title: Type-Specific Human Papillomavirus Distribution in Invasive Squamous Cervical Carcinomas in Tunisia and Vaccine Impact.
abstract: BACKGROUND
  High risk human papillomaviruses (HPVs) are the leading cause of cervical cancer (CC) and Pap smear screening has not been successful in preventing CC in Tunisia. HPV vaccination that targets HPV16 and 18 offers a new efficient prevention tool. Identification of HPV types in CC is thus essential to determine the impact of HPV vaccine implementation. The aim of this study is to provide specific data from Tunisia.
  
  
  METHODS
  A total of 89 histological confirmed paraffin embedded samples isolated from patients with CC diagnosed between 2001 and 2011 were collected from five medical centres from Northern and Southern Tunisia. HPV DNA was detected using a nested PCR (MY09/MY11-GP5+/GP6+) and genotyping was assessed using a reverse blot line hybridisation assay that enables the detection of 32 HPV types.
  
  
  RESULTS
  HPV DNA was detected in all samples. Twelve high risk types were detected; HPV16 and/or 18 were predominant, accounting together for 92.1% of all the CC cases (HPV16: 83.1%). Single infections accounted for 48.8% of the cases and were mostly linked to HPV 16 (32.6%) and less frequently to HPV 18 (2.4%). The other high risk HPV single infections were linked to HPV 35 (4.6%), 45 (4.6%), 58 (2.3%) and 59 (2.3%). Multiple infections with mixing of 2 to 4 genotypes predominately featrued HPV16 and/or 18 with HPV 35 and 45 (96.6 %) and less frequently with HPV 59, 40, 66, 73 and 58. There was no statistically significant variation in the relative distribution of HPV types with age.
  
  
  CONCLUSIONS
  These results strongly indicate that prophylactic HPV vaccines can have a major impact in preventing CC in Tunisia.
authors.affiliation: HPV Research Unit, Laboratory of Molecular Epidemiology and Experimental Pathology Applied to Infectious Diseases, Pasteur Institute of Tunis, Tunis, Tunisia *E-mail : emna.jerbi@pasteur.rns.tn, emnaennaifer@yahoo.fr.
authors.forename: Emna
authors.initials: E
authors.lastname: Ennaifer
authors.forename: Faten
authors.initials: F
authors.lastname: Salhi
authors.forename: Thalja
authors.initials: T
authors.lastname: Laassili
authors.forename: Emna
authors.initials: E
authors.lastname: Fehri
authors.forename: Nissaf
authors.initials: N
authors.lastname: Ben Alaya
authors.forename: Ikram
authors.initials: I
authors.lastname: Guizani
authors.forename: Samir
authors.initials: S
authors.lastname: Boubaker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000821:virology*; D060085:Coinfection / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005838:Genotype; D052162:Human papillomavirus 16 / Q000235:genetics* / Q000302:isolation & purification; D052161:Human papillomavirus 18 / Q000235:genetics* / Q000302:isolation & purification; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology*; D053918:Papillomavirus Vaccines; D014416:Tunisia / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000821:virology*
chemical_list: D004279:DNA, Viral; D053918:Papillomavirus Vaccines