Vaccine
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National Organized Cervical Cancer Screening (NOCCS) programs are lacking in most of the "Extended Middle East and North Africa" (EMENA) countries. Consequently, most cervical cancers are diagnosed late and are associated with high mortality. In fact, in most of these countries, national mortality data are unknown due to the absence of population-based mortality registries. ⋯ These countries are already convinced that prevention of cervical cancers in women who have cervical intraepithelial neoplasia is possible through various screening and treatment algorithms, but most countries still need to invest in well organized programs that can reduce cervical cancer incidence and mortality in women. This article forms part of a regional report entitled "Comprehensive Control of HPV Infections and Related Diseases in the Extended Middle East and North Africa Region" Vaccine Volume 31, Supplement 6, 2013. Updates of the progress in the field are presented in a separate monograph entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.
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In this chapter, we present the available information on the burden of human papillomavirus (HPV)-related cancers (cancers of the cervix, anogenital cancers, and cancers of the oral cavity and pharynx), as well as available data on the prevalence and distribution of HPV types in women with and without cervical cancer, for the countries of the Extended Middle East and North Africa region (EMENA). The EMENA region is characterized by societies that share similar cultures and religions and that are considered to have a more conservative sexual behaviour compared to Western societies. The incidence of cervical cancer is estimated to be relatively low, although it is difficult to assess precisely because systematic and national cancer registries are lacking in many countries of the EMENA region. ⋯ Thus, improving the information on the burden of HPV-related cancers and on the HPV prevalence in the general population is essential to develop a comprehensive intervention policy for future management of cervical cancer in this area. This article forms part of a regional report entitled "Comprehensive Control of HPV Infections and Related Diseases in the Extended Middle East and North Africa Region" Vaccine Volume 31, Supplement 6, 2013. Updates of the progress in the field are presented in a separate monograph entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.
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The extended Middle East and North Africa (EMENA) region is the world region with the second youngest population, where globalization, migration, information technology, and political changes are contributing to the shaping of sexuality and sexual behaviors. Understanding the various sociocultural, demographic and public health dimensions of sexual and reproductive health of young people is fundamental to understanding the pattern of sexual behavior and the burden of sexually transmitted infections (STIs), including human papillomavirus-related diseases. New norms and forms of marriage have emerged to accommodate the changing trends in sexual behavior of premarital and extra-marital sex, as well as reports of increased prevalence of premarital penetrative and non-penetrative sexual behavior. ⋯ Efforts should address establishing national preventive programmes, such as screening for STIs, primary prevention, comprehensive sexuality education, as well as youth-friendly services. This article forms part of a regional report entitled "Comprehensive Control of HPV Infections and Related Diseases in the Extended Middle East and North Africa Region" Vaccine Volume 31, Supplement 6, 2013. Updates of the progress in the field are presented in a separate monograph entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.
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Infection with human papillomavirus (HPV) is recognized as one of the major causes of infection-related cancer worldwide, as well as the causal factor in other diseases. Strong evidence for a causal etiology with HPV has been stated by the International Agency for Research on Cancer for cancers of the cervix uteri, penis, vulva, vagina, anus and oropharynx (including base of the tongue and tonsils). Of the estimated 12.7 million new cancers occurring in 2008 worldwide, 4.8% were attributable to HPV infection, with substantially higher incidence and mortality rates seen in developing versus developed countries. ⋯ Despite the huge advances already achieved, there must be ongoing efforts including international advocacy to achieve widespread-optimally universal-implementation of HPV prevention strategies in both developed and developing countries. This article summarizes information from the chapters presented in a special ICO Monograph 'Comprehensive Control of HPV Infections and Related Diseases' Vaccine Volume 30, Supplement 5, 2012. Additional details on each subtopic and full information regarding the supporting literature references may be found in the original chapters.
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Despite the scarcity of high quality cancer registries and lack of reliable mortality data, it is clear that human papillomavirus (HPV)-associated diseases, particularly cervical cancer, are major causes of morbidity and mortality in sub-Saharan Africa (SSA). Cervical cancer incidence rates in SSA are the highest in the world and the disease is the most common cause of cancer death among women in the region. The high incidence of cervical cancer is a consequence of the inability of most countries to either initiate or sustain cervical cancer prevention services. ⋯ Strategies to reduce the excessive burden of HPV-related diseases in SSA include age-appropriate prophylactic HPV vaccination, cervical cancer prevention services for women of the reproductive ages, and control of HIV/AIDS. This article forms part of a regional report entitled "Comprehensive Control of HPV Infections and Related Diseases in the Sub-Saharan Africa Region" Vaccine Volume 31, Supplement 5, 2013. Updates of the progress in the field are presented in a separate monograph entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.