HPV infection in humans commonly causes skin or mucous membrane growths (warts).
There are more than 100 varieties of human papillomavirus (HPV) approximately 30 to 40
strains that infect the human genital tract. Of these at least 14 strains are oncogenic or highrisk types that are associated with cervical, vulvar, vaginal, and anal cancers, and nononcogenic or low-risk types that are associated with genital warts. HPV 16 is the most
oncogenic, accounting for almost half of all cervical cancers. HPV 16 and 18 together
account for approximately 70% of cervical cancers. HPV 6 and 11 are the most common
strains associated with genital warts and are responsible for approximately 90% of these
lesions. HPV can affect women of any age, but it is more common in sexually active women
and is the cause of most cases of cervical cancer. These infections are often transmitted
sexually or through other skin-to-skin contact.

Worldwide, cervical cancer is the fourth most frequent cancer in women with an estimated
570 000 new cases in 2018 representing 7.5% of all female cancer deaths. Of the estimated
more than 311 000 deaths from cervical cancer every year, more than 85% of these occur in
low- and middle-income countries. Currently, there are no blood tests for HPV, but PAP
test, Colposcopy, HPV DNA test can help in diagnosis.

The Global strategy towards eliminating cervical cancer as a public health problem adopted
by the WHA in 2020, recommends a comprehensive approach to cervical cancer prevention
and control. The recommended set of actions includes interventions across the life course
that are multidisciplinary, including components from community education, social
mobilization, vaccination, screening, treatment, and palliative care. In low- and middleincome countries, there is limited access to preventative measures and cervical cancer is
often not identified until it has advanced, and symptoms develop. In addition, access to
treatment of such late-stage disease (for example, cancer surgery, radiotherapy, and
chemotherapy) may be very limited, resulting in a higher rate of death from cervical cancer in
these countries. The high mortality rate from cervical cancer globally could be reduced by
effective interventions.

Vaccines can help protect against the strains of HPV most likely to cause genital warts or
cervical cancer 2 . HPV vaccines are very safe and effective in protecting against HPV
infections, high grade precancerous lesions and invasive cancer. They work best if
administered prior to exposure to HPV. WHO recommends vaccinating girls, aged between 9
and 14 years, as this is the most cost- effective public health measure against cervical
cancer. Some countries have started to vaccinate boys as the vaccination prevents genital
cancers in males as well as females. HPV vaccination does not replace cervical cancer
screening and in countries where HPV vaccine is introduced, screening programmes will still
need to be developed or strengthened. Since HPV vaccine has also a lot of myths and
misconceptions, a communication strategy to dispel the myths and provide the right
information should also be developed & deployed.

The global strategy to eliminate cervical cancer has set targets to accelerate the elimination:
a threshold of 4 per 100,000 women-year for elimination as a public health problem, 90–70–
90 targets that need to be met by 2030 for countries to be on the path towards cervical
cancer elimination, 90% of girls fully vaccinated with the HPV vaccine by age 15; 70% of
women are screened with a highperformance test by 35; and again by 45 years of age, 90%
of women identified with cervical disease receive treatment (90% of women with pre-cancer
treated; 90% of women with invasive cancer managed). India is yet to adopt HPV vaccination
as a National program and though some states have initiated the work, it is a long road
ahead before the 90-70-90 targets can be met.

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