G, Serrano B, Mena M, Gómez D, 10.1371/journal.pone.0107675, https://doi.org/10.1371/ 10.1016/j.vaccine.2010.07.007, PMid:20643092 Bangladesh had also different studies that focused on and vagina) Genital warts Genital warts after the first dose. girls is predicted to provide long-term protection and cross-protection after a human papillomavirus cofactors. along with a national surveillance program designed Muñoz J, Bosch FX, de Sanjosé S. ICO/IARC journal.pone.0107675, PMid:25271836, PMCid:PMC4182674 Cross-protection 31,33 31, 45 -- against HPV infection and subsequent development HPV genotyping in different groups of females. to determine the longitudinal effects of vaccination 7. Banik U, Ahamad MSU, Bhattacharjee P, Adhikary vaccination programme in Australia: a repeat 38. Schwarz TF,Spaczynski M, Schneider A, Wysocki J, 29 against HPV-types • Information Centre on HPV and Cancer (HPV Nahar Q et al revealed prevalence of HPV infection Strategies for cervical cancer prevention and Females ≥15 years at the time of first dose & of high-grade cervical lesions and cancer. The AK, Rahman Z. cross-sectional study. Lancet Infect Dis.2014; 30. Sultana T, Huq M, Alam A, Mitra DK, Gomes DJ. Galaj A, Schulze K, et al. Persistence of immune on HPV infection at the population level. By linking Information Centre). Human Papillomavirus and was 7.7% with no significant difference between control33: No. of doses 2 2 2 immunocompromised and/or HIV-infected.: a 14(10):958-966.DOI: 10.1016/S1473-3099(14) 70841-2, Prevalence and genotyping of human papillomavirus Dosing interval 0 and 6 months (No 0 and 6 months (No 0 and 6 months (No maximum vaccination, cervical screening, and HPV testing knowledge gained from this review is important for 8. High risk human papillomavirus type 16 and 18 Related Diseases in the World. Summary Report 17 response to HPV-16/18 AS04-adjuvanted cervical 3-dose schedule (0, 1-2, 6 months) is https://doi.org/10.1016/S1473-3099(14)70841-2 (HPV) in female with high-risk behaviour in Dhaka, urban and rural women. HR-HPV (High risk) WHO recommends a comprehensive approach to (flexibility) maximum interval but maximum interval but interval but suggested not more realizing the necessity of the use of a prophylactic infection in the cervical lesions of women with cancer vaccine in women aged 15-55 years. Hum recommended. data, over the study period they found a decline in June 2019. [Date Accessed] Bangladesh. Bangladesh J Microbiol. 2008; infections were more common (4.2%) than LR-HPV cervical cancer prevention and control. The suggested not more than 12- suggested not more than than 12-15 months) HPV16/18 vaccine in Bangladeshi girls. There has epithelial cell abnormality in Pap smear: A 16. Kavanagh K, Pollock KG, Potts A, Love J, Cuschieri Vaccin.2011; 7(9): 958-965. https://doi.org/10.4161/ HPV 16 &18,significant decreases in HPV 31, 33& 23. FernandezJV and De Medeiros Fernandez TAA. 25(1):65-68. https://doi.org/10.3329/bjm.v25i1.4861, infections (3.4%). Most common HR genotypes were recommended set of actions includes following 15 months) 12-15 months) Evaluation of efficacy, immunogenicity and safety cytohistomorphologic association in Bangladeshi K, Cubie H, et al. Introduction and sustained high hv.7.9.15999, PMid:21892005 PMCid:PMC3225769, 45 (suggesting cross-protection). Among non- been little success with screening program against Chapter 1 Human Papillomavirus: Biology and DOI:https://doi.org/10.3329/bjm.v25i1.4861, HPV16,66,18,45,31&53. Sultana T et al30 noted the interventions. Method of Intramuscular injection Intramuscular injection Intramuscular injection women. Cytojournal. 2013; 10: 14. DOI: 10.4103/ coverage of the HPV bivalent vaccine leads to DOI: 10.4161/hv.7.9.15999, https://doi.org/10.4161/ of HPV vaccine: vaccinated women, HPV 16 & 18 infections were cervical cancer in Bangladesh, an intervention that Pathogenesis. Human Papillomavirus and Related https://doi.org/10.3329/bjm.v25i1.4861 prevalence of genital HPV types in the sex workers administration 36 1742-6413.1150888. Borna NN, Tabassum S, Jahan areduction in prevalence of HPV 16/18 and closely hv.7.9.15999, PMid:21892005 PMCid:PMC3225769 a) Primary prevention begins with HPV vaccination HarperDM et al assessed the long-term efficacy, significantly lower in 2013 than in 2009 indicating has helped to significantly reduce cervical cancer in Diseases-From Bench to Bedside-A Clinical was as high as 75.8%, whereas for the high-risk types Presentation and Type 1-dose vial; VVM 30 1-dose vial; VVM 30 1-dose vial; VVM n/a M, Munshi S, Unnesa A. Genotyping of High-Risk related HPV types. Br J Cancer.2014;110(11), 31. Khandker E, Khan M, Chowdhury AK. Human of girls aged 9-13 years, before they become sexually of Vaccine Vial 2-dose vial; VVM 30 immunogenicity, and safety of a bivalent HPV-16/18 herd immunity and sustained effectiveness of the the developed world. Therefore, a National HPV Perspective, 2012. 1-40, Rijeka, Croatia: InTech. DOI: 39. Roteli-Martins CM, Naud P, De Borba P, TeixeiraJC, it was 49.8%. The highest prevalence rate was Human Papillomavirus (HPV) Among Cervical 2804-2811.DOI: 10.1038/bjc.2014.198. https://doi.org/ papillomavirus infection among Bangladeshi women active. Because HPV vaccines do not protect against Monitor (VVM) L1 virus-like particle AS04 vaccine against incident bivalent vaccine onvirologic outcomes at the 10.5772/27154 https://doi.org/10.5772/27154 De Carvalho NS, Zahaf T, et al. Sustained observed for the genotype 16, 18 and 58. Khandker E Vaccination Program seems to be the window of Precancer and Cancer Patients. Acta MedicaInternational. 10.1038/bjc.2014.198,PMid:24736582 with cervical intraepithelial neoplasia and chronic all HPV types that cause cervical cancer, vaccine Shelf-life 48 months at 2-8 °C for 1- 36 months at 2-8 °C, 36 months at 2-8 °C, vaccine is and persistent infection with HPV 16 & 18 and their 17 immunogenicity and efficacy of the HPV-16/18 31 population level. opportunity to reduce the mortality and morbidity of 2015;2(1):19-28.DOI: 10.5530/ami.2015.1.5, https://doi.org/ PMCid:PMC4037824 24. Gómez DT and Santos JL. Human papillomavirus cervicitis. IMC J Med Sci. 2016;10(1): 29-32. et al determine HPV infection rate was 43.1%. CIN dose vial; vaccine is freeze sensitive freeze sensitive associated cytological and histological outcomes. De AS04-adjuvanted vaccine: up to 8.4 years of introduction should be part of comprehensive 10.5530/ami.2015.1.5 infection and cervical cancer: pathogenesis and https://doi.org/10.3329/imcjms.v10i1.31103, DOI: cases had significantly high (p<0.01) HPV infection 36 months at 2-8 °C for 2- 37 Scenario of HPV vaccination in Bangladesh: HPV related cervical cancer in Bangladesh. 17. Cameron RL, Kavanagh K, Pan J, Love J, Cuschieri approach to cervical cancer control. Carvalhoa N et al report efficacy and epidemiology. Communicating Current Research and follow-up. Hum Vaccin. J Immunother.2012; 8(3): dose vial; 9. Michael JC, Karen C. Cervical Cancer Screening and K, Robertson C, et al. Human Papillomavirus https://doi.org/10.3329/imcjms.v10i1.31103 (78.6%) compared to cases with chronic cervicitis immunogenicity of the HPV16/18 vaccine up to 7.3 WHO has developed guidelines on prevention and References : Educational Topics and Trends in Applied 390-397.https://doi.org/10.4161/hv.18865 7 Other recommended preventive interventions for vaccine is freeze sensitive Preinvasive Disease. In: Berek JS, Hacker NF Prevalence and Herd Immunity after Introduction of https://doi.org/10.3329/imcjms.v10i1.31103 (18.2%).BanikU et al find out the extent of HR HPV years post vaccination. No cases of infection or control of cervical cancer through vaccination and 1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre Microbiology. A Mendez Vilas (ed). Spain: Formatex; PMid:22327492,DOI:10.4161/hv.18865 Contraindications -Severe allergic reaction to - Severe allergic reaction - Severe allergic reaction to (editors). Berek and Hacker's Gynecologic Oncology. Vaccination Program, Scotland, 2009-2013. Emerg type 16/18 infection in women with epithelial cell boys and girls are: cytohistological lesions associated with HPV 16/18 screening. By mid-2016, globally 65 countries, LA, Jemal A. Global Cancer Statistics 2018: 2007.p. 680-688. ISBN-13-9788461194223 32. De Vuyst H, Clifford GM, Nascimento MC, https://doi.org/10.4161/hv.18865 any vaccine component after to any vaccine component any vaccine 6th edition. Philadelphia: Wolters Kluwer; 2014. p. Infect Dis.2016; 22 (1), 56-64. https://doi.org/ abnormality in Pap smear. HPV type 16/18 infection mostly in high-income and upper-middle-income GLOBOCAN Estimates of Incidence and Mortality Madeleine MM, Franceschi S. Prevalence and type PMid:22327492 • education about safe sexual practices, delayed first dose after first dose component after first dose were observed in the vaccinee. Another follow up 242-325.ISBN-13-978-1-4511-9007-6. 10.3201/eid2201.150736,PMid:26692336 25. Bosch FX, Broker TR, Forman D, Moscicki AB, was detected in 40.42% of the patients. Borna NN et 38 Worldwide for 36 Cancers in 185 Countries.CA: distribution of human papillomavirus in carcinoma start of sexual activity -Severe febrile illness -Severe febrile illness -Severe febrile illness study (up to 4 years) of SchwarzTF et al showed settings had introduced HPV vaccines into their PMCid:PMC4696690, DOI: 10.3201/eid2201.150736 Gillison ML, Doorbar J. et al. Comprehensive Control 40. World Health Organization. Country office for 8 -Known to be pregnant -Known to be pregnant -Known to be pregnant 33 Cancer J Clin. 2018; 68:394-424.DOI: 10.3322/ 10. Jacqueline S, Cristina H, Christopher E. Beyond Our and intraepithelial neoplasia of the vulva, vagina and al identify HR HPV genotype among women having persistence of immune response to HPV-16/18 national immunization programs . But the global https://doi.org/10.3201/eid2201.150736 of Human Papillomavirus Infections and Related • promotion and provision of condoms for those caac.21492.https://doi.org/10.3322/caac.21492 Borders Cervical cancer in the developing world. anus: a meta-analysis. Int J Cancer. 2009; Bangladesh. Human papillomavirus (HPV) vaccine CIN and carcinoma. HPV 16 was detected in 34 vaccine in women aged 15–55 years. All subjects burden of cervical cancer fallsheaviest on the PMid:26692336 PMCid:PMC4696690 Diseases. Vaccine. 2013;31(7): H1-31. https://doi.org/ already engaged in sex (Adapted fromGuide to Introducing HPV Vaccine into National Immunization Programmes.2016) PMid:30207593 West J Med. 2001; 175: 231-233. DOI: 10.1136/ 124(7):1626-1636. https://doi.org/10.1002/ijc.24116 introduced in Bangladesh. News release.2016.

127 program by visual inspection with acetic acid (VIA), Programhas yet been started in Bangladesh and also the viral capsid. DNA containing approximately 8000 genes. The second is an early region (E), consisting which was considered to be a feasible method for no review has been done related to HPV Vaccination base pairs and harboring an average of 8 open reading of six ORFs: E1, E2, E4, E5, E6, and E7, which screening cervical cancer in the present so far. Hence, this review has been conducted to frames (ORFs). In a functional point of view, the encodes no structural proteins involved in viral socio-economic context. It has been estimated that explore different aspects of HPV vaccines in depth HPV genome is divided into three regions. The first is replication and oncogenesis. The third is a late (L) only 5% of the women in developing countries have which will help to recommend a National a long control region (LCR) that has regulatory region that encodes the L1 and L2 structural proteins. been screened for cervical dysplasia compared with HPVvaccination Program for prevention of cervical function of the transcription of the E6 and E7 viral about 40% to 50% of women in developed cancer among Bangladeshi women by a low-cost 10 countries. bHPV vaccine. One of the greatest medical breakthroughs in the last Review of literature century is the development of HPV vaccine against Human papillomavirus (HPV) vaccine for preventing cervical cancer by Professor Frazer and Dr Jian HPV induced malignancy is a widely studied topic Zhou.11 HPV related anogenital cancers can be for physicians. Different authors explained different prevented using a prophylactic vaccine. The two aspects of HPV, its malignant potential, its preventive prophylactic HPV vaccines, quadrivalent HPV type measures through vaccination and HPV vaccines 6/11/16/18 vaccine and bivalent HPV type 16/18 vaccine, were licensed in 2006 and 2007 under the immunogenicity, efficacy, safety etc through their names of Gardasil® and Cervarix® respectively.12 own view. Articles related to Human papillomavirus Recently nine-valent HPV type 6/11/16/18/31/33/45/52/58 (HPV) vaccine were retrieved from different vaccine with broader cancer coverage has also journals, web pages and books. From them 40 papers received the United States Food and Drug were included to prepare this manuscript. Administration (US-FDA) approval in October 2016 Role of HPV in cancers: 13 under the name of Gardasil9®. Different studies in The connection between persistent infection with USA, Australia and Scotland have begun to show a HPV and cervical cancer was first described by drop in the prevalence of HPV associated diseases Harald Zur Hausen in 1977. In 1983 & 1984 Zur Life cycle of HPV25: become persistently infected; which is the most both in vaccinated and non-vaccinated populations Hausen and his collaborators identified role of HPV indicating establishment, of herd immunity and also The viral life cycle refers mainly to high-risk important risk factor for the development of cervical 16 & 18 in cervical cancer and in the course of the provide cross- protection.14-17 Khatun S et al18 mucosotropic HPVs and is commonly extrapolated to cancer. The most common clinically significant next 12 years of research it has been recognized as a observed high immunogenicity and safety of the all HPVs. Activated cell divisionis necessary for viral manifestation of persistent genital HPV infection is carcinogen influencing its development.21 This bHPV vaccine among Bangladeshi adolescent girls at DNA access to the cell nucleus. Initial viral Cervical Intraepithelial Neoplasia (CIN). Within a finding laid the ground for the idea of a vaccine 7 months of vaccination.Sustained efficacy, replication in the basal cells requires E1 and E2 few years of infection, low-grade CIN(CIN 1) may Introduction: Human papillomavirus (HPV) is the virtually against HPV infection and cervical cancer, and in proteins. The role of E6 and E7 in the basal layer is develop, which may spontaneously resolve and the Cervical cancer is a major public health problem necessary cause of carcinoma cervix. HPVs causing immunogenicity, and safety of the bHPV vaccine 1999 it finally became clear that persistent HPV uncertain; particularly for the low-risk HPVs. infection clear. Persistent HPV infection, may worldwide. It is the 4th most frequently diagnosed not only the vast majority of cervical (99.7%), but were observed in the final analysis of a follow-up study up to 9.4 years postvaccination.19 infection is a necessary cause of invasive cervical Deregulation of E6/E7 expression is critical in progress directly to higher-grade CIN (CIN2 or cancer in women worldwide, with an estimated also a substantial proportion of other anogenital and 3 cancer. HPV infection is commonly found in the determining neoplastic grade. In high-risk HPVs, CIN3). High-grade abnormalities are at risk of 570,000 new cases in 2018. It is also the 4th leading head and neck cancers.3,4 Among all HPV-associated HPV vaccine has introduced in Bangladesh by the anogenital tract of men and women with and without E6/E7 mediates proliferation of the basal and progression to cancer. Some high-grade abnormalities cause of cancer death, with an estimated 311,000 malignancies, cervical cancer is the most important Ministry of Health and Family Planning (MoHFP), clinical lesions. The etiological role of HPV infection parabasal cells, facilitating lesion growth. HPV E6 spontaneously regress. If left, undetected and deaths in 2018. Cervical cancer is the 2nd most cause of morbidity and mortality worldwide. with support from the Global Alliance for Vaccines among women with cervical cancer is and E7 oncoproteins bind to and inactivate tumor untreated, years or decades later CIN2 or 3 can commonly diagnosed cancer and leading cause of Approximately 70% of cervical cancers worldwide and Immunizations (GAVI) for two years in Gazipur well-established, and there is growing evidence of its suppressor proteins p53 and pRb, respectively, progress to cervical cancer. The time lag between the cancer death among females in less developed are associated with two high-risk HPV types (16/18), district and if it is successful, GAVI will provide 1 central role in other anogenital cancers (anus, vulva, leading to malignant transformation of infected cells. peak of HPV infection and the peak of cancer countries. Cervical cancer is the 2nd leading cause of while other high-risk HPV types 31, 33, 35, 45, 52 support for national introduction of HPV vaccine.20 vagina, penis), head and neck cancers. HPV is also incidence generally takes place over a period of 10 to female cancer in incidence and 3rd leading cause of and 58 are responsible for approximately 20% case.5,6 There has been little success with screening program Transmission and natural history of HPV responsible for diseases e.g recurrent juvenile 20 years, making the initiating infections and female cancer deaths among Bangladeshi women HPV type 16/18 infection was detected in 40.42% of against cervical cancer, which is a major public infection26: precursor lesions of cervical cancer anappropriate with an estimated 8,068 new cases and 5,214 deaths the women in Bangladesh with cervical epithelial cell health problem in Bangladesh. Therefore, a National respiratory papillomatosis and genital warts, both HPV infection occurs at the basal epithelium during 2 22 target for screening and early detection. Some lesions in 2018. abnormality.7 HPV type 16 was detected in 81.82%, HPV Vaccination Program will reduce the mortality mainly caused by HPV 6/11. sexual intercourse. Although the incidence of become cancerous more rapidly, sometimes within 2 type 18 in 9.09% and type 45 in 6.06% cases of and morbidity of cervical cancer in Bangladesh.The Structure23 and gene functions24 of HPV: infection is high, but most infections resolve years. Infection with one type of HPV does not cervical carcinoma in Bangladesh.8 objective of the review article is to evaluate the HPV is a relatively small non-enveloped double- spontaneously. Several studies have suggested that current status of the cervical cancer prevention most women successfully clear the HPV infection, prevent infection with another type. If persons In developed countries, incidence and mortality of stranded DNA virus in the family Papillomaviridae. achieved by HPV vaccination worldwide. presumably through the action of a competent infected with mucosal HPV, 5% to 30% are infected cervical cancer has been lowered by effective It is associated with histone-like proteins and immune system. Among the infected individuals, with multiple types of the virus. population-based screening program with Pap smear Rationale of the review protected by a capsid formed by two late proteins, L1 approximately, 90% of lesions regress spontaneously HPV prevalence: and or HPV DNA testing.9 Government of National HPV vaccination programs have been and L2. Each virion contains 72 copies of the L1, the without clinical signs or symptoms within 12 to 36 There have been many studies worldwide on the Bangladesh with the support of UNFPA has taken implemented in many countries to prevent cervical major component of the capsid, and a variable months, a small proportion of infected persons proportion of cervical cancer, other anogenital initiative to develop a cervical cancer screening cancer. But no National HPV Vaccination number of copies of L2, a secondary component of

Human Papilloma Virus Vaccinefor Cervical Cancer Prevention CS Sultana et al cancers, high& low-grade squamous intraepithelial 81.82%followed by 18 in 9.09%& 45 in 6.06% cases • warnings about tobacco use • A quadrivalent vaccine (Gardasil®/Silgard®, Mechanism of vaccine related protection: were seroconverted for anti-HPV-16&18 antibodies developing countries which haven’t introduced the 2. Bruni L, Albero G, Serrano B, Mena M, Gómez D, ewjm.175.4.231. https://doi.org/10.1136/ ewjm. 18. Khatun S, HussainSMA, Chowdhury S, Ferdous J, 10.1016/j.vaccine.2013.10.003, PMid:24332295 PMid:19115209, DOI: 10.1002/ijc.24116, https://doi.org/ Muñoz J, et al. ICO/IARC Information Centre on 175.4.231, PMid:11577044 PMCid:PMC1071564 Hossain F, Begum SR, et al. Safety and PMCid:PMC7605442, DOI: 10.1016/j.vaccine.2013. lesions (HSIL and LSIL) due to different HPV of cervical carcinoma. Among precancerous cases, • male circumcision. produced by Merck & Co)–protects against HPV Systemic immunization with L1 VLPs generates at Month 7. At Month 48 of that study, all subjects HPV vaccine as part of their national public health 10.1002/ijc.24116, PMid:19115209 HPV and Cancer (HPV Information Centre). Human Immunogenicity Profile of Human Papillomavirus- 10.003, https://doi.org/10.1016/j.vaccine.2013.10.003 genotypes as well as prevalence of HPV in general only type 16 was detected. 16 & 18, 6 & 11 that causes anogenital warts antibody concentrations higher than in a natural were still seropositive for anti-HPV-16 antibodies strategy to prevent and control cervical cancer. 11. Zhao KN, Zhang L, Qu J. Dr. Jian Zhou: The great 33. Uterine cervical neoplasms - prevention and control. b) Secondary prevention through screening and Papillomavirus and Related Diseases in Bangladesh. 16/18 AS04 Adjuvant Cervical Cancer Vaccine: A PMid:24332295 PMCid:PMC7605442 population. also. infection. The HPV vaccines are highly and all but one subject in the 46–55 years age group inventor of cervical cancer vaccine. Protein Cell.2017; Comprehensive cervical cancer control: a guide to HPVprevalence in vulvar, vaginal and anal treatment of adult sexually active women for Bivalent HPV vaccine was registered in Bangladesh Summary Report 17 June 2019. [Date Accessed] Randomized Controlled Trial in Healthy Adolescent 27 immunogenic leading to seroconversion in virtually remained seropositive (99.4%) for anti-HPV-18 8(2): 79-82. DOI: 10.1007/s13238-016-0358-2 26. Human Papillomavirus. In: Centers for Disease Bruni L et al performed a meta-analysis of cervical intraepithelial neoplasia (VIN, VAIN, AIN) grades As of December 2014, the U.S.FDA approved Girls of Bangladesh. Jpn J Clin Oncol. 2011;42(1): essential practice. 2nd ed. World Health Organization. precancerous lesions, starting from 30 years of age. 100% of vaccinees. Antibody titers in blood reach 39 in 2009 while qHPV was registered in 2014.HPV 3. Walboomers JM, Jacobs MV, Manos MM, Bosch FX, https://doi.org/10.1007/s13238-016-0358-2 Control and Prevention. Epidemiology and Prevention HPV prevalence among women with normal 1-3 and carcinoma was conducted in 4 continents. antibodies. Roteli-Martins CM et al report the 36-41. https://doi.org/10.1093/jjco/hyr173, PMid:22194637 2014. ISBN 978 92 4 154895 3 Merck’s 9- valent HPV vaccine (GARDASIL 9®) vaccine has recently been introduced in Bangladesh Kummer JA, Shah KV, et al. Human papillomavirus is PMid:28108949 PMCid:PMC5291779 c)Tertiary prevention and palliative care for women peaks 2–3 log higher than in natural infections, long-term efficacy and immunogenicity of the PMCid:PMC3244935, DOI: 10.1093/jjco/hyr173 of Vaccine-Preventable Diseases. Hamborsky J, cytological findings. The estimated global HPV Overall HPV prevalence was 67.8%, 85.3% and which includes the additional five HPV 31, 33, 45, a necessary cause of invasive cervical cancer 34. Guide to introducing HPV vaccine into national affected by invasive cervical cancer include surgery, decrease gradually to levels several-fold lower than HPV-16/18 AS04-adjuvanted vaccine up to 8.4 y by the Ministry of Health and Family Planning 12. Markowitz LE, Dunne EF, Saraiya M, Chesson HW, https://doi.org/10.1093/jjco/hyr173 Kroger A, Wolfe S, eds. 13th ed., Supplement. prevalence was 11.7%. While based on the world 40.4% among VIN1, VIN2/3& vulvar carcinomas; 52& 58 compared to the quadrivalent vaccine. worldwide. J Pathol.1999;189(1): 12-19. https://doi.org/ immunization programmes. Immunization, Vaccines radiotherapy and chemotherapy. peak and then remain stable for years. The IgG is after the first vaccine dose. No new infection or (MoHFP), with support from the Global Alliance for Curtis CR, GEE J, et al. Human Papillomavirus PMid:22194637 PMCid:PMC3244935 Washington D.C. Public Health Foundation, 2017. regions Sub-Saharan Africa (24%), Eastern Europe 100%, 90.1% and 69.9% among VAIN1, VAIN2/3& 10.1002/(SICI)1096-9896(199909)189:1<12::AID-P and Biologicals. World Health Organization. 2016; Both vaccines are composed of type-specific HPV L1 exuded at the possible sites of infection (mucosa of Vaccines and Immunizations (GAVI). This new Vaccination: Recommendations of the Advisory p.175-186. (21.4%) and Latin America (16.1%) showed the vaginal carcinomas; and 91.5%, 93.9% and 84.3% HPV vaccines34: lesions associated with HPV-16/18 occurred in the ATH431>3.0.CO;2-F, DOI: 10.1002/(SICI)1096-9896 19. Naud PS, Roteli-Martins CM, De Carvalho NS, 1-90. ISBN: 978 92 4 154976 9 protein, the major capsid protein of HPV which is genital tract, oral cavity, etc.), neutralizes the virus 19 Committee on Immunization Practices (ACIP). highest prevalence’s. among AIN1, AIN2/3& anal carcinomas, vaccine group. NaudPSet al conducted a long-term vaccine introduction program ran for two years in (199909)189:1<12: AID-PATH431>3.0.CO;2-F Teixeira JC, De Borba PC, Sanchez N, et al. Sustained 27. Bruni L, Diaz M, Castellsagué X, Ferrer E, Bosch FX, The availability of prophylactic HPV vaccines has used as an antigen. Through Recombinant DNA and prevents its entry into the cells. The MMWR Recomm Rep. 2014; 63(RR-05): 35. Human papillomavirus vaccines: Weekly epidemiological respectively. HPV16 was found>75% and 18 <10% follow-up of an initial double-blind, randomized Gazipur district and if it is successful, GAVI will efficacy, immunogenicity, and safety of the De Sanjosé S. Cervical human papillomavirus Alemany L et al28 estimated the HPV type-specific provided a powerful tool for primary prevention of technology the L1 protein undergoes conformal vaccine-induced immune memory in the form of 4. Zur Hausen H. Papillomaviruses in the causation of 1-30.PMID: 25167164 record. WHO position paper.2017;92(19):241-268. in HPV positive vulvar, vaginal and anal carcinomas. (1:1), placebo-controlled study evaluating the provide support for national introduction of HPV HPV-16/18 AS04-adjuvanted vaccine: final analysis prevalence in 5 continents: Meta-analysis of 1 million distribution in a large series of invasive cervical cervical cancer and other HPV-associated diseases. human cancers-a brief historical account. Virology. ISSN 0049-8114 changes to self-assemble into 'virus-like' particles circulating plasma cells and memory B-cells allows 40 13. Meites E, Kempe A, Markowitz LE. Use of a 2-Dose of a long-term follow-up study up to 9.4 years women with normal cytological findings. J Infect Dis. Approximately 40% ofvulvar, 60% of vaginal and The vaccines are most effective when administered to efficacy against HPV16/18 infection and associated vaccine . WHO recommends that girls are 2009; 384(2): 260-265. https://doi.org/ 10.1016/ cancer (ICC) over 70 years from 11 countries in (VLPs). The VLPs are non-infective and non- generation and exudation of protecting IgG each time Schedule for Human Papillomavirus Vaccination - post-vaccination. Hum VaccinImmunother. 2014; 2010; 202(12): 1789-1799. https://doi.org/ 80% of anal carcinoma are responsible for a person prior to exposure to HPV. Two HPV cyto-histopathological abnormalities, persistence vaccinated with HPV vaccine between the ages of j.virol.2008.11.046, PMid:19135222, DOI: 10.1016/ 36. Harper DM, Franco EL, Wheeler CM, Moscick AB, Central-South America, Asia and Europe. Among pathogenic as these are devoid of the viral DNA the body is challenged by exposure to HPV infection. Updated Recommendations of the Advisory 10(8), 2147-2162. https://doi.org/10.4161/hv.29532 10.1086/657321, PMid:21067372, DOI: 10.1086/ HPV16/18.32 ofimmunogenicity, and safety of the HPV-16/18 j.virol.2008.11.046. https://doi.org/10.1016/j.virol. Romanowski B, Roteli-Martins CM, et al. Sustained 4,771 HPV DNA positive ICC cases, HPV16&18 vaccines are currently pre-qualified by WHO: essential to initiate the carcinogenic process. Bivalent 9-13 years. In line with this, the Government of Committee on Immunization Practices. MMWR Morb PMid:25424918 PMCid:PMC4896780, DOI: 657321, https://doi.org/10.1086/657321, PMid:21067372 Animal models suggest that very low antibody titers 2008.11.046, PMid:19135222 efficacy up to 4.5 years of a bivalent L1 virus-like AS04-adjuvanted vaccine. No new HPV 16/18- Bangladesh has decided to vaccinate 10-year-old Mortal Wkly Rep. 2016; 65(49):1405-1408. were the two most common HPVs in all the decades Co-factors associated with cervical cancer: • A bivalent vaccine (Cervarix®, produced by vaccinecontains a novel adjuvant AS04 and may still be protective. Partial cross-protection 10.4161/hv.29532, https://doi.org/10.4161/hv.29532 28. Alemany L, De Sanjosé S, Tous S, Quint W, Vallejos particle vaccine against human papillomavirus types 5 associated infections and cyto-histopathological girls in the primary school setting (Grade 5) with two 5. Mu˜noz N, Castellsagu' E X, De González AB, https://doi.org/10.15585/mmwr.mm6549a5 (HPV16-from 61.5 to 62.1%, and HPV18-from 6.9 to Muñoz N et al stated that although HPV is a GlaxoSmithKline)–protects against HPV 16 & quadrivalent vaccine VLPs are adsorbed on an against HPV31, HPV33 and HPV45 has been PMid:25424918 PMCid:PMC4896780 C, Shin HR.et al. Time trends of human 16 and 18: follow-up from a randomized control trial. 25 abnormalities occurred in the vaccine group. Gissmann L, Chapter 1: HPV in the etiology of human PMid:27977643, DOI: http://dx.doi.org/10.15585/ 7.2%). A meta-analysis update conducted by SmithJS necessary cause of cervical cancer, it is not a 18 that cause the majority of cervical cancers; aluminum-containing adjuvant to ensure robust and described. doses of bHPVvaccine, given 6 months apart. The 20. WORLD HEALTH ORGANIZATION. Country papillomavirus types in invasive cervical cancer, from Lancet.2006; 367(9518):1247-1255. https://doi.org/ 6 18 cancer. Vaccine. 2006; 24 (3): S1-S10. https://doi.org/ mmwr.mm6549a5external icon et al showed HPV type distribution in ICCand HSIL. sufficient cause. Epidemiologic studies indicate that long-lasting immunogenicity.12 Khatun S et al conducted a study to assess the target girls will mainly be reached through the office for Bangladesh. Human papillomavirus (HPV) 1940 to 2007.2014. Int J Cancer. 2014; 135(1):88-95. 10.1016/S0140-6736(06)68439-0, DOI: 10.1016/ and Recommended vaccination schedule: 10.1016/j.vaccine.2006.05.115, PMid:16949995, In ICC, HPV16 was the most common, and HPV18 the risk of contracting genital HPV infection and immunogenicity and safety profile of HPV16/18 14. Markowitz LE, Hariri S, Lin C, Dunne EF, Steinau M, vaccine introduced in Bangladesh.18 May 2016. https://doi.org/10.1002/ijc.28636, PMid:24382655, S0140-6736(06)68439-0, https://doi.org/10.1016/ The primary target group in most of the countries schoolbasedprogramme and girls who are out of DOI: 10.1016/ j.vaccine.2006.05.115, https://doi.org/ the second most common, type in all continents. The cervical cancer is influenced by a variety of factors. vaccines in healthy Bangladeshi girls aged between McquillanG, et al. Reduction in human News release DOI: 10.1002/ijc.28636, https://doi.org/10.1002/ S0140-6736(06)68439-0 recommending HPV vaccination is young adolescent school will receive the vaccine through the routine 10.1016/j.vaccine.2006.05.115, PMid:16949995 papillomavirus (HPV) prevalence among young next most common HPV types were HPV31, 33, 35, Thus, other cofactors are necessary for progression 9–13 years. They recommended that, bHPV vaccine EPI sites at the community level. 21. Morshed K, Polz-Gruszka D, Szymański M, ijc.28636, PMid:24382655 girls, aged 9-14.WHO has recommended the 6. Smith JS, Lindsay L, Hoots B, Keys J, Franceschi S, women following HPV vaccine introduction in the 37. De Carvalho N, Teixeira J, Roteli-Martins CM, Naud 45, 52 and 58. HPV18 was significantly more from cervical HPV infection to cancer. Long-term 35 was generally well tolerated, with no vaccine-related Polz-Dacewicz M. Human Papillomavirus (HPV) - following vaccination schedule . Winer R, et al. Human papillomavirus type United States, National Health and Nutrition 29. Nahar Q, Sultana F, Alam A, Islam JY, Rahman M, P, De Borba P, Zahaf T, et al. Sustained efficacy and prevalent in adeno/adenosquamous carcinoma than use of hormonal contraceptives, high parity, tobacco serious adverse effects. Conclusion: Structure, epidemiology and pathogenesis. Otolaryngol distribution in invasive cervical cancer and high-grade Examination Surveys, 2003-2010. J Infect Khatun F. et al. Genital human papillomavirus immunogenicity of the HPV-16/18 AS04-adjuvanted in squamous cell carcinoma. Among HSIL cases, smoking, and co-infection with HIV have been • Females <15 years at the time of first dose: a Immunization with the HPV vaccine induces Pol. 2014;68(5):213-219. https://doi.org/10.1016/ HPV prevalence, cross-protection and herd cervical lesions: A meta-analysis update. Int. J. Dis.2013;208(3):385-393. https://doi.org/10.1093/ infection among women in Bangladesh: findings from vaccine up to 7.3 years in young adult women. HPV16/18prevalence was 52%. WalboomersJM et identified as established cofactors; co-infection with sustained high levels of antibodies against high-risk j.otpol.2014.06.001, PMid:25283316, DOI: 10.1016/ 2-dose schedule (0, 6 months) is recommended. Cancer. 2007; 121(3): 621-632. https://doi.org/ infdis/jit192, PMid:23785124, DOI:10.1093/infdis/jit192. a Population-based survey. PLoS One. 2014; 9(10): Vaccine.2010; 28(38):6247-6255. https://doi.org/10.1016/ 3 immunity after vaccination: j.otpol.2014.06.001, https://doi.org/10.1016/j.otpol. al found that the worldwide HPV prevalence in Chlamydia trachomatis (CT) and herpes simplex HPV genotypes 16 and 18. The durable immune 10.1002/ijc.22527, PMid:17405118, DOI: 10.1002/ e107675. https://doi.org/10.1371/journal.pone.0107675 j.vaccine.2010.07.007, PMid:20643092, DOI: If the interval between doses is shorter than 5 months, A national HPV immunization program using a 15. Tabrizi SN, Brotherton JM, Kaldor JM, Skinner SR, 2014.06.001, PMid:25283316 cervical carcinomas is 99.7%. virus type-2 (HSV-2), immunosuppression, and response induced by the HPV vaccine in adolescent ijc.22527.https://doi.org/10.1002/ijc.22527 PMid:25271836 PMCid:PMC4182674, DOI: 10.1016/j.vaccine.2010.07.007, https://doi.org/ then a third dose should be given at least 6 months bHPV vaccine was implemented in Scotland in 2008, Liu B, Bateson D,et al. Assessment of herd immunity certain dietary deficiencies are other probable girls is predicted to provide long-term protection PMid:17405118 22. Bruni L, Albero G, Serrano B, Mena M, Gómez D, 10.1371/journal.pone.0107675, https://doi.org/10.1371/ 10.1016/j.vaccine.2010.07.007, PMid:20643092 Bangladesh had also different studies that focused on after the first dose. along with a national surveillance program designed and cross-protection after a human papillomavirus cofactors. against HPV infection and subsequent development Muñoz J, Bosch FX, de Sanjosé S. ICO/IARC journal.pone.0107675, PMid:25271836, PMCid:PMC4182674 HPV genotyping in different groups of females. to determine the longitudinal effects of vaccination 7. Banik U, Ahamad MSU, Bhattacharjee P, Adhikary vaccination programme in Australia: a repeat 38. Schwarz TF,Spaczynski M, Schneider A, Wysocki J, 29 • Information Centre on HPV and Cancer (HPV Nahar Q et al revealed prevalence of HPV infection Strategies for cervical cancer prevention and Females ≥15 years at the time of first dose & of high-grade cervical lesions and cancer. The AK, Rahman Z. cross-sectional study. Lancet Infect Dis.2014; 30. Sultana T, Huq M, Alam A, Mitra DK, Gomes DJ. Galaj A, Schulze K, et al. Persistence of immune on HPV infection at the population level. By linking Information Centre). Human Papillomavirus and was 7.7% with no significant difference between control33: immunocompromised and/or HIV-infected.: a 14(10):958-966.DOI: 10.1016/S1473-3099(14) 70841-2, Prevalence and genotyping of human papillomavirus vaccination, cervical screening, and HPV testing knowledge gained from this review is important for 8. High risk human papillomavirus type 16 and 18 Related Diseases in the World. Summary Report 17 response to HPV-16/18 AS04-adjuvanted cervical 3-dose schedule (0, 1-2, 6 months) is https://doi.org/10.1016/S1473-3099(14)70841-2 (HPV) in female with high-risk behaviour in Dhaka, urban and rural women. HR-HPV (High risk) WHO recommends a comprehensive approach to realizing the necessity of the use of a prophylactic infection in the cervical lesions of women with cancer vaccine in women aged 15-55 years. Hum recommended. data, over the study period they found a decline in June 2019. [Date Accessed] Bangladesh. Bangladesh J Microbiol. 2008; infections were more common (4.2%) than LR-HPV cervical cancer prevention and control. The HPV16/18 vaccine in Bangladeshi girls. There has epithelial cell abnormality in Pap smear: A 16. Kavanagh K, Pollock KG, Potts A, Love J, Cuschieri Vaccin.2011; 7(9): 958-965. https://doi.org/10.4161/ HPV 16 &18,significant decreases in HPV 31, 33& 23. FernandezJV and De Medeiros Fernandez TAA. 25(1):65-68. https://doi.org/10.3329/bjm.v25i1.4861, infections (3.4%). Most common HR genotypes were recommended set of actions includes following Evaluation of efficacy, immunogenicity and safety cytohistomorphologic association in Bangladeshi K, Cubie H, et al. Introduction and sustained high hv.7.9.15999, PMid:21892005 PMCid:PMC3225769, 45 (suggesting cross-protection). Among non- been little success with screening program against Chapter 1 Human Papillomavirus: Biology and DOI:https://doi.org/10.3329/bjm.v25i1.4861, HPV16,66,18,45,31&53. Sultana T et al30 noted the interventions. women. Cytojournal. 2013; 10: 14. DOI: 10.4103/ coverage of the HPV bivalent vaccine leads to DOI: 10.4161/hv.7.9.15999, https://doi.org/10.4161/ of HPV vaccine: vaccinated women, HPV 16 & 18 infections were cervical cancer in Bangladesh, an intervention that Pathogenesis. Human Papillomavirus and Related https://doi.org/10.3329/bjm.v25i1.4861 prevalence of genital HPV types in the sex workers 36 1742-6413.1150888. Borna NN, Tabassum S, Jahan areduction in prevalence of HPV 16/18 and closely hv.7.9.15999, PMid:21892005 PMCid:PMC3225769 a) Primary prevention begins with HPV vaccination HarperDM et al assessed the long-term efficacy, significantly lower in 2013 than in 2009 indicating has helped to significantly reduce cervical cancer in Diseases-From Bench to Bedside-A Clinical was as high as 75.8%, whereas for the high-risk types M, Munshi S, Unnesa A. Genotyping of High-Risk related HPV types. Br J Cancer.2014;110(11), 31. Khandker E, Khan M, Chowdhury AK. Human of girls aged 9-13 years, before they become sexually immunogenicity, and safety of a bivalent HPV-16/18 herd immunity and sustained effectiveness of the the developed world. Therefore, a National HPV Perspective, 2012. 1-40, Rijeka, Croatia: InTech. DOI: 39. Roteli-Martins CM, Naud P, De Borba P, TeixeiraJC, it was 49.8%. The highest prevalence rate was Human Papillomavirus (HPV) Among Cervical 2804-2811.DOI: 10.1038/bjc.2014.198. https://doi.org/ papillomavirus infection among Bangladeshi women active. Because HPV vaccines do not protect against L1 virus-like particle AS04 vaccine against incident bivalent vaccine onvirologic outcomes at the 10.5772/27154 https://doi.org/10.5772/27154 De Carvalho NS, Zahaf T, et al. Sustained observed for the genotype 16, 18 and 58. Khandker E Vaccination Program seems to be the window of Precancer and Cancer Patients. Acta MedicaInternational. 10.1038/bjc.2014.198,PMid:24736582 with cervical intraepithelial neoplasia and chronic all HPV types that cause cervical cancer, vaccine and persistent infection with HPV 16 & 18 and their 17 immunogenicity and efficacy of the HPV-16/18 31 population level. opportunity to reduce the mortality and morbidity of 2015;2(1):19-28.DOI: 10.5530/ami.2015.1.5, https://doi.org/ PMCid:PMC4037824 24. Gómez DT and Santos JL. Human papillomavirus cervicitis. IMC J Med Sci. 2016;10(1): 29-32. et al determine HPV infection rate was 43.1%. CIN associated cytological and histological outcomes. De AS04-adjuvanted vaccine: up to 8.4 years of introduction should be part of comprehensive 10.5530/ami.2015.1.5 infection and cervical cancer: pathogenesis and https://doi.org/10.3329/imcjms.v10i1.31103, DOI: cases had significantly high (p<0.01) HPV infection 37 Scenario of HPV vaccination in Bangladesh: HPV related cervical cancer in Bangladesh. 17. Cameron RL, Kavanagh K, Pan J, Love J, Cuschieri approach to cervical cancer control. Carvalhoa N et al report efficacy and epidemiology. Communicating Current Research and follow-up. Hum Vaccin. J Immunother.2012; 8(3): 9. Michael JC, Karen C. Cervical Cancer Screening and K, Robertson C, et al. Human Papillomavirus https://doi.org/10.3329/imcjms.v10i1.31103 (78.6%) compared to cases with chronic cervicitis immunogenicity of the HPV16/18 vaccine up to 7.3 WHO has developed guidelines on prevention and References : Educational Topics and Trends in Applied 390-397.https://doi.org/10.4161/hv.18865 7 Other recommended preventive interventions for Preinvasive Disease. In: Berek JS, Hacker NF Prevalence and Herd Immunity after Introduction of https://doi.org/10.3329/imcjms.v10i1.31103 (18.2%).BanikU et al find out the extent of HR HPV years post vaccination. No cases of infection or control of cervical cancer through vaccination and 1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre Microbiology. A Mendez Vilas (ed). Spain: Formatex; PMid:22327492,DOI:10.4161/hv.18865 (editors). Berek and Hacker's Gynecologic Oncology. Vaccination Program, Scotland, 2009-2013. Emerg type 16/18 infection in women with epithelial cell boys and girls are: cytohistological lesions associated with HPV 16/18 screening. By mid-2016, globally 65 countries, LA, Jemal A. Global Cancer Statistics 2018: 2007.p. 680-688. ISBN-13-9788461194223 32. De Vuyst H, Clifford GM, Nascimento MC, https://doi.org/10.4161/hv.18865 6th edition. Philadelphia: Wolters Kluwer; 2014. p. Infect Dis.2016; 22 (1), 56-64. https://doi.org/ abnormality in Pap smear. HPV type 16/18 infection mostly in high-income and upper-middle-income GLOBOCAN Estimates of Incidence and Mortality Madeleine MM, Franceschi S. Prevalence and type PMid:22327492 • education about safe sexual practices, delayed were observed in the vaccinee. Another follow up 242-325.ISBN-13-978-1-4511-9007-6. 10.3201/eid2201.150736,PMid:26692336 25. Bosch FX, Broker TR, Forman D, Moscicki AB, was detected in 40.42% of the patients. Borna NN et 38 Worldwide for 36 Cancers in 185 Countries.CA: distribution of human papillomavirus in carcinoma start of sexual activity study (up to 4 years) of SchwarzTF et al showed settings had introduced HPV vaccines into their PMCid:PMC4696690, DOI: 10.3201/eid2201.150736 Gillison ML, Doorbar J. et al. Comprehensive Control 40. World Health Organization. Country office for 8 33 Cancer J Clin. 2018; 68:394-424.DOI: 10.3322/ 10. Jacqueline S, Cristina H, Christopher E. Beyond Our and intraepithelial neoplasia of the vulva, vagina and al identify HR HPV genotype among women having persistence of immune response to HPV-16/18 national immunization programs . But the global https://doi.org/10.3201/eid2201.150736 of Human Papillomavirus Infections and Related • promotion and provision of condoms for those caac.21492.https://doi.org/10.3322/caac.21492 Borders Cervical cancer in the developing world. anus: a meta-analysis. Int J Cancer. 2009; Bangladesh. Human papillomavirus (HPV) vaccine CIN and carcinoma. HPV 16 was detected in vaccine in women aged 15–55 years. All subjects burden of cervical cancer fallsheaviest on the PMid:26692336 PMCid:PMC4696690 Diseases. Vaccine. 2013;31(7): H1-31. https://doi.org/ already engaged in sex PMid:30207593 West J Med. 2001; 175: 231-233. DOI: 10.1136/ 124(7):1626-1636. https://doi.org/10.1002/ijc.24116 introduced in Bangladesh. News release.2016.

128 program by visual inspection with acetic acid (VIA), Programhas yet been started in Bangladesh and also the viral capsid. DNA containing approximately 8000 genes. The second is an early region (E), consisting which was considered to be a feasible method for no review has been done related to HPV Vaccination base pairs and harboring an average of 8 open reading of six ORFs: E1, E2, E4, E5, E6, and E7, which screening cervical cancer in the present so far. Hence, this review has been conducted to frames (ORFs). In a functional point of view, the encodes no structural proteins involved in viral socio-economic context. It has been estimated that explore different aspects of HPV vaccines in depth HPV genome is divided into three regions. The first is replication and oncogenesis. The third is a late (L) only 5% of the women in developing countries have which will help to recommend a National a long control region (LCR) that has regulatory region that encodes the L1 and L2 structural proteins. been screened for cervical dysplasia compared with HPVvaccination Program for prevention of cervical function of the transcription of the E6 and E7 viral about 40% to 50% of women in developed cancer among Bangladeshi women by a low-cost 10 countries. bHPV vaccine. One of the greatest medical breakthroughs in the last Review of literature century is the development of HPV vaccine against Human papillomavirus (HPV) vaccine for preventing cervical cancer by Professor Frazer and Dr Jian HPV induced malignancy is a widely studied topic Zhou.11 HPV related anogenital cancers can be for physicians. Different authors explained different prevented using a prophylactic vaccine. The two aspects of HPV, its malignant potential, its preventive prophylactic HPV vaccines, quadrivalent HPV type measures through vaccination and HPV vaccines 6/11/16/18 vaccine and bivalent HPV type 16/18 vaccine, were licensed in 2006 and 2007 under the immunogenicity, efficacy, safety etc through their names of Gardasil® and Cervarix® respectively.12 own view. Articles related to Human papillomavirus Recently nine-valent HPV type 6/11/16/18/31/33/45/52/58 (HPV) vaccine were retrieved from different vaccine with broader cancer coverage has also journals, web pages and books. From them 40 papers received the United States Food and Drug were included to prepare this manuscript. Administration (US-FDA) approval in October 2016 Role of HPV in cancers: 13 under the name of Gardasil9®. Different studies in The connection between persistent infection with USA, Australia and Scotland have begun to show a HPV and cervical cancer was first described by drop in the prevalence of HPV associated diseases Harald Zur Hausen in 1977. In 1983 & 1984 Zur Life cycle of HPV25: become persistently infected; which is the most both in vaccinated and non-vaccinated populations Hausen and his collaborators identified role of HPV indicating establishment, of herd immunity and also The viral life cycle refers mainly to high-risk important risk factor for the development of cervical 16 & 18 in cervical cancer and in the course of the provide cross- protection.14-17 Khatun S et al18 mucosotropic HPVs and is commonly extrapolated to cancer. The most common clinically significant next 12 years of research it has been recognized as a observed high immunogenicity and safety of the all HPVs. Activated cell divisionis necessary for viral manifestation of persistent genital HPV infection is carcinogen influencing its development.21 This bHPV vaccine among Bangladeshi adolescent girls at DNA access to the cell nucleus. Initial viral Cervical Intraepithelial Neoplasia (CIN). Within a finding laid the ground for the idea of a vaccine 7 months of vaccination.Sustained efficacy, replication in the basal cells requires E1 and E2 few years of infection, low-grade CIN(CIN 1) may Introduction: Human papillomavirus (HPV) is the virtually against HPV infection and cervical cancer, and in proteins. The role of E6 and E7 in the basal layer is develop, which may spontaneously resolve and the Cervical cancer is a major public health problem necessary cause of carcinoma cervix. HPVs causing immunogenicity, and safety of the bHPV vaccine 1999 it finally became clear that persistent HPV uncertain; particularly for the low-risk HPVs. infection clear. Persistent HPV infection, may worldwide. It is the 4th most frequently diagnosed not only the vast majority of cervical (99.7%), but were observed in the final analysis of a follow-up study up to 9.4 years postvaccination.19 infection is a necessary cause of invasive cervical Deregulation of E6/E7 expression is critical in progress directly to higher-grade CIN (CIN2 or cancer in women worldwide, with an estimated also a substantial proportion of other anogenital and 3 cancer. HPV infection is commonly found in the determining neoplastic grade. In high-risk HPVs, CIN3). High-grade abnormalities are at risk of 570,000 new cases in 2018. It is also the 4th leading head and neck cancers.3,4 Among all HPV-associated HPV vaccine has introduced in Bangladesh by the anogenital tract of men and women with and without E6/E7 mediates proliferation of the basal and progression to cancer. Some high-grade abnormalities cause of cancer death, with an estimated 311,000 malignancies, cervical cancer is the most important Ministry of Health and Family Planning (MoHFP), clinical lesions. The etiological role of HPV infection parabasal cells, facilitating lesion growth. HPV E6 spontaneously regress. If left, undetected and deaths in 2018. Cervical cancer is the 2nd most cause of morbidity and mortality worldwide. with support from the Global Alliance for Vaccines among women with cervical cancer is and E7 oncoproteins bind to and inactivate tumor untreated, years or decades later CIN2 or 3 can commonly diagnosed cancer and leading cause of Approximately 70% of cervical cancers worldwide and Immunizations (GAVI) for two years in Gazipur well-established, and there is growing evidence of its suppressor proteins p53 and pRb, respectively, progress to cervical cancer. The time lag between the cancer death among females in less developed are associated with two high-risk HPV types (16/18), district and if it is successful, GAVI will provide 1 central role in other anogenital cancers (anus, vulva, leading to malignant transformation of infected cells. peak of HPV infection and the peak of cancer countries. Cervical cancer is the 2nd leading cause of while other high-risk HPV types 31, 33, 35, 45, 52 support for national introduction of HPV vaccine.20 vagina, penis), head and neck cancers. HPV is also incidence generally takes place over a period of 10 to female cancer in incidence and 3rd leading cause of and 58 are responsible for approximately 20% case.5,6 There has been little success with screening program Transmission and natural history of HPV responsible for diseases e.g recurrent juvenile 20 years, making the initiating infections and female cancer deaths among Bangladeshi women HPV type 16/18 infection was detected in 40.42% of against cervical cancer, which is a major public infection26: precursor lesions of cervical cancer anappropriate with an estimated 8,068 new cases and 5,214 deaths the women in Bangladesh with cervical epithelial cell health problem in Bangladesh. Therefore, a National respiratory papillomatosis and genital warts, both HPV infection occurs at the basal epithelium during 2 22 target for screening and early detection. Some lesions in 2018. abnormality.7 HPV type 16 was detected in 81.82%, HPV Vaccination Program will reduce the mortality mainly caused by HPV 6/11. sexual intercourse. Although the incidence of become cancerous more rapidly, sometimes within 2 type 18 in 9.09% and type 45 in 6.06% cases of and morbidity of cervical cancer in Bangladesh.The Structure23 and gene functions24 of HPV: infection is high, but most infections resolve years. Infection with one type of HPV does not cervical carcinoma in Bangladesh.8 objective of the review article is to evaluate the HPV is a relatively small non-enveloped double- spontaneously. Several studies have suggested that current status of the cervical cancer prevention most women successfully clear the HPV infection, prevent infection with another type. If persons In developed countries, incidence and mortality of stranded DNA virus in the family Papillomaviridae. achieved by HPV vaccination worldwide. presumably through the action of a competent infected with mucosal HPV, 5% to 30% are infected cervical cancer has been lowered by effective It is associated with histone-like proteins and immune system. Among the infected individuals, with multiple types of the virus. population-based screening program with Pap smear Rationale of the review protected by a capsid formed by two late proteins, L1 approximately, 90% of lesions regress spontaneously HPV prevalence: and or HPV DNA testing.9 Government of National HPV vaccination programs have been and L2. Each virion contains 72 copies of the L1, the without clinical signs or symptoms within 12 to 36 There have been many studies worldwide on the Bangladesh with the support of UNFPA has taken implemented in many countries to prevent cervical major component of the capsid, and a variable months, a small proportion of infected persons proportion of cervical cancer, other anogenital initiative to develop a cervical cancer screening cancer. But no National HPV Vaccination number of copies of L2, a secondary component of

Journal of Bangladesh College of Physicians and Surgeons Vol. 39, No. 2, April 2021 cancers, high& low-grade squamous intraepithelial 81.82%followed by 18 in 9.09%& 45 in 6.06% cases • warnings about tobacco use • A quadrivalent vaccine (Gardasil®/Silgard®, Mechanism of vaccine related protection: were seroconverted for anti-HPV-16&18 antibodies developing countries which haven’t introduced the 2. Bruni L, Albero G, Serrano B, Mena M, Gómez D, ewjm.175.4.231. https://doi.org/10.1136/ ewjm. 18. Khatun S, HussainSMA, Chowdhury S, Ferdous J, 10.1016/j.vaccine.2013.10.003, PMid:24332295 PMid:19115209, DOI: 10.1002/ijc.24116, https://doi.org/ Muñoz J, et al. ICO/IARC Information Centre on 175.4.231, PMid:11577044 PMCid:PMC1071564 Hossain F, Begum SR, et al. Safety and PMCid:PMC7605442, DOI: 10.1016/j.vaccine.2013. lesions (HSIL and LSIL) due to different HPV of cervical carcinoma. Among precancerous cases, • male circumcision. produced by Merck & Co)–protects against HPV Systemic immunization with L1 VLPs generates at Month 7. At Month 48 of that study, all subjects HPV vaccine as part of their national public health 10.1002/ijc.24116, PMid:19115209 HPV and Cancer (HPV Information Centre). Human Immunogenicity Profile of Human Papillomavirus- 10.003, https://doi.org/10.1016/j.vaccine.2013.10.003 genotypes as well as prevalence of HPV in general only type 16 was detected. 16 & 18, 6 & 11 that causes anogenital warts antibody concentrations higher than in a natural were still seropositive for anti-HPV-16 antibodies strategy to prevent and control cervical cancer. 11. Zhao KN, Zhang L, Qu J. Dr. Jian Zhou: The great 33. Uterine cervical neoplasms - prevention and control. b) Secondary prevention through screening and Papillomavirus and Related Diseases in Bangladesh. 16/18 AS04 Adjuvant Cervical Cancer Vaccine: A PMid:24332295 PMCid:PMC7605442 population. also. infection. The HPV vaccines are highly and all but one subject in the 46–55 years age group inventor of cervical cancer vaccine. Protein Cell.2017; Comprehensive cervical cancer control: a guide to HPVprevalence in vulvar, vaginal and anal treatment of adult sexually active women for Bivalent HPV vaccine was registered in Bangladesh Summary Report 17 June 2019. [Date Accessed] Randomized Controlled Trial in Healthy Adolescent 27 immunogenic leading to seroconversion in virtually remained seropositive (99.4%) for anti-HPV-18 8(2): 79-82. DOI: 10.1007/s13238-016-0358-2 26. Human Papillomavirus. In: Centers for Disease Bruni L et al performed a meta-analysis of cervical intraepithelial neoplasia (VIN, VAIN, AIN) grades As of December 2014, the U.S.FDA approved Girls of Bangladesh. Jpn J Clin Oncol. 2011;42(1): essential practice. 2nd ed. World Health Organization. precancerous lesions, starting from 30 years of age. 100% of vaccinees. Antibody titers in blood reach 39 in 2009 while qHPV was registered in 2014.HPV 3. Walboomers JM, Jacobs MV, Manos MM, Bosch FX, https://doi.org/10.1007/s13238-016-0358-2 Control and Prevention. Epidemiology and Prevention HPV prevalence among women with normal 1-3 and carcinoma was conducted in 4 continents. antibodies. Roteli-Martins CM et al report the 36-41. https://doi.org/10.1093/jjco/hyr173, PMid:22194637 2014. ISBN 978 92 4 154895 3 Merck’s 9- valent HPV vaccine (GARDASIL 9®) vaccine has recently been introduced in Bangladesh Kummer JA, Shah KV, et al. Human papillomavirus is PMid:28108949 PMCid:PMC5291779 c)Tertiary prevention and palliative care for women peaks 2–3 log higher than in natural infections, long-term efficacy and immunogenicity of the PMCid:PMC3244935, DOI: 10.1093/jjco/hyr173 of Vaccine-Preventable Diseases. Hamborsky J, cytological findings. The estimated global HPV Overall HPV prevalence was 67.8%, 85.3% and which includes the additional five HPV 31, 33, 45, a necessary cause of invasive cervical cancer 34. Guide to introducing HPV vaccine into national affected by invasive cervical cancer include surgery, decrease gradually to levels several-fold lower than HPV-16/18 AS04-adjuvanted vaccine up to 8.4 y by the Ministry of Health and Family Planning 12. Markowitz LE, Dunne EF, Saraiya M, Chesson HW, https://doi.org/10.1093/jjco/hyr173 Kroger A, Wolfe S, eds. 13th ed., Supplement. prevalence was 11.7%. While based on the world 40.4% among VIN1, VIN2/3& vulvar carcinomas; 52& 58 compared to the quadrivalent vaccine. worldwide. J Pathol.1999;189(1): 12-19. https://doi.org/ immunization programmes. Immunization, Vaccines radiotherapy and chemotherapy. peak and then remain stable for years. The IgG is after the first vaccine dose. No new infection or (MoHFP), with support from the Global Alliance for Curtis CR, GEE J, et al. Human Papillomavirus PMid:22194637 PMCid:PMC3244935 Washington D.C. Public Health Foundation, 2017. regions Sub-Saharan Africa (24%), Eastern Europe 100%, 90.1% and 69.9% among VAIN1, VAIN2/3& 10.1002/(SICI)1096-9896(199909)189:1<12::AID-P and Biologicals. World Health Organization. 2016; Both vaccines are composed of type-specific HPV L1 exuded at the possible sites of infection (mucosa of Vaccines and Immunizations (GAVI). This new Vaccination: Recommendations of the Advisory p.175-186. (21.4%) and Latin America (16.1%) showed the vaginal carcinomas; and 91.5%, 93.9% and 84.3% HPV vaccines34: lesions associated with HPV-16/18 occurred in the ATH431>3.0.CO;2-F, DOI: 10.1002/(SICI)1096-9896 19. Naud PS, Roteli-Martins CM, De Carvalho NS, 1-90. ISBN: 978 92 4 154976 9 protein, the major capsid protein of HPV which is genital tract, oral cavity, etc.), neutralizes the virus 19 Committee on Immunization Practices (ACIP). highest prevalence’s. among AIN1, AIN2/3& anal carcinomas, vaccine group. NaudPSet al conducted a long-term vaccine introduction program ran for two years in (199909)189:1<12: AID-PATH431>3.0.CO;2-F Teixeira JC, De Borba PC, Sanchez N, et al. Sustained 27. Bruni L, Diaz M, Castellsagué X, Ferrer E, Bosch FX, The availability of prophylactic HPV vaccines has used as an antigen. Through Recombinant DNA and prevents its entry into the cells. The MMWR Recomm Rep. 2014; 63(RR-05): 35. Human papillomavirus vaccines: Weekly epidemiological respectively. HPV16 was found>75% and 18 <10% follow-up of an initial double-blind, randomized Gazipur district and if it is successful, GAVI will efficacy, immunogenicity, and safety of the De Sanjosé S. Cervical human papillomavirus Alemany L et al28 estimated the HPV type-specific provided a powerful tool for primary prevention of technology the L1 protein undergoes conformal vaccine-induced immune memory in the form of 4. Zur Hausen H. Papillomaviruses in the causation of 1-30.PMID: 25167164 record. WHO position paper.2017;92(19):241-268. in HPV positive vulvar, vaginal and anal carcinomas. (1:1), placebo-controlled study evaluating the provide support for national introduction of HPV HPV-16/18 AS04-adjuvanted vaccine: final analysis prevalence in 5 continents: Meta-analysis of 1 million distribution in a large series of invasive cervical cervical cancer and other HPV-associated diseases. human cancers-a brief historical account. Virology. ISSN 0049-8114 changes to self-assemble into 'virus-like' particles circulating plasma cells and memory B-cells allows 40 13. Meites E, Kempe A, Markowitz LE. Use of a 2-Dose of a long-term follow-up study up to 9.4 years women with normal cytological findings. J Infect Dis. Approximately 40% ofvulvar, 60% of vaginal and The vaccines are most effective when administered to efficacy against HPV16/18 infection and associated vaccine . WHO recommends that girls are 2009; 384(2): 260-265. https://doi.org/ 10.1016/ cancer (ICC) over 70 years from 11 countries in (VLPs). The VLPs are non-infective and non- generation and exudation of protecting IgG each time Schedule for Human Papillomavirus Vaccination - post-vaccination. Hum VaccinImmunother. 2014; 2010; 202(12): 1789-1799. https://doi.org/ 80% of anal carcinoma are responsible for a person prior to exposure to HPV. Two HPV cyto-histopathological abnormalities, persistence vaccinated with HPV vaccine between the ages of j.virol.2008.11.046, PMid:19135222, DOI: 10.1016/ 36. Harper DM, Franco EL, Wheeler CM, Moscick AB, Central-South America, Asia and Europe. Among pathogenic as these are devoid of the viral DNA the body is challenged by exposure to HPV infection. Updated Recommendations of the Advisory 10(8), 2147-2162. https://doi.org/10.4161/hv.29532 10.1086/657321, PMid:21067372, DOI: 10.1086/ HPV16/18.32 ofimmunogenicity, and safety of the HPV-16/18 j.virol.2008.11.046. https://doi.org/10.1016/j.virol. Romanowski B, Roteli-Martins CM, et al. Sustained 4,771 HPV DNA positive ICC cases, HPV16&18 vaccines are currently pre-qualified by WHO: essential to initiate the carcinogenic process. Bivalent 9-13 years. In line with this, the Government of Committee on Immunization Practices. MMWR Morb PMid:25424918 PMCid:PMC4896780, DOI: 657321, https://doi.org/10.1086/657321, PMid:21067372 Animal models suggest that very low antibody titers 2008.11.046, PMid:19135222 efficacy up to 4.5 years of a bivalent L1 virus-like AS04-adjuvanted vaccine. No new HPV 16/18- Bangladesh has decided to vaccinate 10-year-old Mortal Wkly Rep. 2016; 65(49):1405-1408. were the two most common HPVs in all the decades Co-factors associated with cervical cancer: • A bivalent vaccine (Cervarix®, produced by vaccinecontains a novel adjuvant AS04 and may still be protective. Partial cross-protection 10.4161/hv.29532, https://doi.org/10.4161/hv.29532 28. Alemany L, De Sanjosé S, Tous S, Quint W, Vallejos particle vaccine against human papillomavirus types 5 associated infections and cyto-histopathological girls in the primary school setting (Grade 5) with two 5. Mu˜noz N, Castellsagu' E X, De González AB, https://doi.org/10.15585/mmwr.mm6549a5 (HPV16-from 61.5 to 62.1%, and HPV18-from 6.9 to Muñoz N et al stated that although HPV is a GlaxoSmithKline)–protects against HPV 16 & quadrivalent vaccine VLPs are adsorbed on an against HPV31, HPV33 and HPV45 has been PMid:25424918 PMCid:PMC4896780 C, Shin HR.et al. Time trends of human 16 and 18: follow-up from a randomized control trial. 25 abnormalities occurred in the vaccine group. Gissmann L, Chapter 1: HPV in the etiology of human PMid:27977643, DOI: http://dx.doi.org/10.15585/ 7.2%). A meta-analysis update conducted by SmithJS necessary cause of cervical cancer, it is not a 18 that cause the majority of cervical cancers; aluminum-containing adjuvant to ensure robust and described. doses of bHPVvaccine, given 6 months apart. The 20. WORLD HEALTH ORGANIZATION. Country papillomavirus types in invasive cervical cancer, from Lancet.2006; 367(9518):1247-1255. https://doi.org/ 6 18 cancer. Vaccine. 2006; 24 (3): S1-S10. https://doi.org/ mmwr.mm6549a5external icon et al showed HPV type distribution in ICCand HSIL. sufficient cause. Epidemiologic studies indicate that long-lasting immunogenicity.12 Khatun S et al conducted a study to assess the target girls will mainly be reached through the office for Bangladesh. Human papillomavirus (HPV) 1940 to 2007.2014. Int J Cancer. 2014; 135(1):88-95. 10.1016/S0140-6736(06)68439-0, DOI: 10.1016/ and Recommended vaccination schedule: 10.1016/j.vaccine.2006.05.115, PMid:16949995, In ICC, HPV16 was the most common, and HPV18 the risk of contracting genital HPV infection and immunogenicity and safety profile of HPV16/18 14. Markowitz LE, Hariri S, Lin C, Dunne EF, Steinau M, vaccine introduced in Bangladesh.18 May 2016. https://doi.org/10.1002/ijc.28636, PMid:24382655, S0140-6736(06)68439-0, https://doi.org/10.1016/ The primary target group in most of the countries schoolbasedprogramme and girls who are out of DOI: 10.1016/ j.vaccine.2006.05.115, https://doi.org/ the second most common, type in all continents. The cervical cancer is influenced by a variety of factors. vaccines in healthy Bangladeshi girls aged between McquillanG, et al. Reduction in human News release DOI: 10.1002/ijc.28636, https://doi.org/10.1002/ S0140-6736(06)68439-0 recommending HPV vaccination is young adolescent school will receive the vaccine through the routine 10.1016/j.vaccine.2006.05.115, PMid:16949995 papillomavirus (HPV) prevalence among young next most common HPV types were HPV31, 33, 35, Thus, other cofactors are necessary for progression 9–13 years. They recommended that, bHPV vaccine EPI sites at the community level. 21. Morshed K, Polz-Gruszka D, Szymański M, ijc.28636, PMid:24382655 girls, aged 9-14.WHO has recommended the 6. Smith JS, Lindsay L, Hoots B, Keys J, Franceschi S, women following HPV vaccine introduction in the 37. De Carvalho N, Teixeira J, Roteli-Martins CM, Naud 45, 52 and 58. HPV18 was significantly more from cervical HPV infection to cancer. Long-term 35 was generally well tolerated, with no vaccine-related Polz-Dacewicz M. Human Papillomavirus (HPV) - following vaccination schedule . Winer R, et al. Human papillomavirus type United States, National Health and Nutrition 29. Nahar Q, Sultana F, Alam A, Islam JY, Rahman M, P, De Borba P, Zahaf T, et al. Sustained efficacy and prevalent in adeno/adenosquamous carcinoma than use of hormonal contraceptives, high parity, tobacco serious adverse effects. Conclusion: Structure, epidemiology and pathogenesis. Otolaryngol distribution in invasive cervical cancer and high-grade Examination Surveys, 2003-2010. J Infect Khatun F. et al. Genital human papillomavirus immunogenicity of the HPV-16/18 AS04-adjuvanted in squamous cell carcinoma. Among HSIL cases, smoking, and co-infection with HIV have been • Females <15 years at the time of first dose: a Immunization with the HPV vaccine induces Pol. 2014;68(5):213-219. https://doi.org/10.1016/ HPV prevalence, cross-protection and herd cervical lesions: A meta-analysis update. Int. J. Dis.2013;208(3):385-393. https://doi.org/10.1093/ infection among women in Bangladesh: findings from vaccine up to 7.3 years in young adult women. HPV16/18prevalence was 52%. WalboomersJM et identified as established cofactors; co-infection with sustained high levels of antibodies against high-risk j.otpol.2014.06.001, PMid:25283316, DOI: 10.1016/ 2-dose schedule (0, 6 months) is recommended. Cancer. 2007; 121(3): 621-632. https://doi.org/ infdis/jit192, PMid:23785124, DOI:10.1093/infdis/jit192. a Population-based survey. PLoS One. 2014; 9(10): Vaccine.2010; 28(38):6247-6255. https://doi.org/10.1016/ 3 immunity after vaccination: j.otpol.2014.06.001, https://doi.org/10.1016/j.otpol. al found that the worldwide HPV prevalence in Chlamydia trachomatis (CT) and herpes simplex HPV genotypes 16 and 18. The durable immune 10.1002/ijc.22527, PMid:17405118, DOI: 10.1002/ e107675. https://doi.org/10.1371/journal.pone.0107675 j.vaccine.2010.07.007, PMid:20643092, DOI: If the interval between doses is shorter than 5 months, A national HPV immunization program using a 15. Tabrizi SN, Brotherton JM, Kaldor JM, Skinner SR, 2014.06.001, PMid:25283316 cervical carcinomas is 99.7%. virus type-2 (HSV-2), immunosuppression, and response induced by the HPV vaccine in adolescent ijc.22527.https://doi.org/10.1002/ijc.22527 PMid:25271836 PMCid:PMC4182674, DOI: 10.1016/j.vaccine.2010.07.007, https://doi.org/ then a third dose should be given at least 6 months bHPV vaccine was implemented in Scotland in 2008, Liu B, Bateson D,et al. Assessment of herd immunity certain dietary deficiencies are other probable girls is predicted to provide long-term protection PMid:17405118 22. Bruni L, Albero G, Serrano B, Mena M, Gómez D, 10.1371/journal.pone.0107675, https://doi.org/10.1371/ 10.1016/j.vaccine.2010.07.007, PMid:20643092 Bangladesh had also different studies that focused on after the first dose. along with a national surveillance program designed and cross-protection after a human papillomavirus cofactors. against HPV infection and subsequent development Muñoz J, Bosch FX, de Sanjosé S. ICO/IARC journal.pone.0107675, PMid:25271836, PMCid:PMC4182674 HPV genotyping in different groups of females. to determine the longitudinal effects of vaccination 7. Banik U, Ahamad MSU, Bhattacharjee P, Adhikary vaccination programme in Australia: a repeat 38. Schwarz TF,Spaczynski M, Schneider A, Wysocki J, 29 • Information Centre on HPV and Cancer (HPV Nahar Q et al revealed prevalence of HPV infection Strategies for cervical cancer prevention and Females ≥15 years at the time of first dose & of high-grade cervical lesions and cancer. The AK, Rahman Z. cross-sectional study. Lancet Infect Dis.2014; 30. Sultana T, Huq M, Alam A, Mitra DK, Gomes DJ. Galaj A, Schulze K, et al. Persistence of immune on HPV infection at the population level. By linking Information Centre). Human Papillomavirus and was 7.7% with no significant difference between control33: immunocompromised and/or HIV-infected.: a 14(10):958-966.DOI: 10.1016/S1473-3099(14) 70841-2, Prevalence and genotyping of human papillomavirus vaccination, cervical screening, and HPV testing knowledge gained from this review is important for 8. High risk human papillomavirus type 16 and 18 Related Diseases in the World. Summary Report 17 response to HPV-16/18 AS04-adjuvanted cervical 3-dose schedule (0, 1-2, 6 months) is https://doi.org/10.1016/S1473-3099(14)70841-2 (HPV) in female with high-risk behaviour in Dhaka, urban and rural women. HR-HPV (High risk) WHO recommends a comprehensive approach to realizing the necessity of the use of a prophylactic infection in the cervical lesions of women with cancer vaccine in women aged 15-55 years. Hum recommended. data, over the study period they found a decline in June 2019. [Date Accessed] Bangladesh. Bangladesh J Microbiol. 2008; infections were more common (4.2%) than LR-HPV cervical cancer prevention and control. The HPV16/18 vaccine in Bangladeshi girls. There has epithelial cell abnormality in Pap smear: A 16. Kavanagh K, Pollock KG, Potts A, Love J, Cuschieri Vaccin.2011; 7(9): 958-965. https://doi.org/10.4161/ HPV 16 &18,significant decreases in HPV 31, 33& 23. FernandezJV and De Medeiros Fernandez TAA. 25(1):65-68. https://doi.org/10.3329/bjm.v25i1.4861, infections (3.4%). Most common HR genotypes were recommended set of actions includes following Evaluation of efficacy, immunogenicity and safety cytohistomorphologic association in Bangladeshi K, Cubie H, et al. Introduction and sustained high hv.7.9.15999, PMid:21892005 PMCid:PMC3225769, 45 (suggesting cross-protection). Among non- been little success with screening program against Chapter 1 Human Papillomavirus: Biology and DOI:https://doi.org/10.3329/bjm.v25i1.4861, HPV16,66,18,45,31&53. Sultana T et al30 noted the interventions. women. Cytojournal. 2013; 10: 14. DOI: 10.4103/ coverage of the HPV bivalent vaccine leads to DOI: 10.4161/hv.7.9.15999, https://doi.org/10.4161/ of HPV vaccine: vaccinated women, HPV 16 & 18 infections were cervical cancer in Bangladesh, an intervention that Pathogenesis. Human Papillomavirus and Related https://doi.org/10.3329/bjm.v25i1.4861 prevalence of genital HPV types in the sex workers 36 1742-6413.1150888. Borna NN, Tabassum S, Jahan areduction in prevalence of HPV 16/18 and closely hv.7.9.15999, PMid:21892005 PMCid:PMC3225769 a) Primary prevention begins with HPV vaccination HarperDM et al assessed the long-term efficacy, significantly lower in 2013 than in 2009 indicating has helped to significantly reduce cervical cancer in Diseases-From Bench to Bedside-A Clinical was as high as 75.8%, whereas for the high-risk types M, Munshi S, Unnesa A. Genotyping of High-Risk related HPV types. Br J Cancer.2014;110(11), 31. Khandker E, Khan M, Chowdhury AK. Human of girls aged 9-13 years, before they become sexually immunogenicity, and safety of a bivalent HPV-16/18 herd immunity and sustained effectiveness of the the developed world. Therefore, a National HPV Perspective, 2012. 1-40, Rijeka, Croatia: InTech. DOI: 39. Roteli-Martins CM, Naud P, De Borba P, TeixeiraJC, it was 49.8%. The highest prevalence rate was Human Papillomavirus (HPV) Among Cervical 2804-2811.DOI: 10.1038/bjc.2014.198. https://doi.org/ papillomavirus infection among Bangladeshi women active. Because HPV vaccines do not protect against L1 virus-like particle AS04 vaccine against incident bivalent vaccine onvirologic outcomes at the 10.5772/27154 https://doi.org/10.5772/27154 De Carvalho NS, Zahaf T, et al. Sustained observed for the genotype 16, 18 and 58. Khandker E Vaccination Program seems to be the window of Precancer and Cancer Patients. Acta MedicaInternational. 10.1038/bjc.2014.198,PMid:24736582 with cervical intraepithelial neoplasia and chronic all HPV types that cause cervical cancer, vaccine and persistent infection with HPV 16 & 18 and their 17 immunogenicity and efficacy of the HPV-16/18 31 population level. opportunity to reduce the mortality and morbidity of 2015;2(1):19-28.DOI: 10.5530/ami.2015.1.5, https://doi.org/ PMCid:PMC4037824 24. Gómez DT and Santos JL. Human papillomavirus cervicitis. IMC J Med Sci. 2016;10(1): 29-32. et al determine HPV infection rate was 43.1%. CIN associated cytological and histological outcomes. De AS04-adjuvanted vaccine: up to 8.4 years of introduction should be part of comprehensive 10.5530/ami.2015.1.5 infection and cervical cancer: pathogenesis and https://doi.org/10.3329/imcjms.v10i1.31103, DOI: cases had significantly high (p<0.01) HPV infection 37 Scenario of HPV vaccination in Bangladesh: HPV related cervical cancer in Bangladesh. 17. Cameron RL, Kavanagh K, Pan J, Love J, Cuschieri approach to cervical cancer control. Carvalhoa N et al report efficacy and epidemiology. Communicating Current Research and follow-up. Hum Vaccin. J Immunother.2012; 8(3): 9. Michael JC, Karen C. Cervical Cancer Screening and K, Robertson C, et al. Human Papillomavirus https://doi.org/10.3329/imcjms.v10i1.31103 (78.6%) compared to cases with chronic cervicitis immunogenicity of the HPV16/18 vaccine up to 7.3 WHO has developed guidelines on prevention and References : Educational Topics and Trends in Applied 390-397.https://doi.org/10.4161/hv.18865 7 Other recommended preventive interventions for Preinvasive Disease. In: Berek JS, Hacker NF Prevalence and Herd Immunity after Introduction of https://doi.org/10.3329/imcjms.v10i1.31103 (18.2%).BanikU et al find out the extent of HR HPV years post vaccination. No cases of infection or control of cervical cancer through vaccination and 1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre Microbiology. A Mendez Vilas (ed). Spain: Formatex; PMid:22327492,DOI:10.4161/hv.18865 (editors). Berek and Hacker's Gynecologic Oncology. Vaccination Program, Scotland, 2009-2013. Emerg type 16/18 infection in women with epithelial cell boys and girls are: cytohistological lesions associated with HPV 16/18 screening. By mid-2016, globally 65 countries, LA, Jemal A. Global Cancer Statistics 2018: 2007.p. 680-688. ISBN-13-9788461194223 32. De Vuyst H, Clifford GM, Nascimento MC, https://doi.org/10.4161/hv.18865 6th edition. Philadelphia: Wolters Kluwer; 2014. p. Infect Dis.2016; 22 (1), 56-64. https://doi.org/ abnormality in Pap smear. HPV type 16/18 infection mostly in high-income and upper-middle-income GLOBOCAN Estimates of Incidence and Mortality Madeleine MM, Franceschi S. Prevalence and type PMid:22327492 • education about safe sexual practices, delayed were observed in the vaccinee. Another follow up 242-325.ISBN-13-978-1-4511-9007-6. 10.3201/eid2201.150736,PMid:26692336 25. Bosch FX, Broker TR, Forman D, Moscicki AB, was detected in 40.42% of the patients. Borna NN et 38 Worldwide for 36 Cancers in 185 Countries.CA: distribution of human papillomavirus in carcinoma start of sexual activity study (up to 4 years) of SchwarzTF et al showed settings had introduced HPV vaccines into their PMCid:PMC4696690, DOI: 10.3201/eid2201.150736 Gillison ML, Doorbar J. et al. Comprehensive Control 40. World Health Organization. Country office for 8 33 Cancer J Clin. 2018; 68:394-424.DOI: 10.3322/ 10. Jacqueline S, Cristina H, Christopher E. Beyond Our and intraepithelial neoplasia of the vulva, vagina and al identify HR HPV genotype among women having persistence of immune response to HPV-16/18 national immunization programs . But the global https://doi.org/10.3201/eid2201.150736 of Human Papillomavirus Infections and Related • promotion and provision of condoms for those caac.21492.https://doi.org/10.3322/caac.21492 Borders Cervical cancer in the developing world. anus: a meta-analysis. Int J Cancer. 2009; Bangladesh. Human papillomavirus (HPV) vaccine CIN and carcinoma. HPV 16 was detected in vaccine in women aged 15–55 years. All subjects burden of cervical cancer fallsheaviest on the PMid:26692336 PMCid:PMC4696690 Diseases. Vaccine. 2013;31(7): H1-31. https://doi.org/ already engaged in sex PMid:30207593 West J Med. 2001; 175: 231-233. DOI: 10.1136/ 124(7):1626-1636. https://doi.org/10.1002/ijc.24116 introduced in Bangladesh. News release.2016.

129 program by visual inspection with acetic acid (VIA), Programhas yet been started in Bangladesh and also the viral capsid. DNA containing approximately 8000 genes. The second is an early region (E), consisting which was considered to be a feasible method for no review has been done related to HPV Vaccination base pairs and harboring an average of 8 open reading of six ORFs: E1, E2, E4, E5, E6, and E7, which screening cervical cancer in the present so far. Hence, this review has been conducted to frames (ORFs). In a functional point of view, the encodes no structural proteins involved in viral socio-economic context. It has been estimated that explore different aspects of HPV vaccines in depth HPV genome is divided into three regions. The first is replication and oncogenesis. The third is a late (L) only 5% of the women in developing countries have which will help to recommend a National a long control region (LCR) that has regulatory region that encodes the L1 and L2 structural proteins. been screened for cervical dysplasia compared with HPVvaccination Program for prevention of cervical function of the transcription of the E6 and E7 viral about 40% to 50% of women in developed cancer among Bangladeshi women by a low-cost 10 countries. bHPV vaccine. One of the greatest medical breakthroughs in the last Review of literature century is the development of HPV vaccine against Human papillomavirus (HPV) vaccine for preventing cervical cancer by Professor Frazer and Dr Jian HPV induced malignancy is a widely studied topic Zhou.11 HPV related anogenital cancers can be for physicians. Different authors explained different prevented using a prophylactic vaccine. The two aspects of HPV, its malignant potential, its preventive prophylactic HPV vaccines, quadrivalent HPV type measures through vaccination and HPV vaccines 6/11/16/18 vaccine and bivalent HPV type 16/18 vaccine, were licensed in 2006 and 2007 under the immunogenicity, efficacy, safety etc through their names of Gardasil® and Cervarix® respectively.12 own view. Articles related to Human papillomavirus Recently nine-valent HPV type 6/11/16/18/31/33/45/52/58 (HPV) vaccine were retrieved from different vaccine with broader cancer coverage has also journals, web pages and books. From them 40 papers received the United States Food and Drug were included to prepare this manuscript. Administration (US-FDA) approval in October 2016 Role of HPV in cancers: 13 under the name of Gardasil9®. Different studies in The connection between persistent infection with USA, Australia and Scotland have begun to show a HPV and cervical cancer was first described by drop in the prevalence of HPV associated diseases Harald Zur Hausen in 1977. In 1983 & 1984 Zur Life cycle of HPV25: become persistently infected; which is the most both in vaccinated and non-vaccinated populations Hausen and his collaborators identified role of HPV indicating establishment, of herd immunity and also The viral life cycle refers mainly to high-risk important risk factor for the development of cervical 16 & 18 in cervical cancer and in the course of the provide cross- protection.14-17 Khatun S et al18 mucosotropic HPVs and is commonly extrapolated to cancer. The most common clinically significant next 12 years of research it has been recognized as a observed high immunogenicity and safety of the all HPVs. Activated cell divisionis necessary for viral manifestation of persistent genital HPV infection is carcinogen influencing its development.21 This bHPV vaccine among Bangladeshi adolescent girls at DNA access to the cell nucleus. Initial viral Cervical Intraepithelial Neoplasia (CIN). Within a finding laid the ground for the idea of a vaccine 7 months of vaccination.Sustained efficacy, replication in the basal cells requires E1 and E2 few years of infection, low-grade CIN(CIN 1) may Introduction: Human papillomavirus (HPV) is the virtually against HPV infection and cervical cancer, and in proteins. The role of E6 and E7 in the basal layer is develop, which may spontaneously resolve and the Cervical cancer is a major public health problem necessary cause of carcinoma cervix. HPVs causing immunogenicity, and safety of the bHPV vaccine 1999 it finally became clear that persistent HPV uncertain; particularly for the low-risk HPVs. infection clear. Persistent HPV infection, may worldwide. It is the 4th most frequently diagnosed not only the vast majority of cervical (99.7%), but were observed in the final analysis of a follow-up study up to 9.4 years postvaccination.19 infection is a necessary cause of invasive cervical Deregulation of E6/E7 expression is critical in progress directly to higher-grade CIN (CIN2 or cancer in women worldwide, with an estimated also a substantial proportion of other anogenital and 3 cancer. HPV infection is commonly found in the determining neoplastic grade. In high-risk HPVs, CIN3). High-grade abnormalities are at risk of 570,000 new cases in 2018. It is also the 4th leading head and neck cancers.3,4 Among all HPV-associated HPV vaccine has introduced in Bangladesh by the anogenital tract of men and women with and without E6/E7 mediates proliferation of the basal and progression to cancer. Some high-grade abnormalities cause of cancer death, with an estimated 311,000 malignancies, cervical cancer is the most important Ministry of Health and Family Planning (MoHFP), clinical lesions. The etiological role of HPV infection parabasal cells, facilitating lesion growth. HPV E6 spontaneously regress. If left, undetected and deaths in 2018. Cervical cancer is the 2nd most cause of morbidity and mortality worldwide. with support from the Global Alliance for Vaccines among women with cervical cancer is and E7 oncoproteins bind to and inactivate tumor untreated, years or decades later CIN2 or 3 can commonly diagnosed cancer and leading cause of Approximately 70% of cervical cancers worldwide and Immunizations (GAVI) for two years in Gazipur well-established, and there is growing evidence of its suppressor proteins p53 and pRb, respectively, progress to cervical cancer. The time lag between the cancer death among females in less developed are associated with two high-risk HPV types (16/18), district and if it is successful, GAVI will provide 1 central role in other anogenital cancers (anus, vulva, leading to malignant transformation of infected cells. peak of HPV infection and the peak of cancer countries. Cervical cancer is the 2nd leading cause of while other high-risk HPV types 31, 33, 35, 45, 52 support for national introduction of HPV vaccine.20 vagina, penis), head and neck cancers. HPV is also incidence generally takes place over a period of 10 to female cancer in incidence and 3rd leading cause of and 58 are responsible for approximately 20% case.5,6 There has been little success with screening program Transmission and natural history of HPV responsible for diseases e.g recurrent juvenile 20 years, making the initiating infections and female cancer deaths among Bangladeshi women HPV type 16/18 infection was detected in 40.42% of against cervical cancer, which is a major public infection26: precursor lesions of cervical cancer anappropriate with an estimated 8,068 new cases and 5,214 deaths the women in Bangladesh with cervical epithelial cell health problem in Bangladesh. Therefore, a National respiratory papillomatosis and genital warts, both HPV infection occurs at the basal epithelium during 2 22 target for screening and early detection. Some lesions in 2018. abnormality.7 HPV type 16 was detected in 81.82%, HPV Vaccination Program will reduce the mortality mainly caused by HPV 6/11. sexual intercourse. Although the incidence of become cancerous more rapidly, sometimes within 2 type 18 in 9.09% and type 45 in 6.06% cases of and morbidity of cervical cancer in Bangladesh.The Structure23 and gene functions24 of HPV: infection is high, but most infections resolve years. Infection with one type of HPV does not cervical carcinoma in Bangladesh.8 objective of the review article is to evaluate the HPV is a relatively small non-enveloped double- spontaneously. Several studies have suggested that current status of the cervical cancer prevention most women successfully clear the HPV infection, prevent infection with another type. If persons In developed countries, incidence and mortality of stranded DNA virus in the family Papillomaviridae. achieved by HPV vaccination worldwide. presumably through the action of a competent infected with mucosal HPV, 5% to 30% are infected cervical cancer has been lowered by effective It is associated with histone-like proteins and immune system. Among the infected individuals, with multiple types of the virus. population-based screening program with Pap smear Rationale of the review protected by a capsid formed by two late proteins, L1 approximately, 90% of lesions regress spontaneously HPV prevalence: and or HPV DNA testing.9 Government of National HPV vaccination programs have been and L2. Each virion contains 72 copies of the L1, the without clinical signs or symptoms within 12 to 36 There have been many studies worldwide on the Bangladesh with the support of UNFPA has taken implemented in many countries to prevent cervical major component of the capsid, and a variable months, a small proportion of infected persons proportion of cervical cancer, other anogenital initiative to develop a cervical cancer screening cancer. But no National HPV Vaccination number of copies of L2, a secondary component of

Human Papilloma Virus Vaccinefor Cervical Cancer Prevention CS Sultana et al cancers, high& low-grade squamous intraepithelial 81.82%followed by 18 in 9.09%& 45 in 6.06% cases • warnings about tobacco use • A quadrivalent vaccine (Gardasil®/Silgard®, Mechanism of vaccine related protection: were seroconverted for anti-HPV-16&18 antibodies developing countries which haven’t introduced the 2. Bruni L, Albero G, Serrano B, Mena M, Gómez D, ewjm.175.4.231. https://doi.org/10.1136/ ewjm. 18. Khatun S, HussainSMA, Chowdhury S, Ferdous J, 10.1016/j.vaccine.2013.10.003, PMid:24332295 PMid:19115209, DOI: 10.1002/ijc.24116, https://doi.org/ Muñoz J, et al. ICO/IARC Information Centre on 175.4.231, PMid:11577044 PMCid:PMC1071564 Hossain F, Begum SR, et al. Safety and , lesions (HSIL and LSIL) due to different HPV of cervical carcinoma. Among precancerous cases, • male circumcision. produced by Merck & Co)–protects against HPV Systemic immunization with L1 VLPs generates at Month 7. At Month 48 of that study, all subjects HPV vaccine as part of their national public health PMCid:PMC7605442 DOI: 10.1016/j.vaccine.2013. 10.1002/ijc.24116, PMid:19115209 HPV and Cancer (HPV Information Centre). Human Immunogenicity Profile of Human Papillomavirus- 10.003, https://doi.org/10.1016/j.vaccine.2013.10.003 genotypes as well as prevalence of HPV in general only type 16 was detected. 16 & 18, 6 & 11 that causes anogenital warts antibody concentrations higher than in a natural were still seropositive for anti-HPV-16 antibodies strategy to prevent and control cervical cancer. 11. Zhao KN, Zhang L, Qu J. Dr. Jian Zhou: The great 33. Uterine cervical neoplasms - prevention and control. b) Secondary prevention through screening and Papillomavirus and Related Diseases in Bangladesh. 16/18 AS04 Adjuvant Cervical Cancer Vaccine: A PMid:24332295 PMCid:PMC7605442 population. also. infection. The HPV vaccines are highly and all but one subject in the 46–55 years age group inventor of cervical cancer vaccine. Protein Cell.2017; Comprehensive cervical cancer control: a guide to HPVprevalence in vulvar, vaginal and anal treatment of adult sexually active women for Bivalent HPV vaccine was registered in Bangladesh Summary Report 17 June 2019. [Date Accessed] Randomized Controlled Trial in Healthy Adolescent 27 immunogenic leading to seroconversion in virtually remained seropositive (99.4%) for anti-HPV-18 8(2): 79-82. DOI: 10.1007/s13238-016-0358-2 26. Human Papillomavirus. In: Centers for Disease Bruni L et al performed a meta-analysis of cervical intraepithelial neoplasia (VIN, VAIN, AIN) grades As of December 2014, the U.S.FDA approved Girls of Bangladesh. Jpn J Clin Oncol. 2011;42(1): essential practice. 2nd ed. World Health Organization. precancerous lesions, starting from 30 years of age. 100% of vaccinees. Antibody titers in blood reach 39 in 2009 while qHPV was registered in 2014.HPV 3. Walboomers JM, Jacobs MV, Manos MM, Bosch FX, https://doi.org/10.1007/s13238-016-0358-2 Control and Prevention. Epidemiology and Prevention HPV prevalence among women with normal 1-3 and carcinoma was conducted in 4 continents. antibodies. Roteli-Martins CM et al report the 36-41. https://doi.org/10.1093/jjco/hyr173, PMid:22194637 2014. ISBN 978 92 4 154895 3 Merck’s 9- valent HPV vaccine (GARDASIL 9®) vaccine has recently been introduced in Bangladesh Kummer JA, Shah KV, et al. Human papillomavirus is PMid:28108949 PMCid:PMC5291779 c)Tertiary prevention and palliative care for women peaks 2–3 log higher than in natural infections, long-term efficacy and immunogenicity of the PMCid:PMC3244935, DOI: 10.1093/jjco/hyr173 of Vaccine-Preventable Diseases. Hamborsky J, cytological findings. The estimated global HPV Overall HPV prevalence was 67.8%, 85.3% and which includes the additional five HPV 31, 33, 45, a necessary cause of invasive cervical cancer 34. Guide to introducing HPV vaccine into national affected by invasive cervical cancer include surgery, decrease gradually to levels several-fold lower than HPV-16/18 AS04-adjuvanted vaccine up to 8.4 y by the Ministry of Health and Family Planning 12. Markowitz LE, Dunne EF, Saraiya M, Chesson HW, https://doi.org/10.1093/jjco/hyr173 Kroger A, Wolfe S, eds. 13th ed., Supplement. prevalence was 11.7%. While based on the world 40.4% among VIN1, VIN2/3& vulvar carcinomas; 52& 58 compared to the quadrivalent vaccine. worldwide. J Pathol.1999;189(1): 12-19. https://doi.org/ immunization programmes. Immunization, Vaccines radiotherapy and chemotherapy. peak and then remain stable for years. The IgG is after the first vaccine dose. No new infection or (MoHFP), with support from the Global Alliance for Curtis CR, GEE J, et al. Human Papillomavirus PMid:22194637 PMCid:PMC3244935 Washington D.C. Public Health Foundation, 2017. regions Sub-Saharan Africa (24%), Eastern Europe 100%, 90.1% and 69.9% among VAIN1, VAIN2/3& 10.1002/(SICI)1096-9896(199909)189:1<12::AID-P and Biologicals. World Health Organization. 2016; Both vaccines are composed of type-specific HPV L1 exuded at the possible sites of infection (mucosa of Vaccines and Immunizations (GAVI). This new Vaccination: Recommendations of the Advisory p.175-186. (21.4%) and Latin America (16.1%) showed the vaginal carcinomas; and 91.5%, 93.9% and 84.3% HPV vaccines34: lesions associated with HPV-16/18 occurred in the ATH431>3.0.CO;2-F, DOI: 10.1002/(SICI)1096-9896 19. Naud PS, Roteli-Martins CM, De Carvalho NS, 1-90. ISBN: 978 92 4 154976 9 protein, the major capsid protein of HPV which is genital tract, oral cavity, etc.), neutralizes the virus 19 Committee on Immunization Practices (ACIP). highest prevalence’s. among AIN1, AIN2/3& anal carcinomas, vaccine group. NaudPSet al conducted a long-term vaccine introduction program ran for two years in (199909)189:1<12: AID-PATH431>3.0.CO;2-F Teixeira JC, De Borba PC, Sanchez N, et al. Sustained 27. Bruni L, Diaz M, Castellsagué X, Ferrer E, Bosch FX, The availability of prophylactic HPV vaccines has used as an antigen. Through Recombinant DNA and prevents its entry into the cells. The MMWR Recomm Rep. 2014; 63(RR-05): 35. Human papillomavirus vaccines: Weekly epidemiological respectively. HPV16 was found>75% and 18 <10% follow-up of an initial double-blind, randomized Gazipur district and if it is successful, GAVI will efficacy, immunogenicity, and safety of the De Sanjosé S. Cervical human papillomavirus Alemany L et al28 estimated the HPV type-specific provided a powerful tool for primary prevention of technology the L1 protein undergoes conformal vaccine-induced immune memory in the form of 4. Zur Hausen H. Papillomaviruses in the causation of 1-30.PMID: 25167164 record. WHO position paper.2017;92(19):241-268. in HPV positive vulvar, vaginal and anal carcinomas. (1:1), placebo-controlled study evaluating the provide support for national introduction of HPV HPV-16/18 AS04-adjuvanted vaccine: final analysis prevalence in 5 continents: Meta-analysis of 1 million distribution in a large series of invasive cervical cervical cancer and other HPV-associated diseases. human cancers-a brief historical account. Virology. ISSN 0049-8114 changes to self-assemble into 'virus-like' particles circulating plasma cells and memory B-cells allows 40 13. Meites E, Kempe A, Markowitz LE. Use of a 2-Dose of a long-term follow-up study up to 9.4 years women with normal cytological findings. J Infect Dis. Approximately 40% ofvulvar, 60% of vaginal and The vaccines are most effective when administered to efficacy against HPV16/18 infection and associated vaccine . WHO recommends that girls are 2009; 384(2): 260-265. https://doi.org/ 10.1016/ cancer (ICC) over 70 years from 11 countries in (VLPs). The VLPs are non-infective and non- generation and exudation of protecting IgG each time Schedule for Human Papillomavirus Vaccination - post-vaccination. Hum VaccinImmunother. 2014; 2010; 202(12): 1789-1799. https://doi.org/ 80% of anal carcinoma are responsible for a person prior to exposure to HPV. Two HPV cyto-histopathological abnormalities, persistence vaccinated with HPV vaccine between the ages of j.virol.2008.11.046, PMid:19135222, DOI: 10.1016/ 36. Harper DM, Franco EL, Wheeler CM, Moscick AB, Central-South America, Asia and Europe. Among pathogenic as these are devoid of the viral DNA the body is challenged by exposure to HPV infection. Updated Recommendations of the Advisory 10(8), 2147-2162. https://doi.org/10.4161/hv.29532 10.1086/657321, PMid:21067372, DOI: 10.1086/ HPV16/18.32 ofimmunogenicity, and safety of the HPV-16/18 j.virol.2008.11.046. https://doi.org/10.1016/j.virol. Romanowski B, Roteli-Martins CM, et al. Sustained 4,771 HPV DNA positive ICC cases, HPV16&18 vaccines are currently pre-qualified by WHO: essential to initiate the carcinogenic process. Bivalent 9-13 years. In line with this, the Government of Committee on Immunization Practices. MMWR Morb PMid:25424918 PMCid:PMC4896780, DOI: 657321, https://doi.org/10.1086/657321, PMid:21067372 Animal models suggest that very low antibody titers 2008.11.046, PMid:19135222 efficacy up to 4.5 years of a bivalent L1 virus-like AS04-adjuvanted vaccine. No new HPV 16/18- Bangladesh has decided to vaccinate 10-year-old Mortal Wkly Rep. 2016; 65(49):1405-1408. were the two most common HPVs in all the decades Co-factors associated with cervical cancer: • A bivalent vaccine (Cervarix®, produced by vaccinecontains a novel adjuvant AS04 and may still be protective. Partial cross-protection 10.4161/hv.29532, https://doi.org/10.4161/hv.29532 28. Alemany L, De Sanjosé S, Tous S, Quint W, Vallejos particle vaccine against human papillomavirus types 5 associated infections and cyto-histopathological girls in the primary school setting (Grade 5) with two 5. Mu˜noz N, Castellsagu' E X, De González AB, https://doi.org/10.15585/mmwr.mm6549a5 (HPV16-from 61.5 to 62.1%, and HPV18-from 6.9 to Muñoz N et al stated that although HPV is a GlaxoSmithKline)–protects against HPV 16 & quadrivalent vaccine VLPs are adsorbed on an against HPV31, HPV33 and HPV45 has been PMid:25424918 PMCid:PMC4896780 C, Shin HR.et al. Time trends of human 16 and 18: follow-up from a randomized control trial. 25 abnormalities occurred in the vaccine group. Gissmann L, Chapter 1: HPV in the etiology of human PMid:27977643, DOI: http://dx.doi.org/10.15585/ 7.2%). A meta-analysis update conducted by SmithJS necessary cause of cervical cancer, it is not a 18 that cause the majority of cervical cancers; aluminum-containing adjuvant to ensure robust and described. doses of bHPVvaccine, given 6 months apart. The 20. WORLD HEALTH ORGANIZATION. Country papillomavirus types in invasive cervical cancer, from Lancet.2006; 367(9518):1247-1255. https://doi.org/ 6 18 cancer. Vaccine. 2006; 24 (3): S1-S10. https://doi.org/ mmwr.mm6549a5external icon et al showed HPV type distribution in ICCand HSIL. sufficient cause. Epidemiologic studies indicate that long-lasting immunogenicity.12 Khatun S et al conducted a study to assess the target girls will mainly be reached through the office for Bangladesh. Human papillomavirus (HPV) 1940 to 2007.2014. Int J Cancer. 2014; 135(1):88-95. 10.1016/S0140-6736(06)68439-0, DOI: 10.1016/ and Recommended vaccination schedule: 10.1016/j.vaccine.2006.05.115, PMid:16949995, In ICC, HPV16 was the most common, and HPV18 the risk of contracting genital HPV infection and immunogenicity and safety profile of HPV16/18 14. Markowitz LE, Hariri S, Lin C, Dunne EF, Steinau M, vaccine introduced in Bangladesh.18 May 2016. https://doi.org/10.1002/ijc.28636, PMid:24382655, S0140-6736(06)68439-0, https://doi.org/10.1016/ The primary target group in most of the countries schoolbasedprogramme and girls who are out of DOI: 10.1016/ j.vaccine.2006.05.115, https://doi.org/ the second most common, type in all continents. The cervical cancer is influenced by a variety of factors. vaccines in healthy Bangladeshi girls aged between McquillanG, et al. Reduction in human News release DOI: 10.1002/ijc.28636, https://doi.org/10.1002/ S0140-6736(06)68439-0 recommending HPV vaccination is young adolescent school will receive the vaccine through the routine 10.1016/j.vaccine.2006.05.115, PMid:16949995 papillomavirus (HPV) prevalence among young next most common HPV types were HPV31, 33, 35, Thus, other cofactors are necessary for progression 9–13 years. They recommended that, bHPV vaccine EPI sites at the community level. 21. Morshed K, Polz-Gruszka D, Szymański M, ijc.28636, PMid:24382655 girls, aged 9-14.WHO has recommended the 6. Smith JS, Lindsay L, Hoots B, Keys J, Franceschi S, women following HPV vaccine introduction in the 37. De Carvalho N, Teixeira J, Roteli-Martins CM, Naud 45, 52 and 58. HPV18 was significantly more from cervical HPV infection to cancer. Long-term 35 was generally well tolerated, with no vaccine-related Polz-Dacewicz M. Human Papillomavirus (HPV) - following vaccination schedule . Winer R, et al. Human papillomavirus type United States, National Health and Nutrition 29. Nahar Q, Sultana F, Alam A, Islam JY, Rahman M, P, De Borba P, Zahaf T, et al. Sustained efficacy and prevalent in adeno/adenosquamous carcinoma than use of hormonal contraceptives, high parity, tobacco serious adverse effects. Conclusion: Structure, epidemiology and pathogenesis. Otolaryngol distribution in invasive cervical cancer and high-grade Examination Surveys, 2003-2010. J Infect Khatun F. et al. Genital human papillomavirus immunogenicity of the HPV-16/18 AS04-adjuvanted in squamous cell carcinoma. Among HSIL cases, smoking, and co-infection with HIV have been • Females <15 years at the time of first dose: a Immunization with the HPV vaccine induces Pol. 2014;68(5):213-219. https://doi.org/10.1016/ HPV prevalence, cross-protection and herd cervical lesions: A meta-analysis update. Int. J. Dis.2013;208(3):385-393. https://doi.org/10.1093/ infection among women in Bangladesh: findings from vaccine up to 7.3 years in young adult women. HPV16/18prevalence was 52%. WalboomersJM et identified as established cofactors; co-infection with sustained high levels of antibodies against high-risk j.otpol.2014.06.001, PMid:25283316, DOI: 10.1016/ 2-dose schedule (0, 6 months) is recommended. Cancer. 2007; 121(3): 621-632. https://doi.org/ infdis/jit192, PMid:23785124, DOI:10.1093/infdis/jit192. a Population-based survey. PLoS One. 2014; 9(10): Vaccine.2010; 28(38):6247-6255. https://doi.org/10.1016/ 3 immunity after vaccination: j.otpol.2014.06.001, https://doi.org/10.1016/j.otpol. al found that the worldwide HPV prevalence in Chlamydia trachomatis (CT) and herpes simplex HPV genotypes 16 and 18. The durable immune 10.1002/ijc.22527, PMid:17405118, DOI: 10.1002/ e107675. https://doi.org/10.1371/journal.pone.0107675 j.vaccine.2010.07.007, PMid:20643092, DOI: If the interval between doses is shorter than 5 months, A national HPV immunization program using a 15. Tabrizi SN, Brotherton JM, Kaldor JM, Skinner SR, 2014.06.001, PMid:25283316 cervical carcinomas is 99.7%. virus type-2 (HSV-2), immunosuppression, and response induced by the HPV vaccine in adolescent ijc.22527.https://doi.org/10.1002/ijc.22527 PMid:25271836 PMCid:PMC4182674, DOI: 10.1016/j.vaccine.2010.07.007, https://doi.org/ then a third dose should be given at least 6 months bHPV vaccine was implemented in Scotland in 2008, Liu B, Bateson D,et al. Assessment of herd immunity certain dietary deficiencies are other probable girls is predicted to provide long-term protection PMid:17405118 22. Bruni L, Albero G, Serrano B, Mena M, Gómez D, 10.1371/journal.pone.0107675, https://doi.org/10.1371/ 10.1016/j.vaccine.2010.07.007, PMid:20643092 Bangladesh had also different studies that focused on after the first dose. along with a national surveillance program designed and cross-protection after a human papillomavirus cofactors. against HPV infection and subsequent development Muñoz J, Bosch FX, de Sanjosé S. ICO/IARC journal.pone.0107675, PMid:25271836, PMCid:PMC4182674 HPV genotyping in different groups of females. to determine the longitudinal effects of vaccination 7. Banik U, Ahamad MSU, Bhattacharjee P, Adhikary vaccination programme in Australia: a repeat 38. Schwarz TF,Spaczynski M, Schneider A, Wysocki J, 29 • Information Centre on HPV and Cancer (HPV Nahar Q et al revealed prevalence of HPV infection Strategies for cervical cancer prevention and Females ≥15 years at the time of first dose & of high-grade cervical lesions and cancer. The AK, Rahman Z. cross-sectional study. Lancet Infect Dis.2014; 30. Sultana T, Huq M, Alam A, Mitra DK, Gomes DJ. Galaj A, Schulze K, et al. Persistence of immune on HPV infection at the population level. By linking Information Centre). Human Papillomavirus and was 7.7% with no significant difference between control33: immunocompromised and/or HIV-infected.: a 14(10):958-966.DOI: 10.1016/S1473-3099(14) 70841-2, Prevalence and genotyping of human papillomavirus vaccination, cervical screening, and HPV testing knowledge gained from this review is important for 8. High risk human papillomavirus type 16 and 18 Related Diseases in the World. Summary Report 17 response to HPV-16/18 AS04-adjuvanted cervical 3-dose schedule (0, 1-2, 6 months) is https://doi.org/10.1016/S1473-3099(14)70841-2 (HPV) in female with high-risk behaviour in Dhaka, urban and rural women. HR-HPV (High risk) WHO recommends a comprehensive approach to realizing the necessity of the use of a prophylactic infection in the cervical lesions of women with cancer vaccine in women aged 15-55 years. Hum recommended. data, over the study period they found a decline in June 2019. [Date Accessed] Bangladesh. Bangladesh J Microbiol. 2008; infections were more common (4.2%) than LR-HPV cervical cancer prevention and control. The HPV16/18 vaccine in Bangladeshi girls. There has epithelial cell abnormality in Pap smear: A 16. Kavanagh K, Pollock KG, Potts A, Love J, Cuschieri Vaccin.2011; 7(9): 958-965. https://doi.org/10.4161/ HPV 16 &18,significant decreases in HPV 31, 33& 23. FernandezJV and De Medeiros Fernandez TAA. 25(1):65-68. https://doi.org/10.3329/bjm.v25i1.4861, infections (3.4%). Most common HR genotypes were recommended set of actions includes following Evaluation of efficacy, immunogenicity and safety cytohistomorphologic association in Bangladeshi K, Cubie H, et al. Introduction and sustained high hv.7.9.15999, PMid:21892005 PMCid:PMC3225769, 45 (suggesting cross-protection). Among non- been little success with screening program against Chapter 1 Human Papillomavirus: Biology and DOI:https://doi.org/10.3329/bjm.v25i1.4861, HPV16,66,18,45,31&53. Sultana T et al30 noted the interventions. women. Cytojournal. 2013; 10: 14. DOI: 10.4103/ coverage of the HPV bivalent vaccine leads to DOI: 10.4161/hv.7.9.15999, https://doi.org/10.4161/ of HPV vaccine: vaccinated women, HPV 16 & 18 infections were cervical cancer in Bangladesh, an intervention that Pathogenesis. Human Papillomavirus and Related https://doi.org/10.3329/bjm.v25i1.4861 prevalence of genital HPV types in the sex workers 36 1742-6413.1150888. Borna NN, Tabassum S, Jahan areduction in prevalence of HPV 16/18 and closely hv.7.9.15999, PMid:21892005 PMCid:PMC3225769 a) Primary prevention begins with HPV vaccination HarperDM et al assessed the long-term efficacy, significantly lower in 2013 than in 2009 indicating has helped to significantly reduce cervical cancer in Diseases-From Bench to Bedside-A Clinical was as high as 75.8%, whereas for the high-risk types M, Munshi S, Unnesa A. Genotyping of High-Risk related HPV types. Br J Cancer.2014;110(11), 31. Khandker E, Khan M, Chowdhury AK. Human of girls aged 9-13 years, before they become sexually immunogenicity, and safety of a bivalent HPV-16/18 herd immunity and sustained effectiveness of the the developed world. Therefore, a National HPV Perspective, 2012. 1-40, Rijeka, Croatia: InTech. DOI: 39. Roteli-Martins CM, Naud P, De Borba P, TeixeiraJC, it was 49.8%. The highest prevalence rate was Human Papillomavirus (HPV) Among Cervical 2804-2811.DOI: 10.1038/bjc.2014.198. https://doi.org/ papillomavirus infection among Bangladeshi women active. Because HPV vaccines do not protect against L1 virus-like particle AS04 vaccine against incident bivalent vaccine onvirologic outcomes at the 10.5772/27154 https://doi.org/10.5772/27154 De Carvalho NS, Zahaf T, et al. Sustained observed for the genotype 16, 18 and 58. Khandker E Vaccination Program seems to be the window of Precancer and Cancer Patients. Acta MedicaInternational. 10.1038/bjc.2014.198,PMid:24736582 with cervical intraepithelial neoplasia and chronic all HPV types that cause cervical cancer, vaccine and persistent infection with HPV 16 & 18 and their 17 immunogenicity and efficacy of the HPV-16/18 31 population level. opportunity to reduce the mortality and morbidity of 2015;2(1):19-28.DOI: 10.5530/ami.2015.1.5, https://doi.org/ PMCid:PMC4037824 24. Gómez DT and Santos JL. Human papillomavirus cervicitis. IMC J Med Sci. 2016;10(1): 29-32. et al determine HPV infection rate was 43.1%. CIN associated cytological and histological outcomes. De AS04-adjuvanted vaccine: up to 8.4 years of introduction should be part of comprehensive 10.5530/ami.2015.1.5 infection and cervical cancer: pathogenesis and https://doi.org/10.3329/imcjms.v10i1.31103, DOI: cases had significantly high (p<0.01) HPV infection 37 Scenario of HPV vaccination in Bangladesh: HPV related cervical cancer in Bangladesh. 17. Cameron RL, Kavanagh K, Pan J, Love J, Cuschieri approach to cervical cancer control. Carvalhoa N et al report efficacy and epidemiology. Communicating Current Research and follow-up. Hum Vaccin. J Immunother.2012; 8(3): 9. Michael JC, Karen C. Cervical Cancer Screening and K, Robertson C, et al. Human Papillomavirus https://doi.org/10.3329/imcjms.v10i1.31103 (78.6%) compared to cases with chronic cervicitis immunogenicity of the HPV16/18 vaccine up to 7.3 WHO has developed guidelines on prevention and References : Educational Topics and Trends in Applied 390-397.https://doi.org/10.4161/hv.18865 7 Other recommended preventive interventions for Preinvasive Disease. In: Berek JS, Hacker NF Prevalence and Herd Immunity after Introduction of https://doi.org/10.3329/imcjms.v10i1.31103 (18.2%).BanikU et al find out the extent of HR HPV years post vaccination. No cases of infection or control of cervical cancer through vaccination and 1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre Microbiology. A Mendez Vilas (ed). Spain: Formatex; PMid:22327492,DOI:10.4161/hv.18865 (editors). Berek and Hacker's Gynecologic Oncology. Vaccination Program, Scotland, 2009-2013. Emerg type 16/18 infection in women with epithelial cell boys and girls are: cytohistological lesions associated with HPV 16/18 screening. By mid-2016, globally 65 countries, LA, Jemal A. Global Cancer Statistics 2018: 2007.p. 680-688. ISBN-13-9788461194223 32. De Vuyst H, Clifford GM, Nascimento MC, https://doi.org/10.4161/hv.18865 6th edition. Philadelphia: Wolters Kluwer; 2014. p. Infect Dis.2016; 22 (1), 56-64. https://doi.org/ abnormality in Pap smear. HPV type 16/18 infection mostly in high-income and upper-middle-income GLOBOCAN Estimates of Incidence and Mortality Madeleine MM, Franceschi S. Prevalence and type PMid:22327492 • education about safe sexual practices, delayed were observed in the vaccinee. Another follow up 242-325.ISBN-13-978-1-4511-9007-6. 10.3201/eid2201.150736,PMid:26692336 25. Bosch FX, Broker TR, Forman D, Moscicki AB, was detected in 40.42% of the patients. Borna NN et 38 Worldwide for 36 Cancers in 185 Countries.CA: distribution of human papillomavirus in carcinoma start of sexual activity study (up to 4 years) of SchwarzTF et al showed settings had introduced HPV vaccines into their PMCid:PMC4696690, DOI: 10.3201/eid2201.150736 Gillison ML, Doorbar J. et al. Comprehensive Control 40. World Health Organization. Country office for 8 33 Cancer J Clin. 2018; 68:394-424.DOI: 10.3322/ 10. Jacqueline S, Cristina H, Christopher E. Beyond Our and intraepithelial neoplasia of the vulva, vagina and al identify HR HPV genotype among women having persistence of immune response to HPV-16/18 national immunization programs . But the global https://doi.org/10.3201/eid2201.150736 of Human Papillomavirus Infections and Related • promotion and provision of condoms for those caac.21492.https://doi.org/10.3322/caac.21492 Borders Cervical cancer in the developing world. anus: a meta-analysis. Int J Cancer. 2009; Bangladesh. Human papillomavirus (HPV) vaccine CIN and carcinoma. HPV 16 was detected in vaccine in women aged 15–55 years. All subjects burden of cervical cancer fallsheaviest on the PMid:26692336 PMCid:PMC4696690 Diseases. Vaccine. 2013;31(7): H1-31. https://doi.org/ already engaged in sex PMid:30207593 West J Med. 2001; 175: 231-233. DOI: 10.1136/ 124(7):1626-1636. https://doi.org/10.1002/ijc.24116 introduced in Bangladesh. News release.2016.

130 program by visual inspection with acetic acid (VIA), Programhas yet been started in Bangladesh and also the viral capsid. DNA containing approximately 8000 genes. The second is an early region (E), consisting which was considered to be a feasible method for no review has been done related to HPV Vaccination base pairs and harboring an average of 8 open reading of six ORFs: E1, E2, E4, E5, E6, and E7, which screening cervical cancer in the present so far. Hence, this review has been conducted to frames (ORFs). In a functional point of view, the encodes no structural proteins involved in viral socio-economic context. It has been estimated that explore different aspects of HPV vaccines in depth HPV genome is divided into three regions. The first is replication and oncogenesis. The third is a late (L) only 5% of the women in developing countries have which will help to recommend a National a long control region (LCR) that has regulatory region that encodes the L1 and L2 structural proteins. been screened for cervical dysplasia compared with HPVvaccination Program for prevention of cervical function of the transcription of the E6 and E7 viral about 40% to 50% of women in developed cancer among Bangladeshi women by a low-cost 10 countries. bHPV vaccine. One of the greatest medical breakthroughs in the last Review of literature century is the development of HPV vaccine against Human papillomavirus (HPV) vaccine for preventing cervical cancer by Professor Frazer and Dr Jian HPV induced malignancy is a widely studied topic Zhou.11 HPV related anogenital cancers can be for physicians. Different authors explained different prevented using a prophylactic vaccine. The two aspects of HPV, its malignant potential, its preventive prophylactic HPV vaccines, quadrivalent HPV type measures through vaccination and HPV vaccines 6/11/16/18 vaccine and bivalent HPV type 16/18 vaccine, were licensed in 2006 and 2007 under the immunogenicity, efficacy, safety etc through their names of Gardasil® and Cervarix® respectively.12 own view. Articles related to Human papillomavirus Recently nine-valent HPV type 6/11/16/18/31/33/45/52/58 (HPV) vaccine were retrieved from different vaccine with broader cancer coverage has also journals, web pages and books. From them 40 papers received the United States Food and Drug were included to prepare this manuscript. Administration (US-FDA) approval in October 2016 Role of HPV in cancers: 13 under the name of Gardasil9®. Different studies in The connection between persistent infection with USA, Australia and Scotland have begun to show a HPV and cervical cancer was first described by drop in the prevalence of HPV associated diseases Harald Zur Hausen in 1977. In 1983 & 1984 Zur Life cycle of HPV25: become persistently infected; which is the most both in vaccinated and non-vaccinated populations Hausen and his collaborators identified role of HPV indicating establishment, of herd immunity and also The viral life cycle refers mainly to high-risk important risk factor for the development of cervical 16 & 18 in cervical cancer and in the course of the provide cross- protection.14-17 Khatun S et al18 mucosotropic HPVs and is commonly extrapolated to cancer. The most common clinically significant next 12 years of research it has been recognized as a observed high immunogenicity and safety of the all HPVs. Activated cell divisionis necessary for viral manifestation of persistent genital HPV infection is carcinogen influencing its development.21 This bHPV vaccine among Bangladeshi adolescent girls at DNA access to the cell nucleus. Initial viral Cervical Intraepithelial Neoplasia (CIN). Within a finding laid the ground for the idea of a vaccine 7 months of vaccination.Sustained efficacy, replication in the basal cells requires E1 and E2 few years of infection, low-grade CIN(CIN 1) may Introduction: Human papillomavirus (HPV) is the virtually against HPV infection and cervical cancer, and in proteins. The role of E6 and E7 in the basal layer is develop, which may spontaneously resolve and the Cervical cancer is a major public health problem necessary cause of carcinoma cervix. HPVs causing immunogenicity, and safety of the bHPV vaccine 1999 it finally became clear that persistent HPV uncertain; particularly for the low-risk HPVs. infection clear. Persistent HPV infection, may worldwide. It is the 4th most frequently diagnosed not only the vast majority of cervical (99.7%), but were observed in the final analysis of a follow-up study up to 9.4 years postvaccination.19 infection is a necessary cause of invasive cervical Deregulation of E6/E7 expression is critical in progress directly to higher-grade CIN (CIN2 or cancer in women worldwide, with an estimated also a substantial proportion of other anogenital and 3 cancer. HPV infection is commonly found in the determining neoplastic grade. In high-risk HPVs, CIN3). High-grade abnormalities are at risk of 570,000 new cases in 2018. It is also the 4th leading head and neck cancers.3,4 Among all HPV-associated HPV vaccine has introduced in Bangladesh by the anogenital tract of men and women with and without E6/E7 mediates proliferation of the basal and progression to cancer. Some high-grade abnormalities cause of cancer death, with an estimated 311,000 malignancies, cervical cancer is the most important Ministry of Health and Family Planning (MoHFP), clinical lesions. The etiological role of HPV infection parabasal cells, facilitating lesion growth. HPV E6 spontaneously regress. If left, undetected and deaths in 2018. Cervical cancer is the 2nd most cause of morbidity and mortality worldwide. with support from the Global Alliance for Vaccines among women with cervical cancer is and E7 oncoproteins bind to and inactivate tumor untreated, years or decades later CIN2 or 3 can commonly diagnosed cancer and leading cause of Approximately 70% of cervical cancers worldwide and Immunizations (GAVI) for two years in Gazipur well-established, and there is growing evidence of its suppressor proteins p53 and pRb, respectively, progress to cervical cancer. The time lag between the cancer death among females in less developed are associated with two high-risk HPV types (16/18), district and if it is successful, GAVI will provide 1 central role in other anogenital cancers (anus, vulva, leading to malignant transformation of infected cells. peak of HPV infection and the peak of cancer countries. Cervical cancer is the 2nd leading cause of while other high-risk HPV types 31, 33, 35, 45, 52 support for national introduction of HPV vaccine.20 vagina, penis), head and neck cancers. HPV is also incidence generally takes place over a period of 10 to female cancer in incidence and 3rd leading cause of and 58 are responsible for approximately 20% case.5,6 There has been little success with screening program Transmission and natural history of HPV responsible for diseases e.g recurrent juvenile 20 years, making the initiating infections and female cancer deaths among Bangladeshi women HPV type 16/18 infection was detected in 40.42% of against cervical cancer, which is a major public infection26: precursor lesions of cervical cancer anappropriate with an estimated 8,068 new cases and 5,214 deaths the women in Bangladesh with cervical epithelial cell health problem in Bangladesh. Therefore, a National respiratory papillomatosis and genital warts, both HPV infection occurs at the basal epithelium during 2 22 target for screening and early detection. Some lesions in 2018. abnormality.7 HPV type 16 was detected in 81.82%, HPV Vaccination Program will reduce the mortality mainly caused by HPV 6/11. sexual intercourse. Although the incidence of become cancerous more rapidly, sometimes within 2 type 18 in 9.09% and type 45 in 6.06% cases of and morbidity of cervical cancer in Bangladesh.The Structure23 and gene functions24 of HPV: infection is high, but most infections resolve years. Infection with one type of HPV does not cervical carcinoma in Bangladesh.8 objective of the review article is to evaluate the HPV is a relatively small non-enveloped double- spontaneously. Several studies have suggested that current status of the cervical cancer prevention most women successfully clear the HPV infection, prevent infection with another type. If persons In developed countries, incidence and mortality of stranded DNA virus in the family Papillomaviridae. achieved by HPV vaccination worldwide. presumably through the action of a competent infected with mucosal HPV, 5% to 30% are infected cervical cancer has been lowered by effective It is associated with histone-like proteins and immune system. Among the infected individuals, with multiple types of the virus. population-based screening program with Pap smear Rationale of the review protected by a capsid formed by two late proteins, L1 approximately, 90% of lesions regress spontaneously HPV prevalence: and or HPV DNA testing.9 Government of National HPV vaccination programs have been and L2. Each virion contains 72 copies of the L1, the without clinical signs or symptoms within 12 to 36 There have been many studies worldwide on the Bangladesh with the support of UNFPA has taken implemented in many countries to prevent cervical major component of the capsid, and a variable months, a small proportion of infected persons proportion of cervical cancer, other anogenital initiative to develop a cervical cancer screening cancer. But no National HPV Vaccination number of copies of L2, a secondary component of

Journal of Bangladesh College of Physicians and Surgeons Vol. 39, No. 2, April 2021 cancers, high& low-grade squamous intraepithelial 81.82%followed by 18 in 9.09%& 45 in 6.06% cases • warnings about tobacco use • A quadrivalent vaccine (Gardasil®/Silgard®, Mechanism of vaccine related protection: were seroconverted for anti-HPV-16&18 antibodies developing countries which haven’t introduced the 2. Bruni L, Albero G, Serrano B, Mena M, Gómez D, ewjm.175.4.231. https://doi.org/10.1136/ ewjm. 18. Khatun S, HussainSMA, Chowdhury S, Ferdous J, 10.1016/j.vaccine.2013.10.003, PMid:24332295 PMid:19115209, DOI: 10.1002/ijc.24116, https://doi.org/ Muñoz J, et al. ICO/IARC Information Centre on 175.4.231, PMid:11577044 PMCid:PMC1071564 Hossain F, Begum SR, et al. Safety and , lesions (HSIL and LSIL) due to different HPV of cervical carcinoma. Among precancerous cases, • male circumcision. produced by Merck & Co)–protects against HPV Systemic immunization with L1 VLPs generates at Month 7. At Month 48 of that study, all subjects HPV vaccine as part of their national public health PMCid:PMC7605442 DOI: 10.1016/j.vaccine.2013. 10.1002/ijc.24116, PMid:19115209 HPV and Cancer (HPV Information Centre). Human Immunogenicity Profile of Human Papillomavirus- 10.003, https://doi.org/10.1016/j.vaccine.2013.10.003 genotypes as well as prevalence of HPV in general only type 16 was detected. 16 & 18, 6 & 11 that causes anogenital warts antibody concentrations higher than in a natural were still seropositive for anti-HPV-16 antibodies strategy to prevent and control cervical cancer. 11. Zhao KN, Zhang L, Qu J. Dr. Jian Zhou: The great 33. Uterine cervical neoplasms - prevention and control. b) Secondary prevention through screening and Papillomavirus and Related Diseases in Bangladesh. 16/18 AS04 Adjuvant Cervical Cancer Vaccine: A PMid:24332295 PMCid:PMC7605442 population. also. infection. The HPV vaccines are highly and all but one subject in the 46–55 years age group inventor of cervical cancer vaccine. Protein Cell.2017; Comprehensive cervical cancer control: a guide to HPVprevalence in vulvar, vaginal and anal treatment of adult sexually active women for Bivalent HPV vaccine was registered in Bangladesh Summary Report 17 June 2019. [Date Accessed] Randomized Controlled Trial in Healthy Adolescent 27 immunogenic leading to seroconversion in virtually remained seropositive (99.4%) for anti-HPV-18 8(2): 79-82. DOI: 10.1007/s13238-016-0358-2 26. Human Papillomavirus. In: Centers for Disease Bruni L et al performed a meta-analysis of cervical intraepithelial neoplasia (VIN, VAIN, AIN) grades As of December 2014, the U.S.FDA approved Girls of Bangladesh. Jpn J Clin Oncol. 2011;42(1): essential practice. 2nd ed. World Health Organization. precancerous lesions, starting from 30 years of age. 100% of vaccinees. Antibody titers in blood reach 39 in 2009 while qHPV was registered in 2014.HPV 3. Walboomers JM, Jacobs MV, Manos MM, Bosch FX, https://doi.org/10.1007/s13238-016-0358-2 Control and Prevention. Epidemiology and Prevention HPV prevalence among women with normal 1-3 and carcinoma was conducted in 4 continents. antibodies. Roteli-Martins CM et al report the 36-41. https://doi.org/10.1093/jjco/hyr173, PMid:22194637 2014. ISBN 978 92 4 154895 3 Merck’s 9- valent HPV vaccine (GARDASIL 9®) vaccine has recently been introduced in Bangladesh Kummer JA, Shah KV, et al. Human papillomavirus is PMid:28108949 PMCid:PMC5291779 c)Tertiary prevention and palliative care for women peaks 2–3 log higher than in natural infections, long-term efficacy and immunogenicity of the PMCid:PMC3244935, DOI: 10.1093/jjco/hyr173 of Vaccine-Preventable Diseases. Hamborsky J, cytological findings. The estimated global HPV Overall HPV prevalence was 67.8%, 85.3% and which includes the additional five HPV 31, 33, 45, a necessary cause of invasive cervical cancer 34. Guide to introducing HPV vaccine into national affected by invasive cervical cancer include surgery, decrease gradually to levels several-fold lower than HPV-16/18 AS04-adjuvanted vaccine up to 8.4 y by the Ministry of Health and Family Planning 12. Markowitz LE, Dunne EF, Saraiya M, Chesson HW, https://doi.org/10.1093/jjco/hyr173 Kroger A, Wolfe S, eds. 13th ed., Supplement. prevalence was 11.7%. While based on the world 40.4% among VIN1, VIN2/3& vulvar carcinomas; 52& 58 compared to the quadrivalent vaccine. worldwide. J Pathol.1999;189(1): 12-19. https://doi.org/ immunization programmes. Immunization, Vaccines radiotherapy and chemotherapy. peak and then remain stable for years. The IgG is after the first vaccine dose. No new infection or (MoHFP), with support from the Global Alliance for Curtis CR, GEE J, et al. Human Papillomavirus PMid:22194637 PMCid:PMC3244935 Washington D.C. Public Health Foundation, 2017. regions Sub-Saharan Africa (24%), Eastern Europe 100%, 90.1% and 69.9% among VAIN1, VAIN2/3& 10.1002/(SICI)1096-9896(199909)189:1<12::AID-P and Biologicals. World Health Organization. 2016; Both vaccines are composed of type-specific HPV L1 exuded at the possible sites of infection (mucosa of Vaccines and Immunizations (GAVI). This new Vaccination: Recommendations of the Advisory p.175-186. (21.4%) and Latin America (16.1%) showed the vaginal carcinomas; and 91.5%, 93.9% and 84.3% HPV vaccines34: lesions associated with HPV-16/18 occurred in the ATH431>3.0.CO;2-F, DOI: 10.1002/(SICI)1096-9896 19. Naud PS, Roteli-Martins CM, De Carvalho NS, 1-90. ISBN: 978 92 4 154976 9 protein, the major capsid protein of HPV which is genital tract, oral cavity, etc.), neutralizes the virus 19 Committee on Immunization Practices (ACIP). highest prevalence’s. among AIN1, AIN2/3& anal carcinomas, vaccine group. NaudPSet al conducted a long-term vaccine introduction program ran for two years in (199909)189:1<12: AID-PATH431>3.0.CO;2-F Teixeira JC, De Borba PC, Sanchez N, et al. Sustained 27. Bruni L, Diaz M, Castellsagué X, Ferrer E, Bosch FX, The availability of prophylactic HPV vaccines has used as an antigen. Through Recombinant DNA and prevents its entry into the cells. The MMWR Recomm Rep. 2014; 63(RR-05): 35. Human papillomavirus vaccines: Weekly epidemiological respectively. HPV16 was found>75% and 18 <10% follow-up of an initial double-blind, randomized Gazipur district and if it is successful, GAVI will efficacy, immunogenicity, and safety of the De Sanjosé S. Cervical human papillomavirus Alemany L et al28 estimated the HPV type-specific provided a powerful tool for primary prevention of technology the L1 protein undergoes conformal vaccine-induced immune memory in the form of 4. Zur Hausen H. Papillomaviruses in the causation of 1-30.PMID: 25167164 record. WHO position paper.2017;92(19):241-268. in HPV positive vulvar, vaginal and anal carcinomas. (1:1), placebo-controlled study evaluating the provide support for national introduction of HPV HPV-16/18 AS04-adjuvanted vaccine: final analysis prevalence in 5 continents: Meta-analysis of 1 million distribution in a large series of invasive cervical cervical cancer and other HPV-associated diseases. human cancers-a brief historical account. Virology. ISSN 0049-8114 changes to self-assemble into 'virus-like' particles circulating plasma cells and memory B-cells allows 40 13. Meites E, Kempe A, Markowitz LE. Use of a 2-Dose of a long-term follow-up study up to 9.4 years women with normal cytological findings. J Infect Dis. Approximately 40% ofvulvar, 60% of vaginal and The vaccines are most effective when administered to efficacy against HPV16/18 infection and associated vaccine . WHO recommends that girls are 2009; 384(2): 260-265. https://doi.org/ 10.1016/ cancer (ICC) over 70 years from 11 countries in (VLPs). The VLPs are non-infective and non- generation and exudation of protecting IgG each time Schedule for Human Papillomavirus Vaccination - post-vaccination. Hum VaccinImmunother. 2014; 2010; 202(12): 1789-1799. https://doi.org/ 80% of anal carcinoma are responsible for a person prior to exposure to HPV. Two HPV cyto-histopathological abnormalities, persistence vaccinated with HPV vaccine between the ages of j.virol.2008.11.046, PMid:19135222, DOI: 10.1016/ 36. Harper DM, Franco EL, Wheeler CM, Moscick AB, Central-South America, Asia and Europe. Among pathogenic as these are devoid of the viral DNA the body is challenged by exposure to HPV infection. Updated Recommendations of the Advisory 10(8), 2147-2162. https://doi.org/10.4161/hv.29532 10.1086/657321, PMid:21067372, DOI: 10.1086/ HPV16/18.32 ofimmunogenicity, and safety of the HPV-16/18 j.virol.2008.11.046. https://doi.org/10.1016/j.virol. Romanowski B, Roteli-Martins CM, et al. Sustained 4,771 HPV DNA positive ICC cases, HPV16&18 vaccines are currently pre-qualified by WHO: essential to initiate the carcinogenic process. Bivalent 9-13 years. In line with this, the Government of Committee on Immunization Practices. MMWR Morb PMid:25424918 PMCid:PMC4896780, DOI: 657321, https://doi.org/10.1086/657321, PMid:21067372 Animal models suggest that very low antibody titers 2008.11.046, PMid:19135222 efficacy up to 4.5 years of a bivalent L1 virus-like AS04-adjuvanted vaccine. No new HPV 16/18- Bangladesh has decided to vaccinate 10-year-old Mortal Wkly Rep. 2016; 65(49):1405-1408. were the two most common HPVs in all the decades Co-factors associated with cervical cancer: • A bivalent vaccine (Cervarix®, produced by vaccinecontains a novel adjuvant AS04 and may still be protective. Partial cross-protection 10.4161/hv.29532, https://doi.org/10.4161/hv.29532 28. Alemany L, De Sanjosé S, Tous S, Quint W, Vallejos particle vaccine against human papillomavirus types 5 associated infections and cyto-histopathological girls in the primary school setting (Grade 5) with two 5. Mu˜noz N, Castellsagu' E X, De González AB, https://doi.org/10.15585/mmwr.mm6549a5 (HPV16-from 61.5 to 62.1%, and HPV18-from 6.9 to Muñoz N et al stated that although HPV is a GlaxoSmithKline)–protects against HPV 16 & quadrivalent vaccine VLPs are adsorbed on an against HPV31, HPV33 and HPV45 has been PMid:25424918 PMCid:PMC4896780 C, Shin HR.et al. Time trends of human 16 and 18: follow-up from a randomized control trial. 25 abnormalities occurred in the vaccine group. Gissmann L, Chapter 1: HPV in the etiology of human PMid:27977643, DOI: http://dx.doi.org/10.15585/ 7.2%). A meta-analysis update conducted by SmithJS necessary cause of cervical cancer, it is not a 18 that cause the majority of cervical cancers; aluminum-containing adjuvant to ensure robust and described. doses of bHPVvaccine, given 6 months apart. The 20. WORLD HEALTH ORGANIZATION. Country papillomavirus types in invasive cervical cancer, from Lancet.2006; 367(9518):1247-1255. https://doi.org/ 6 18 cancer. Vaccine. 2006; 24 (3): S1-S10. https://doi.org/ mmwr.mm6549a5external icon et al showed HPV type distribution in ICCand HSIL. sufficient cause. Epidemiologic studies indicate that long-lasting immunogenicity.12 Khatun S et al conducted a study to assess the target girls will mainly be reached through the office for Bangladesh. Human papillomavirus (HPV) 1940 to 2007.2014. Int J Cancer. 2014; 135(1):88-95. 10.1016/S0140-6736(06)68439-0, DOI: 10.1016/ and Recommended vaccination schedule: 10.1016/j.vaccine.2006.05.115, PMid:16949995, In ICC, HPV16 was the most common, and HPV18 the risk of contracting genital HPV infection and immunogenicity and safety profile of HPV16/18 14. Markowitz LE, Hariri S, Lin C, Dunne EF, Steinau M, vaccine introduced in Bangladesh.18 May 2016. https://doi.org/10.1002/ijc.28636, PMid:24382655, S0140-6736(06)68439-0, https://doi.org/10.1016/ The primary target group in most of the countries schoolbasedprogramme and girls who are out of DOI: 10.1016/ j.vaccine.2006.05.115, https://doi.org/ the second most common, type in all continents. The cervical cancer is influenced by a variety of factors. vaccines in healthy Bangladeshi girls aged between McquillanG, et al. Reduction in human News release DOI: 10.1002/ijc.28636, https://doi.org/10.1002/ S0140-6736(06)68439-0 recommending HPV vaccination is young adolescent school will receive the vaccine through the routine 10.1016/j.vaccine.2006.05.115, PMid:16949995 papillomavirus (HPV) prevalence among young next most common HPV types were HPV31, 33, 35, Thus, other cofactors are necessary for progression 9–13 years. They recommended that, bHPV vaccine EPI sites at the community level. 21. Morshed K, Polz-Gruszka D, Szymański M, ijc.28636, PMid:24382655 girls, aged 9-14.WHO has recommended the 6. Smith JS, Lindsay L, Hoots B, Keys J, Franceschi S, women following HPV vaccine introduction in the 37. De Carvalho N, Teixeira J, Roteli-Martins CM, Naud 45, 52 and 58. HPV18 was significantly more from cervical HPV infection to cancer. Long-term 35 was generally well tolerated, with no vaccine-related Polz-Dacewicz M. Human Papillomavirus (HPV) - following vaccination schedule . Winer R, et al. Human papillomavirus type United States, National Health and Nutrition 29. Nahar Q, Sultana F, Alam A, Islam JY, Rahman M, P, De Borba P, Zahaf T, et al. Sustained efficacy and prevalent in adeno/adenosquamous carcinoma than use of hormonal contraceptives, high parity, tobacco serious adverse effects. Conclusion: Structure, epidemiology and pathogenesis. Otolaryngol distribution in invasive cervical cancer and high-grade Examination Surveys, 2003-2010. J Infect Khatun F. et al. Genital human papillomavirus immunogenicity of the HPV-16/18 AS04-adjuvanted in squamous cell carcinoma. Among HSIL cases, smoking, and co-infection with HIV have been • Females <15 years at the time of first dose: a Immunization with the HPV vaccine induces Pol. 2014;68(5):213-219. https://doi.org/10.1016/ HPV prevalence, cross-protection and herd cervical lesions: A meta-analysis update. Int. J. Dis.2013;208(3):385-393. https://doi.org/10.1093/ infection among women in Bangladesh: findings from vaccine up to 7.3 years in young adult women. HPV16/18prevalence was 52%. WalboomersJM et identified as established cofactors; co-infection with sustained high levels of antibodies against high-risk j.otpol.2014.06.001, PMid:25283316, DOI: 10.1016/ 2-dose schedule (0, 6 months) is recommended. Cancer. 2007; 121(3): 621-632. https://doi.org/ infdis/jit192, PMid:23785124, DOI:10.1093/infdis/jit192. a Population-based survey. PLoS One. 2014; 9(10): Vaccine.2010; 28(38):6247-6255. https://doi.org/10.1016/ 3 immunity after vaccination: j.otpol.2014.06.001, https://doi.org/10.1016/j.otpol. al found that the worldwide HPV prevalence in Chlamydia trachomatis (CT) and herpes simplex HPV genotypes 16 and 18. The durable immune 10.1002/ijc.22527, PMid:17405118, DOI: 10.1002/ e107675. https://doi.org/10.1371/journal.pone.0107675 j.vaccine.2010.07.007, PMid:20643092, DOI: If the interval between doses is shorter than 5 months, A national HPV immunization program using a 15. Tabrizi SN, Brotherton JM, Kaldor JM, Skinner SR, 2014.06.001, PMid:25283316 cervical carcinomas is 99.7%. virus type-2 (HSV-2), immunosuppression, and response induced by the HPV vaccine in adolescent ijc.22527.https://doi.org/10.1002/ijc.22527 PMid:25271836 PMCid:PMC4182674, DOI: 10.1016/j.vaccine.2010.07.007, https://doi.org/ then a third dose should be given at least 6 months bHPV vaccine was implemented in Scotland in 2008, Liu B, Bateson D,et al. Assessment of herd immunity certain dietary deficiencies are other probable girls is predicted to provide long-term protection PMid:17405118 22. Bruni L, Albero G, Serrano B, Mena M, Gómez D, 10.1371/journal.pone.0107675, https://doi.org/10.1371/ 10.1016/j.vaccine.2010.07.007, PMid:20643092 Bangladesh had also different studies that focused on after the first dose. along with a national surveillance program designed and cross-protection after a human papillomavirus cofactors. against HPV infection and subsequent development Muñoz J, Bosch FX, de Sanjosé S. ICO/IARC journal.pone.0107675, PMid:25271836, PMCid:PMC4182674 HPV genotyping in different groups of females. to determine the longitudinal effects of vaccination 7. Banik U, Ahamad MSU, Bhattacharjee P, Adhikary vaccination programme in Australia: a repeat 38. Schwarz TF,Spaczynski M, Schneider A, Wysocki J, 29 • Information Centre on HPV and Cancer (HPV Nahar Q et al revealed prevalence of HPV infection Strategies for cervical cancer prevention and Females ≥15 years at the time of first dose & of high-grade cervical lesions and cancer. The AK, Rahman Z. cross-sectional study. Lancet Infect Dis.2014; 30. Sultana T, Huq M, Alam A, Mitra DK, Gomes DJ. Galaj A, Schulze K, et al. Persistence of immune on HPV infection at the population level. By linking Information Centre). Human Papillomavirus and was 7.7% with no significant difference between control33: immunocompromised and/or HIV-infected.: a 14(10):958-966.DOI: 10.1016/S1473-3099(14) 70841-2, Prevalence and genotyping of human papillomavirus vaccination, cervical screening, and HPV testing knowledge gained from this review is important for 8. High risk human papillomavirus type 16 and 18 Related Diseases in the World. Summary Report 17 response to HPV-16/18 AS04-adjuvanted cervical 3-dose schedule (0, 1-2, 6 months) is https://doi.org/10.1016/S1473-3099(14)70841-2 (HPV) in female with high-risk behaviour in Dhaka, urban and rural women. HR-HPV (High risk) WHO recommends a comprehensive approach to realizing the necessity of the use of a prophylactic infection in the cervical lesions of women with cancer vaccine in women aged 15-55 years. Hum recommended. data, over the study period they found a decline in June 2019. [Date Accessed] Bangladesh. Bangladesh J Microbiol. 2008; infections were more common (4.2%) than LR-HPV cervical cancer prevention and control. The HPV16/18 vaccine in Bangladeshi girls. There has epithelial cell abnormality in Pap smear: A 16. Kavanagh K, Pollock KG, Potts A, Love J, Cuschieri Vaccin.2011; 7(9): 958-965. https://doi.org/10.4161/ HPV 16 &18,significant decreases in HPV 31, 33& 23. FernandezJV and De Medeiros Fernandez TAA. 25(1):65-68. https://doi.org/10.3329/bjm.v25i1.4861, infections (3.4%). Most common HR genotypes were recommended set of actions includes following Evaluation of efficacy, immunogenicity and safety cytohistomorphologic association in Bangladeshi K, Cubie H, et al. Introduction and sustained high hv.7.9.15999, PMid:21892005 PMCid:PMC3225769, 45 (suggesting cross-protection). Among non- been little success with screening program against Chapter 1 Human Papillomavirus: Biology and DOI:https://doi.org/10.3329/bjm.v25i1.4861, HPV16,66,18,45,31&53. Sultana T et al30 noted the interventions. women. Cytojournal. 2013; 10: 14. DOI: 10.4103/ coverage of the HPV bivalent vaccine leads to DOI: 10.4161/hv.7.9.15999, https://doi.org/10.4161/ of HPV vaccine: vaccinated women, HPV 16 & 18 infections were cervical cancer in Bangladesh, an intervention that Pathogenesis. Human Papillomavirus and Related https://doi.org/10.3329/bjm.v25i1.4861 prevalence of genital HPV types in the sex workers 36 1742-6413.1150888. Borna NN, Tabassum S, Jahan areduction in prevalence of HPV 16/18 and closely hv.7.9.15999, PMid:21892005 PMCid:PMC3225769 a) Primary prevention begins with HPV vaccination HarperDM et al assessed the long-term efficacy, significantly lower in 2013 than in 2009 indicating has helped to significantly reduce cervical cancer in Diseases-From Bench to Bedside-A Clinical was as high as 75.8%, whereas for the high-risk types M, Munshi S, Unnesa A. Genotyping of High-Risk related HPV types. Br J Cancer.2014;110(11), 31. Khandker E, Khan M, Chowdhury AK. Human of girls aged 9-13 years, before they become sexually immunogenicity, and safety of a bivalent HPV-16/18 herd immunity and sustained effectiveness of the the developed world. Therefore, a National HPV Perspective, 2012. 1-40, Rijeka, Croatia: InTech. DOI: 39. Roteli-Martins CM, Naud P, De Borba P, TeixeiraJC, it was 49.8%. The highest prevalence rate was Human Papillomavirus (HPV) Among Cervical 2804-2811.DOI: 10.1038/bjc.2014.198. https://doi.org/ papillomavirus infection among Bangladeshi women active. Because HPV vaccines do not protect against L1 virus-like particle AS04 vaccine against incident bivalent vaccine onvirologic outcomes at the 10.5772/27154 https://doi.org/10.5772/27154 De Carvalho NS, Zahaf T, et al. Sustained observed for the genotype 16, 18 and 58. Khandker E Vaccination Program seems to be the window of Precancer and Cancer Patients. Acta MedicaInternational. 10.1038/bjc.2014.198,PMid:24736582 with cervical intraepithelial neoplasia and chronic all HPV types that cause cervical cancer, vaccine and persistent infection with HPV 16 & 18 and their 17 immunogenicity and efficacy of the HPV-16/18 31 population level. opportunity to reduce the mortality and morbidity of 2015;2(1):19-28.DOI: 10.5530/ami.2015.1.5, https://doi.org/ PMCid:PMC4037824 24. Gómez DT and Santos JL. Human papillomavirus cervicitis. IMC J Med Sci. 2016;10(1): 29-32. et al determine HPV infection rate was 43.1%. CIN associated cytological and histological outcomes. De AS04-adjuvanted vaccine: up to 8.4 years of introduction should be part of comprehensive 10.5530/ami.2015.1.5 infection and cervical cancer: pathogenesis and https://doi.org/10.3329/imcjms.v10i1.31103, DOI: cases had significantly high (p<0.01) HPV infection 37 Scenario of HPV vaccination in Bangladesh: HPV related cervical cancer in Bangladesh. 17. Cameron RL, Kavanagh K, Pan J, Love J, Cuschieri approach to cervical cancer control. Carvalhoa N et al report efficacy and epidemiology. Communicating Current Research and follow-up. Hum Vaccin. J Immunother.2012; 8(3): 9. Michael JC, Karen C. Cervical Cancer Screening and K, Robertson C, et al. Human Papillomavirus https://doi.org/10.3329/imcjms.v10i1.31103 (78.6%) compared to cases with chronic cervicitis immunogenicity of the HPV16/18 vaccine up to 7.3 WHO has developed guidelines on prevention and References : Educational Topics and Trends in Applied 390-397.https://doi.org/10.4161/hv.18865 7 Other recommended preventive interventions for Preinvasive Disease. In: Berek JS, Hacker NF Prevalence and Herd Immunity after Introduction of https://doi.org/10.3329/imcjms.v10i1.31103 (18.2%).BanikU et al find out the extent of HR HPV years post vaccination. No cases of infection or control of cervical cancer through vaccination and 1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre Microbiology. A Mendez Vilas (ed). Spain: Formatex; PMid:22327492,DOI:10.4161/hv.18865 (editors). Berek and Hacker's Gynecologic Oncology. Vaccination Program, Scotland, 2009-2013. 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Human papillomavirus (HPV) vaccine CIN and carcinoma. HPV 16 was detected in vaccine in women aged 15–55 years. All subjects burden of cervical cancer fallsheaviest on the PMid:26692336 PMCid:PMC4696690 Diseases. Vaccine. 2013;31(7): H1-31. https://doi.org/ already engaged in sex PMid:30207593 West J Med. 2001; 175: 231-233. DOI: 10.1136/ 124(7):1626-1636. https://doi.org/10.1002/ijc.24116 introduced in Bangladesh. News release.2016.

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