Cervical cancer (CC) is the fourth most common pathology in women worldwide and presents a high impact in developing countries due to limited financial resources as well as difficulties in monitoring and access to health services. Human papillomavirus (HPV) is the leading cause of CC, and despite the approval of prophylactic vaccines, there is no effective treatment for patients with pre-existing infections or HPV-induced carcinomas. High-risk (HR) HPV E6 and E7 oncoproteins are considered biomarkers in CC progression. Since the E6 structure was resolved, it has been one of the most studied targets to develop novel and specific therapeutics to treat/manage CC. Therefore, several small molecules (plant-derived or synthetic compounds) have been reported as blockers/inhibitors of E6 oncoprotein action, and computational-aided methods have been of high relevance in their discovery and development. In silico approaches have become a powerful tool for reducing the time and cost of the drug development process. Thus, this review will depict small molecules that are already being explored as HR HPV E6 protein blockers and in silico approaches to the design of novel therapeutics for managing CC. Besides, future perspectives in CC therapy will be briefly discussed. Cancers are some of the deadliest pathologies, and according to Globocan, the global cancer burden in 2020 increased to 19.3 million cases and 10 million cancer deaths. With these new data, it is estimated that 1 in 5 people will develop cancer during their lifetime, and 1 in 8 men and 1 in 11 women will die from the disease ,5. In deThe current treatments for CC are based on excisional or ablative procedures, surgical resection, radiotherapy, or chemotherapy, which do not specifically target the oncogenic properties of HPV, and therefore lesion recurrence can occur . In addiDrug discovery and development is a very expensive and time-consuming process, which can take 10 to 15 years until a drug reaches the market. In the last decades, the pharmaceutical industry has been employing computer-aided drug design (CADD) techniques to accelerate drug development, intending to reduce time, costs, and failures, namely in the final stage ,10. ThisHence, in this review, we intend to summarize the current treatment used for CC stages induced by HPV persistent infection, present the small molecules that are already being explored as inhibitors/blockers for E6 protein, and retrospectively analyze the studies published in the last years that applied in silico approaches to the design of novel therapeutics for CC treatment. In addition, we will concisely discuss the future perspectives for CC management.HPV is the etiological agent associated with CC. There are about 200 HPV genotypes of high-risk (HR HPV) and low-risk (LR HPV) identified. HPV16 and 18 are responsible for more than 70% of invasive CC. The HPV genome presents tropism for epithelial cells, and the infections appear mainly in the anogenital tract ,5,15 andThe HPV genome encodes eight genes; the L1 and L2 structural proteins constitute the capsid that protects the viral genome, and the E1, E2, E4, E5, E6, and E7 proteins are involved in replication, transcription regulation, and oncogenesis. E6 and E7 oncoprotein expression disrupt the cell repair mechanisms by degradation or inhibition of the tumor suppressor proteins p53 and retinoblastoma protein (pRB), respectively, resulting in the immortalization and cellular transformation of infected cells ,20,21. TCC is staged according to different systems. The most widely used is the FIGO system proposed by the International Federation of Gynecology and Obstetrics in collaboration with the International Union Against Cancer (IUCC) . Table 1All surgical interventions can cause side effects or complications, including bleeding and damage in the tissue nearby, and simple or radical hysterectomy results in infertility or bladder/bowel dysfunction . With thAs mentioned before, E6 and E7 proteins of HR HPV play a major role in CC development once its growth is dependent on sustained E6/E7 expression. The interest in HR HPV E6 protein as a potential therapeutic target has arisen in the past years. This protein is essentially found in the cell nucleus and is constituted by 150–160 amino acids and two zinc-binding motifs. In 2013, Zanier and co-workers published in PDB the 3D structure of HPV16 E6 protein bound to the E6AP interaction domain (ID: 4GIZ) . More reThe E6 protein binds to E6AP (E6-associated protein), a ubiquitin ligase required for the interaction with p53 protein. The formation of the trimeric E6-E6AP-p53 complex is responsible for the ubiquitination and degradation of p53, resulting in p53-dependent apoptosis blockage. The crystallization data revealed that HPV16 E6 is composed of an N-terminal and a C-terminal connected by an alpha helix, forming the hydrophobic binding pocket for E6AP . E6 targThe HR HPV E6 protein has different binding pockets, including the hydrophobic pocket where the LxxLL motif of E6AP binds, the PDZ-binding domain, and the p53 binding site, Researchers have been taking advantage of the E6/E6AP complex 3D structure available on PDB (ID: 4GIZ) to understand the interactions involved between both proteins and to apply in silico methods to design potential inhibitors. E6AP is required to induce E6-mediated p53 degradation by inducing structural changes in the E6 protein, which allow the formation of the trimeric complex E6/E6AP/p53 . The hyd1 (ZINC111606147), compound 2 (ZINC362643639), and compound 3 (ZINC96096545)   were selnd 2 ZINC2643639, Anisomeles malabarica, as being able to inhibit E6 and E7 protein expression and induce apoptosis in HPV-positive cancer cells. Then, they decided to perform a structure–activity relationship study with several AA analogues to identify potent inhibitors of HPV E6 and E7 oncoproteins thiazol-2-yl)phenyl)-5-chloro-2-methoxybenzamide (compound 22 or A-07, Modi and co-workers explored the anticancer properties of 10 benzothiazole derivatives in CC cell lines. Later, by in silico and in vitro studies, they aimed to identify the molecular pathways involved in the apoptosis induced by The natural and synthetic compounds presented here as HR HPV E6 protein inhibitors by either target E6/E6AP complex or the E6/E6AP/p53 complex formation are a valid starting point for drug design and development in cervical cancer management. However, strategies that combine both targets, the hydrophobic pocket and the p53-binding cleft of E6 protein, could result in an effective way to disrupt the E6/E6AP/p53 complex to specifically affect the viability of HPV-positive cancer cell lines and proposing specific anti-HPV therapies.CC management still needs improvements, as current therapies are mainly surgery, chemotherapy, or radiotherapy. Several drugs have been proposed for treating patients with CC, but most do not overcome clinical trials due to low efficacy . BearingOverall, our research group aims to propose a more specific, efficient, and non-toxic/invasive therapeutic approach for cervical cancer management. Thus, in silico approaches, such as those described in the present manuscript, will be used to select promising compounds as E6 potential inhibitors. Additional studies will be conducted with HPV E6 recombinant proteins and the selected compounds to characterize the kinetic magnitude and affinity constants of the compound–protein interaction. Then, the most promising compounds will be applied in in vitro studies with HPV-positive and HPV-negative cell lines to confirm the inhibitor/blocker effects of the E6 oncoprotein. In addition, drug delivery systems can be developed to circumvent a possible high toxicity and low availability of the compounds and, for instance, to combine this approach of E6 inhibitors with gene therapy to supplement p53 content and induce the cancer cell apoptosis.The high impact that CC has in developing countries is undeniable. This review has briefly discussed the role of HPV in CC carcinogenesis as well as its different stages and current treatments. Subsequently, the potential of natural and synthetic small molecules in HR HPV E6 protein inhibition, mainly by targeting the E6/E6AP complex or the E6/E6AP/p53 complex, was discussed. The drug development process is a very expensive and time-consuming process until achieving regulatory agency approval. In silico methods represent a viable solution to these current problems by allowing a fast screening and identification of potential drugs and effective predictions. In terms of impact, in silico methodologies can help to increase the speed of acceptance of potential antiviral drugs with ADMET acceptable profiles for CC management. Moreover, in silico methods have been applied in the medical field, representing the therapeutic response of drugs on virtual organs and body systems and predicting patients’ biological responses to the treatment, and this significantly improves outcomes. Computational-based approaches hold a great promise for improving drug development and revolutionizing clinical research by providing a specific treatment for women diagnosed with cervical cancer. Considering the costs of screening and treatment of CC, and knowing that the highest incidence occurs in developing countries, a more cost-effective treatment is needed. Thus, exploring natural compounds with the ability to impair E6-p53 interaction could be a specific and promising strategy for CC management in a more economical way.


All patients underwent cold excision and laser vaporisation of papillomatous lesions. Samples were analysed for the presence of 120 viral genotypes  using a highly sensitive multiplex genotyping assay.P = 0.018). Number of HPV infections was also associated with clinical outcomes, with an average of 0.5 surgical procedures/year in patients with mono-infection, 1.2 for double-infection, 2.6 for ≥ 3 infections (P = 0.006).Twenty patients with JoRRP, aged 0.3–11 years, were included, with a median follow-up of 13.5 years. All samples were HPV DNA positive: 20 (100%) for alpha-HPV DNA; 7 (35%) for beta—HPV DNA; 0 for gamma-HPV DNA. Three groups were defined according to the number of infections: seven cases (35%) with HPV mono-infection; ten cases (50%) with HPV double-infection; three cases (15%) with ≥ 3 HPV infections. At diagnosis, patients with ≥ 3 HPV infections reported higher median Derkay’s score than those with mono-infection (21 vs 14, Despite the small sample size, these preliminary data support an association between the number of different alpha and beta HPV co-infections and the clinical severity of the disease. Juvenile onset recurrent respiratory papillomatosis (JoRRP) is a rare and challenging HPV-induced disease, frequently associated with mucosal HPV-type infection, in particular HPV 6 and 11, and characterised by the growth of squamous papillomata in the airway epithelium . BecauseThere is currently no eradicative cure for JoRRP. Furthermore, no reliable markers predicting the course of the disease, the risk of recurrence or malignant transformation exist . HoweverMany studies have investigated whether the severity and aggressivity of JoRRP may be influenced by the infection with mucosal HPV types, 6 and 11, but the results provided inconsistent and contrasting conclusions , 8. ThusThis observational study included consecutive children aged < 12 years at onset of JoRRP, in a referral centre  between October 2000 and October 2018 and followed-up until October 2020. A clinical and surgical database of all patients, including age and Derkay’s score  at onsetInclusion criteria comprehended: (a) diagnosis of JoRRP; (b) age ≤ 12 years old at onset; (c) surgical treatment; (d) histological and clinical data available in hospital database; (e) written consent for data processing.in remission; (b) with persistence; (c) in progression. We defined in remission patients with no evidence of papillomata in the past 5 years; with persistence the patients submitted to less than 4 surgical procedures in the last year and/or without a longitudinal progression of papillomatosis, and in progression the patient submitted to more than or equal to 4 surgical procedures in the last year and/or with a longitudinal progression of papillomatosis.From October 2000 to October 2018, 23 children age ≤ 12 years were diagnosed with JoRRP and underwent surgical treatment. Three cases were excluded due to lack of tissue specimen for analysis. Thus, the final case series included 20 patients. Depending on clinical course of the disease, considering the number of surgical procedures/year and the presence of a longitudinal progression of papillomatosis, we stratified the patients in three groups: (a) Paraffined tissue samples for molecular analysis were obtained from surgical specimens. Micro slices of all paraffined samples were shipped to the Infection and Cancer Biology Group at the International Agency for Research on Cancer in Lyon, France. DNA was obtained by an overnight incubation at 37 °C of the paraffin tissue sections in a digestion buffer  [a and b, 70, 73 and 82), 46 beta-papillomavirus types  and 52 gamma–papillomavirus types . Primers for the amplification of beta-globin were also added to provide a positive control for the quality of the template DNA. Amplification of beta-globin gene showed that in all cases the samples contained good quality DNA. The results were expressed as mean fluorescence intensity (MFI) [The identification of 120 viral genotypes was performed by using a high sensible type—specific multiplex genotyping assays (TS-MPG), which combine multiplex polymerase chain reaction (PCR) and bead-based Luminex technology  as described in the literature , 12. MulP reported in the tables were considered significant when ≤ 0.05. For each patient and for each year after diagnosis, the cumulative number of surgical procedures was calculated as the total number of surgical procedures from the diagnosis.Differences in socio-demographic and clinical characteristics of the patients across strata were assessed with the Kruskal–Wallis test or Fisher’s exact test. The values of , the larynx was the most involved site (95% of cases). The median number of procedures/year at onset was 2, ranging between 1 and 10. The total number of surgeries ranged from 1 to 45 with a median value of 9.5, while the maximum number of surgeries/year ranged from 1 and 13, with a median value of 3. Three patients received adjuvant cidofovir and two patients received indole-3 carbinol following surgical treatment for recurrence JoRRP.Patients’ clinical data were included in Table 2All samples were HPV-DNA positive and they reported at least one infection for alpha-HPV DNA; seven cases (35%) were also positive for beta-HPV DNA, while no gamma-HPV DNA was detected in any specimen Table .Depending on the number of infections, patients were categorised into three groups Table : (1) patP = 0.018) (Table P = 0.012), the average number of surgical procedures/year (P = 0.022) and the total number of surgeries (P = 0.006) increased with increasing number of HPV co-infections. Three patients were considered in progression and they were all co-infected patients: one positive for double co-infection and two positives for multiple co-infections. The majority of patient with HPV mono-infection (57%) was clinically in remission, whereas, no one showed progression . The Derkay’s score at diagnosis increased with the increasing number of co-infections, reaching 21 for ≥ 3 HPV co-infection compared to 9 for patients with mono-infection . Conversely, patients with ≥ 3 HPV infections showed an upward trend over the all period of observation, reaching an average cumulative number of 43.0 surgical procedures after 20 years from diagnosis  than HPV6 E7, leading to reduced immune responses and the more severe disease course observed in HPV11 RRPs , 18. Howto HPV11 , 20. Oth. On the other hand, by considering the clinical course of papillomatosis with respect to alpha-HPV infection only, it was observed that HPV11 is the genotype involved in a more aggressive course of the disease. However, it was clear only when HPV11 was associated with other viral genotypes (co-infections) but not in cases of mono-infection, where instead the disease has a more indolent course (Fig. Our findings showed that single infections have a lower prevalence than co-infections and that the latter have a much more aggressive outcome than the others which instead tend to stabilise after a follow-up of about 4 years Fig. . Considerse Fig. .Multiple studies concerning the biological mechanism and the role of interactions and co-infections between different HPV genotypes were conducted on other widely spread HPV-related tumours . PrimariOther authors had also highlighted the presence of co-infections in respiratory papillomatosis, considering both other viruses—such as EBV, HSV and CMV, and other alpha-HPV genotypes, assuming their co-presence as an additional risk factor for the clinical outcome of the RRP . In 2015However, the data of the present study do not provide any evidence of a direct role of co-infections in determining the greater aggressiveness of the disease. It has been observed that immunosuppressed patients often harbour multiple oral HPV infections . Thus, tLimited sample size is the major limitation of the present study, and, therefore, the results should be considered as preliminary. JoRRP is an extremely rare disease. Considering that our centre serves a population of 775,000 children under the age of 12, the estimated incidence of 0.15 per 100 000 child/year is in line with the data reported in the literature . FurtherJoRRP still remains an investigating pathology in terms of treatment and clinical course. Both alpha and beta HPV genera may be involved in JoRRP pathogenesis and the number of different HPV-type co-infections may serve as a prognostic indicator of the clinical course of the disease. The results of this study, although preliminary and based on a small number of patients, underline the importance of a highly sensitive diagnostic method in this pathology. However, further studies are needed to confirm our observations.


The women were aged 17–50 years with an average age of 27.12 ± 6.09 years. The pathogens identified were HPV 54.94% (100/120), Neisseria gonorrhoeae (13.74%), Chlamydia trachomatis (11.54%) and Mycoplasma genitalium (11.54%). The most common HPV genotypes were HPV68, HPV38 and HPV52. The antibiotic resistance genes identified were bla QNR B 24.00%, bla GES 22.00%, bla SHV 17.00%, blaCTX-M 13.00% and bla QNR S 1.00%. This study revealed the presence of various HPV genotypes associated with other pathogens with problems of antibiotic resistance among sex workers of West and Central African origin working in Ouagadougou.Viral and bacterial infections represent an occupational risk for female sex workers. This study aimed at determining HPV coinfection with genital pathogens among female sex workers in West and Central Africa and identifying antibiotic resistance genes. A total of 182 samples from female sex workers were analyzed by real-time PCR and classic PCR. For the molecular diagnosis of HPV, the real-time multiplex amplification kit “HPV Genotypes 14 Real-TM Quant” from SACACE Biotechnologies Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Mycoplasma genitalium (MG) and Trichomonas vaginalis (TV) [Chlamydia trachomatis often being the most common. Neisseria gonorrhoeae also remains a pathogenic bacterium of considerable health risk, especially in developing countries [NG, CT, and MG—are able to cross the cervical barrier and infect glandular crypts, therefore leading to endocervicitis. In addition, HPV infection is most prevalent in a risk population for sexually transmitted infections (STIs). To this effect, the objectives of the study were to characterize by real-time PCR the pathogens such as NG, CT, MG and TV responsible for STIs in female sex workers in West and Central Africa with known HPV status so as to detect antibiotics resistance genes.Genital infections represent a great public health concern. They can facilitate infection with HIV, HPV and many other sexually transmitted infections (STIs) such as lis (TV) . STIs arlis (TV) , with Chountries ,3,4,5. Iountries . The thrThe study was conducted in Ouagadougou, both in the Gynecology Department of Saint Camille Hospital in Ouagadougou and the Molecular Biology Laboratory of the Pietro Annigoni Center for Biomolecular Research (CERBA) in Burkina Faso. It was a cross-sectional study with descriptive and analytical aims, which took place from July 2017 to July 2020.N. gonorrhoeae, C. trachomatis, M. genitalium, T. vaginalis).The following variables were studied: sociodemographic characteristics ; HIV status; HPV molecular diagnostic results by real-time PCR; and pathogen status  was obtained following a 4-week collection. Each patient was placed in a gynecological position on the examination table. After the cervix and anogenital areas were highlighted using a disposable speculum, a cotton swab for specimen collection was inserted into the endocervix and ectocervix at the squamocolumnar junction. The collected specimen was placed in a transport medium (SACACE Amplification Kit Transport Medium) and stored at −20 °C pending DNA extraction.This study consisted of analyzing data from 182 female sex workers who were living in Burkina Faso at that period. They were from nine (09) nationalities namely: Burkina Faso, Nigeria, Cameroon, Benin, Togo, Senegal, Ghana, Côte d’Ivoire and Mali.An endocervical cervical sampling was performed for them in 2017; these included all women who met the recommended conditions for good vaginal sampling (VSP), and whose samples after HPV testing were properly stored at minus eighty degrees Celsius (−80 °C) for further molecular analyses, including those in this study.® , following the protocol provided by the manufacturer. For the molecular diagnosis of HPV, the “HPV Genotypes 14 Real-TM Quant” real-time amplification kit from SACACE Biotechnologies®  detecting 14 high-risk HPV genotypes was used . PCR was performed using the SaCycler-96 real-time PCR device in version 7.3 of SACACE Biotechnologies®. For other pathogenic germs, the Sacace Biotechnologies N. gonorrhoeae/C. trachomatis/M. genitalium/T. vaginais Real-TM analysis protocol kit was used, following the protocol provided by the manufacturer and allowing their simultaneous detection.DNA extraction was performed at CERBA/LABIOGENE using the DNA-Sorb-A kit from SACACE BiotechnologiesThe real-time PCR performed was multiplexed with four tubes for each sample. The reaction mixture yielded a volume of 25 µL, i.e., 10 µL of the volume of DNA and 15 µL of the preparation of PCR mix-1-FL, PCR mix-2-FRT and polymerase (TaqF) . The mixture was vortexed and distributed to each well. The program used is the Sacace™ for the urogenital “STD” assays proposed by the manufacturer. This amplification program was: 1 cycle of 95 °C for 10 min followed by 5 cycles of 95 °C for 5 s; 60 °C for 20 s; 72 °C for 15 s and finally 40 cycles of 95 °C for 5 s; 60 °C for 30 s and 72 °C for 15 s. An internal amplification control and negative and positive controls were used. Interpretation of the results was performed using the Microsoft Excel Starter 2010, Real-Time Program provided by the manufacturer .2O, 10.80 µL; and DNA, 5.00 µL. For the amplification of the desired genes, several programs were used. Antibiotic resistance genes were detected by amplification using the Gene Amp System PCR 9700 thermal cycler . Migration was performed by electrophoresis on a 2.00% agarose gel at 120 volts for 40 min. Visualization was performed using ethidium bromide (BET). A 100 bp molecular weight marker was used as a molecular weight index.In order to detect antibiotic resistance genes, specific primers were used . The PCRp ˂ 0.05.Data were entered and analyzed and tables and figures were produced using the IBM SPSS software version 21 and Epi Info 6 and Microsoft Excel 2007. The Chi-square test was used for comparisons with a significant difference for NG, CT, MG and HPV. Concerning the HIV status of female sex workers, 7/182 were HIV positive or 3.85%. The secondary and university schooling levels were respectively 35.71% and 20.33% by HPV and pathogens  identified  were infected with at least one of the pathogens encountered. For bacteria, 13.74% of the study population were infected with N. gonorrhea was associated with five combinations of the HPV genotype, such as HPV31, HPV45, HPV59, HPV58 and HPV52, while C. trachomatis was associated with four genotype combinations .All 14 HPV genotypes were found . The HPVNegative HIV status was reported by female sex workers in 92.86% of cases, while 3.85% of female sex workers reported HIV positive status. In addition, 3.29% had an unknown serological status. Coinfection with HIV and HPV  was found in 14.28% of cases.NG and CT.It is worth noting that beyond the HIV/HPV coinfection, there was also the presence of two bacteria namely blaQNB gene is shown in The presence of the bla CTX-M 13.00%, blaSHV 17.00%, bla QNR B 24.00%, bla QNR S 1.00%, and bla GES 22.00%. Of the bacterial species studied, M. genitalium was the only species to simultaneously host the five resistance genes found: bla CTX-M, bla HVS, bla GES, bla QNR B and bla QNR S. The percentage of antibiotic resistance genes found was 77.00% with a predominance of bla QNR B  resistance genes were sought, of which five (5) were tested positive . These ala QNR B . NG, CT, MG, TV. There is no statistically significant difference between HPV/NG and HPV/NG/MG coinfections. This high rate of coinfection has the combinations HPV/NG, HPV/CT, HPV/MG, HPV/NG/CT, HPV/NG/MG and HPV/CT/MG with no statistically significant difference for HPV/NG and HPV/NG/MG.Among HPV-infected women, according to this study, the age range of 21–30 years was the most represented, which is also the most indicated age range for female sex workers infected with MG/NG/CT pathogens. According to several authors, the age range of 21–30 years is the period when women are most exposed to HPV infection and other STIs ,8. This NG/MG/CT coinfection among sex workers in Burkina Faso.Detecting viral and bacterial coinfection is a critical issue in a population at risk such as sex workers. The present study has made it possible to highlight this HPV/NG, CT, TV, and herpes simplex-2 virus (HSV-2) [NG, CT, MG and TV have been reported by other authors such as Coudray and Madhivanan in 2020 in the USA and Lv et al. 2019 in China [NG, MG and CT would promote HPV infection which in turn could persist and induce precancerous lesions or cervical intraepithelial neoplasia type 1, 2 or 3 , which may regress or progress to cervical cancer.Most of the countries concerned by our study share their borders with Burkina Faso, which therefore facilitated women’s easy access to the country. They migrated into Ouagadougou because they found easy access. In addition, the other reason is that they did not want to be recognized as sex workers in their home countries ,10. In t (HSV-2) . In addiin China ,15. HPV in China ,17,18. Pp < 0.001). Traoré et al. (2016) in Burkina Faso, in their study on HPV among general population women who are not sex workers, found a prevalence of (46/120) 38.3% . HPV infection is higher in women who are sex workers than in the general population [Our study on HPV in female sex workers found 54.94% (100/182) of HPV-positive cases. Several authors have (unlike us) conducted studies in the general female population, particularly in sexually active women. According to the study by Zohoncon et al. in 2020 on HPV in the general population of five West African countries, there is a prevalence of 717/2133) 33.61% of high-risk HPV infection (Tovo vs. Zohoncon, 17/2133 3Thus, the treatment of these pathogens detected would make it possible to break the chain of transmission of these genital infections for the health of populations.bla QNR B is predominantly represented, the study by Dabiré et al. in 2013 showed a predominance of blaCTX-M. The coexistence of several resistance genes observed in the present study was also detected in previous studies in Burkina Faso [With regard to resistance genes, our study revealed the presence of several genes hosted by the different species studied. These resistance genes were also identified in previous studies in Burkina Faso but in other biological samples such as urine, fecal matter and pus. In contrast to our study in which ina Faso ,20,21,22NG, MG, CT and HPV. This confirms that the presence of STIs remains a real public health issue. The magnitude of STIs among female sex workers in West and Central Africa and the detection of associated resistance genes require increased surveillance of the molecular epidemiology of these pathogens.Despite all the control measures that have been taken so far against STIs, this study showed that female sex workers of West and Central African origin were infected with


ABSTRACT IMPACT: The impact of this study is that the results may lead to the development of effective educational programs and a comprehensive cancer control program while verifying patients and medical care providers adherence and compliance with cancer clinical guidelines. OBJECTIVES/GOALS: The objective of this study is to assess risk factors, preventive measures, and screening practices for human papilloma virus (HPV) associated cancers in a sub-population in Central-Eastern Puerto Rico (PR). METHODS/STUDY POPULATION: This is a sub-analysis from an annual descriptive cross-sectional questionnaire of risk factors, preventive measures, and screening practices for cancer in PR administered at a private hospital campus using a convenience sample of healthy and non-healthy adults. RESULTS/ANTICIPATED RESULTS: Out of 345 enrolled subjects in 2019 for the questionnaire, 67 were enrolled by the first author, from which 66 (19%) subjects qualified for this sub-analysis for completing the study: 79% females. When analyzing HPV risk factors, 5% of the participants were smokers. Eleven percent of the subjects received the preventive HPV vaccine. Among those non-vaccinated and eligible for vaccination, 95% were willing to get it. Seventy one percent of females 21-29 years old and 97% of 30-65 years olds had age-appropriate cervical cancer screening. DISCUSSION/SIGNIFICANCE OF FINDINGS: Despite the low prevalence of HPV vaccination, almost all of the subjects within the age range for HPV vaccination were willing to get it. Also, there was a lower prevalence of cervical cancer screening in females 21-29 years old when compared with 30-45 years old. In conclusion, there is a need for more education about HPV associated cancers and vaccine.


Childhood cancer survivors are at higher risk of human papillomavirus (HPV)‐related second cancers than adolescents without cancer, yet their HPV vaccination uptake is lower. Using a statewide sample, we evaluated whether survivors are at higher risk of missed opportunities for concomitant HPV vaccination.n = 1,911). Mixed‐effects Poisson regression estimated the rate of concomitant missed opportunities per vaccine encounter and 95% confidence intervals by vaccine encounter type  from 2013 to 2016.From statewide healthcare data, we identified encounters where vaccines were received. Concomitant HPV vaccine missed opportunities were defined as a vaccine encounter where the HPV vaccine was not administered, although eligibility criteria were met. From these encounters, our sample included 327 survivors identified from the Utah Cancer Registry, diagnosed 2000–2016 at ages 0–9, and a birth year and sex‐matched sample without cancer from the general population (Survivors had more concomitant HPV vaccine missed opportunities than the population sample (70.0% vs. 59.0%). On average, survivors were 12% more likely to have missed opportunities at vaccine encounters and 4% more likely at flu shot only encounters. The predicted excess risk of concomitant missed opportunities for survivors ranged from 0.5 per10 vaccine encounters to 1.1 per10 vaccine encounters. Higher parental education, rurality, younger first vaccine age, and chemotherapy were associated with missed opportunities.Childhood cancer survivors have more missed opportunities for concomitant HPV vaccination than a population sample. As flu shots should be administered annually, providers have a regular opportunity to recommend and deliver the HPV vaccine to survivors. Childhood cancer survivors face a higher risk of HPV‐related cancers than adolescents without a cancer history; however, their vaccination rates tend to be lower. We assessed HPV vaccine missed opportunities among age‐eligible childhood cancer survivors and found significantly more missed opportunities for survivors than adolescents without a cancer history. The most important factor prompting HPV vaccination, for children with and without a cancer history, is a strong provider recommendation.Understanding concomitant missed opportunities among survivors is important for identifying strategies to improve HPV vaccine uptake in this vulnerable population. We report on demographic and clinical predictors of concomitant HPV vaccine missed opportunities among a statewide cohort of Utah‐based children and adolescents diagnosed with childhood cancer. Drawing on electronic health records (EHRs) from two major health care systems, a statewide insurance claims database, and data from an immunization information system, we compared concomitant HPV vaccine missed opportunities for survivors and a cancer‐free birth year and sex‐matched sample drawn from the general population.2All study procedures and materials were approved by the University of Utah institutional review board (IRB).2.12.1.1Study data are from the Utah Population Database (UPDB), a powerful statewide population registry that contains linked demographic, residential, clinical, and vital status records for over eight million individuals.2.1.2Sample eligibility was based on the years of APCD availability (2013–2016), as APCD provided the majority of vaccination data. We identified individuals diagnosed with childhood cancer from UCR records. Eligible survivors were diagnosed with cancer defined by an International Classification of Childhood Cancer (ICCC) code, excluding non‐malignant and in situ cancers, ≤9 years of age from 2000 to 2016.We included survivors and members of the population sample in this analysis who were living in Utah in 2013 and were age eligible for the HPV vaccine based on the ACIP and Centers for Disease Control and Prevention (CDC) guidelines during 2013–2016.2.22.2.1We identified vaccination encounters from claims and encounter records  using Current Procedural Terminology (CPT) codes and National Drug Codes (NDCs). Text string matching was used to identify vaccines in claims missing NDCs. CPTs and NDCs were mapped to the vaccine administered code list (CVX) from the CDC.We classified each vaccination encounter by vaccine(s) administered. Visits were grouped as: (1) only HPV vaccine, (2) only flu shot, (3) adolescent/catch‐up vaccines, or (4) other vaccine(s). Adolescent/catch‐up vaccines were defined as vaccines included in the standard adolescent schedule  or the recommended catch‐up schedule for adolescents . “Other” vaccines included vaccinations not included in adolescent/catch‐up schedules . We excluded vaccines used to test for or treat disease . None of the vaccines of interest allow for dosing intervals of less than 1 month. We therefore considered vaccines in the same CVX group that took place within 21 days of each other as belonging to the same encounter as the minor variation in timing likely represents an artifact of the different data collection processes within the various data and healthcare systems.2.2.2We defined missed opportunities for an HPV vaccine dose as a healthcare encounter where the individual was eligible for the HPV vaccine and received ≥1 vaccination(s) without concomitant HPV vaccination. We did not count encounters as missed opportunities if a dose of the HPV vaccine was received or if other vaccines were received within the minimum dosing intervals for subsequent HPV vaccination: 4 weeks between the first and second dose and 12 weeks between the second and third dose. Vaccination encounters without concomitant HPV vaccination that took place after the minimum HPV vaccine dosing intervals had passed were considered missed opportunities, even if the individual later went on to complete the series. Consistent with ACIP and CDC recommendations for 2013–2016, HPV vaccination was considered complete if the three‐dose series was finished within 18 months.2.2.3We generated variables for race/ethnicity, parental education, sex, and birthdate using UPDB, UUHC, IHC, APCD, and UCR records. Race/ethnicity was classified as either non‐Hispanic White or Hispanic/other. Average parental education was based on educational attainment listed for each parent on the subject's birth certificate from UPDB. Cancer‐specific measures were obtained through UCR, including age at diagnosis, diagnosis date, and whether or not they received chemotherapy and/or radiotherapy as treatment for their cancer. We grouped ICCC diagnoses into the following categories: leukemia, lymphoma, central nervous system (CNS) neoplasms, solid tumors , sarcomas/bone tumors, and epithelial neoplasms.2.3For survivors, eligibility for concomitant missed opportunities began on: their 9th birthday, their cancer diagnosis date, or January 1, 2013, whichever was latest. Individuals in the population sample were considered eligible for missed opportunities for concomitant HPV vaccine missed opportunities on their 9th birthday or January 1, 2013, whichever was latest. Follow‐up for survivors and the population sample started at their first vaccine encounter following eligibility and was bounded by the dates APCD was available: January 1, 2013–December 31, 2016. Participants were considered censored if they died, as confirmed through a death certificate, or if they left Utah. Follow‐up ended if the three‐dose HPV vaccination series was completed. Matched survivors and members of the population sample who met eligibility criteria but did not receive vaccinations during the study period were excluded from the analysis.2.4t‐test statistics. We evaluated concomitant HPV vaccine missed opportunities for survivors and the population sample using count of missed opportunities for the duration of the follow‐up period. Analyses were conducted for all vaccination encounters combined and stratified by the type of vaccine encounter: adolescent/catch‐up or flu shot only. There were insufficient vaccine encounters classified as “Other” for assessment in stratified models. Missed opportunities were also examined by whether or not individuals had ever received an HPV vaccine.Demographic characteristics were compared between survivors and the population sample using chi‐squared and α = 0.05 used for all statistical tests. Statistical analyses were performed in Stata version 14.2.We calculated the rate of concomitant HPV vaccine missed opportunities. To do this, we used mixed‐effects Poisson regression with robust standard errors and exchangeable covariance structure. This modeling approach was selected to decrease the likelihood of biased estimates due to any potential clustering between survivors and their sex‐ and birth year‐matched population sample. We also calculated the expected excess number of concomitant HPV vaccine missed opportunities by subtracting the estimated count of missed opportunities for the population sample from that of survivors. Stratified models were used to assess associations between demographic characteristics and missed opportunities. We used multivariable Poisson regression with robust standard errors for survivor‐only models to examine demographic, treatment, and clinical risk factors for concomitant HPV vaccine missed opportunities. The total number of vaccine encounters was used as the offset in all Poisson models. All models were adjusted for sex, race/ethnicity, and age at first vaccination in the study period with 3Demographic and clinical characteristics of survivors and the population sample who received ≥1 vaccine during the study are summarized in Table n = 922) of the population sample and 39.8% (n = 130) of the survivors received ≥1 HPV vaccine (p = 0.004), with 10.2% (n = 195) of the population sample completing the three‐dose HPV series compared to 7.3% (n = 24) of the survivors (p = 0.107). Survivors and the population sample contributed a total of 5108 vaccine encounters during follow‐up . The expected number of missed opportunities was significantly higher for survivors than the population sample for all vaccination encounters and flu shot encounters, regardless of whether any HPV vaccine doses were ever received (Table Survivors were followed for an average of 1.91 years (SD = 1.18 years) with a mean of 3.7 vaccines received (range: 1–15) and the population sample was followed for an average of 2.10 years (SD = 1.17) with 3.5 vaccines received . A total of 48.2% . Missed opportunities declined with increasing age at first vaccine in the study window for all vaccine encounters  and flu shot encounters . Survivors who lived in rural areas  and were diagnosed at older ages  also had significantly higher rates of missed opportunities. For flu shot encounters, a significant decrease in the rate of missed opportunities was observed for survivors who were treated with radiation .Among survivors, there were few significant differences in the rate of missed opportunities for concomitant HPV vaccination by demographic and clinical characteristics Table . Across 4The Children's Oncology Group recommends routine administration of the HPV vaccine for all age‐eligible childhood cancer survivors,Prior studies have shown that a strong provider recommendation is one of the most important motivating factors for HPV vaccination.Survivors treated with chemotherapy had more missed opportunities for concomitant HPV vaccination than survivors who did not receive chemotherapy, indicating that providers may need guidance regarding vaccine safety following cancer treatments. At the same time, caregivers of survivors have cited lack of information on the vaccine and concerns over potential side effects as their primary reason for not vaccinating their child.Among survivors, trends in increasing rates of missed opportunities for concomitant HPV vaccination were observed by rurality, age at first adolescent vaccine, parental education, and diagnosis age. Rural residents tend to have higher incidence of HPV‐related cancers and lower rates of HPV vaccination due to a complex mixture of interpersonal, organizational, and community/societal factors, including a lower availability of cancer prevention and treatment services than individuals living in urban areas.We also observed increased missed opportunities with older age at diagnosis, indicating that a childhood cancer diagnosis closer to adolescence can be highly disruptive to receiving the HPV vaccination. Parents could feel concerned with having their child receive multiple vaccinations so soon after treatment and the HPV vaccine is the most likely to be delayed during adolescence.This study has certain limitations. Our study was conducted over a narrow time window, 2013–2016, due to limited availability of APCD data. Additionally, we defined missed opportunities for HPV vaccination as healthcare encounters where a vaccine was received without concomitant administration of the HPV vaccine. Therefore, this analysis did not capture primary care‐based missed opportunities among survivors and members of the population sample who did not receive any vaccinations during the study window. However, because survivors often have delayed transitions from oncology to primary care or could be more likely to experience conditions that contraindicate vaccination such as fevers, which are poorly documented in EHRs assessing primary care‐based missed opportunities are unlikely to provide an accurate picture of vaccination behaviors in childhood cancer survivors.5Although survivors of childhood cancer face greater risk for HPV‐related second cancers, our analysis showed they have significantly higher rates of missed opportunities for concomitant HPV vaccination than a population sample of adolescents without cancer, particularly for flu shot vaccine encounters. As the flu shot should be administered annually, providers have a regular opportunity to strongly recommend and deliver the HPV vaccine to survivors. Providers should emphasize the safety and efficacy of the vaccine and motivate vaccination against HPV within the recommended age range, particularly if survivors were treated with chemotherapy. Improved communication and coordination between oncology and primary care teams could also help to increase PCP comfort and knowledge surrounding follow‐up care for childhood cancer survivors.All study procedures and materials were approved by the University of Utah IRB.Dr. Kepka receives a small portion of her salary from a grant that is provided and supported by the American Cancer Society, who received funding from Merck, for the purpose of the “Mission: HPV Cancer Free Quality Improvement Initiative.”The other authors have no conflicts of interest to disclose.Joemy Ramsay: Conceptualization, data curation, formal analysis, methodology, writing, and review/editing. Heydon Kaddas: Data curation, methodology, and review/editing. Judy Ou: Methodology and review/editing. Deanna Kepka: Conceptualization, funding acquisition, review/editing, and supervision. Anne Kirchhoff: Conceptualization, funding acquisition, methodology, project administration, resources, review/editing, and supervision.Table S1‐S2Click here for additional data file.


Infection with HPV starts with the access of the viral particles to basal cells in the epidermis, potentially via microtraumas to the skin. The basal cells are able to keep away these pathogens in normal circumstances through a robust immune response from the host, as HPV infections are, in general, cleared within 2 to 3 weeks. However, the rare instances of persistent infection and/or in cases where the host immune system is compromised are major risk factors for the development of lesions potentially leading to malignancy. Evolutionarily, obligatory pathogens such as HPVs would not be expected to risk exposing the host to lethal cancer, as this would entail challenging their own life cycle, but infection with these viruses is highly correlated with cancer and malignancy—as in cancer of the cervix, which is almost always associated with these viruses. Despite this key associative cause and the availability of very effective vaccines against these viruses, therapeutic interventions against HPV-induced cancers are still a challenge, indicating the need for focused translational research. In this review, we will consider the key roles that the viral proteins play in driving the host cells to carcinogenesis, mainly focusing on events orchestrated by early proteins E5, E6 and E7—the not-so-good, the bad and the ugly—and discuss and summarize the major events that lead to these viruses mechanistically corrupting cellular homeostasis, giving rise to cancer and malignancy. Helicobacter pylori, Schistosoma haematobium and Opisthorchiasis viverrini are known to cause approximately 15% of human cancers . A,2. A1,2] cancers ,4. WhileHPVs cause almost one-third of the 15.4% human cancers attributable to carcinogenic infections . Cervicamyc ), impairing DSB repair, and contributing to genomic instability . More reAn initial event in the induction of genomic instability in HPV infection, and probably responsible for cases of co-existing episomal and integrated HPV DNA, is the upsetting possibility of ‘onion skin’ type of HPV DNA replication, caused by activation of the viral origin of replication multiple times within a single cell cycle, leading to single- or double-strand breaks and recruitment of the DNA repair machinery, thus potentially promoting chromosomal defects . In addiAlterations in DNA methylation are associated with a number of human diseases and are one of the hallmarks of cancer. The HPV-16 E7 oncoprotein has been shown to bind directly to DNMT1 and stimulate its methyltransferase activity . FurtherHPV E7 has also been shown to interact with HDAC1 and HDAC2 through the Mi2β protein : both MiINK4A. Higher expression of p16INK4A caused by HPV-16 E7 mediated KDM6D upregulation represents an E7-triggered oncogene-induced senescence (OIS) response. This response, as RAS/RAF cause KDM6B upregulation, leads to de-repression of p16INK4A transcription, followed by inhibition of CDK4/6 activity and inhibition of pRB phosphorylation. The ultimate effect is G1 cell cycle arrest and senescence; however, HPVs have evolved to target pRB for ubiquitin-dependent proteasomal degradation, which is why p16INK4A upregulation in HPV-positive cancer cells does not inhibit proliferation [CIP1 and this activity was shown to be required in high-risk E7 expressing cells for p21CIP1’s ability to inhibit DNA replication through PCNA binding [HPV E7 has also been shown to induce expression of histone H3 lysine 27 demethylase, KDM6A and KDM6B, enzymes responsible for H3K27me3 demethylation . Furtherferation ,333,334.feration . Further binding .The polycomb group of proteins forms polycomb repressive complexes (PRC) that repress gene transcription . PRC2, fAmong many other factors, microRNAs (miRNAs) are also known to regulate the expression and activities of cellular proteins by acting as post-transcriptional regulators of gene expression . These aAnother facet of the development and progression of tumours and cancers is compromised immune detection. Immunological surveillance for virus-infected cells is constantly monitored by our ever-alert immune system, to resist and eradicate the formation and progression of incipient neoplasias. However, high risk-HPV oncoproteins play a significant role in perturbing this surveillance system by perturbing the expression and trafficking of several immune receptors and mediators, essential for detection and targeting of virus-infected cells. Foreign antigen presentation on major histocompatibility complex (MHC) class I molecules is important for T-cell recognition of virus-infected cells, but HPV E5 proteins from several HPV types  have been demonstrated to specifically downregulate this class of surface molecules (HLA-A and HLA-B) ,344. MecHigh-risk E6 and E7 also contribute to modulating the immune response to infection. HPV-16 E6 interaction with IFN regulatory factor 3 (IFR3) has been suggested to prevent the transactivation of IFN-beta expression . In HPV-Chalmydia trachomatis, may well serve as cofactors for the development of the intense chronic inflammatory response leading to HPV-associated disease [Cellular, innate, and adaptive immune responses, with an array of secreted cytokines, play a significant role in progression of both infection and cancer. Inflammation is a host defence strategy against foreign agents, actively mediated to the site of breach (or stimulus) and involves the release of cytokines and mediators that act to facilitate recruitment of effector cells to the site of injury. In most instances, the inflammatory process is disabled upon clearance of the stimulus, however, if it persists, inflammation can tend to become chronic and can lead to cancer. Expression of high-risk HPV oncoproteins can induce an inflammatory response by upregulating pro-inflammatory cytokines and chemokines ,361,362. disease ,374.prognosis/outcome, as discussed above. Despite a multitude of data regarding the mechanisms behind the carcinogenic effects of these viral oncoproteins, many mechanisms still remain to be uncovered , and sp


We propose ‘Tapestry’, a single-round pooled testing method with application to COVID-19 testing using quantitative Reverse Transcription Polymerase Chain Reaction (RT-PCR) that can result in shorter testing time and conservation of reagents and testing kits, at clinically acceptable false positive or false negative rates. Tapestry combines ideas from compressed sensing and combinatorial group testing to create a new kind of algorithm that is very effective in deconvoluting pooled tests. Unlike Boolean group testing algorithms, the input is a quantitative readout from each test and the output is a list of viral loads for each sample relative to the pool with the highest viral load. For guaranteed recovery of  I.The coronavirus disease of 2019 (COVID-19) crisis has led to widespread lockdowns in several countries, and has had a major negative impact on the economy. Early identification of infected individuals can enable quarantining of the individuals and thus control the spread of the disease. Such individuals may often be asymptomatic for many days. Widespread testing with the RT-PCR (reverse transcription polymerase chain reaction) method can help identify the infected individuals. However, widespread testing is not an available option in many countries due to constraints on resources such as testing time (The current low rate of COVID-19 infection in the world population 1)Tapestry delivers results in a single round of testing, without the need for a second confirmatory round, at clinically acceptable false negative and false positive rates. The number 2)Tapestry reconstructs relative viral loads i.e., ratio of viral amounts in each sample to the highest viral amount across pools. It is believed that super-spreaders and people with severe symptoms have higher viral load 3)Comp  Tapestry takes advantage of quantitative information in PCR tests. Hence it returns far fewer false positives than traditional binary group testing algorithms such as 4)Because each sample is tested in three pools, Tapestry can detect some degree of noise in terms of cross-contamination of samples and pipetting errors.5)Tapestry allows PCR test measurements to be noisy. We develop a novel noise model to describe noise in PCR experiments. Our algorithms are tested on this noise model in simulation.6)All tuning parameters for execution of the algorithms are inferred on the fly in a data driven fashion.7)Each sample contributes to exactly three pools, and each pool has the same number of samples. This simplifies the experimental design, conserves samples, keeps pipetting overhead to a minimum, and makes sure that dilution due to pool size is in a manageable regime. The organization of the paper is as follows. We first present a brief overview of the RT-PCR method in We present Tapestry, a novel combination of ideas from combinatorial group testing and compressed sensing (CS) II.We present here a brief summary of the RT-PCR process, referring to III.A.Let 1)For a positive pool ent} see . In ordeent} see , we derient} see , the numConstants B.Comp) is a Boolean nonadaptive group testing method . Here one uses the simple idea that if a mixture Comp algorithm is largely insensitive to noise. Moreover a small variant of it can also produce a list of ‘high confidence positives,’ after identifying the (sure) negatives. This happens when a positive mixture Definite Defectives (Dd) Algorithm . However Dd labels all remaining items to be negative, potentially leading to a large number of false-negatives. The performance guarantees for Comp have been analyzed in Comp requires Comp can result in a large number of false positives if not enough tests are used, and it also does not predict viral loads.Combinatorial Orthogonal Matching Pursuit  is solved in practice:P1 is a convex optimization problem which yields the same solution as the earlier problem (with similar conditions on Group testing is intimately related to the field of compressed sensing (CS) deterministic binary sensing matrix designs Comp typically produces a large number of false positives. The CS algorithms help reduce the number of false positives as we shall see in later sections.2)Comp does not estimate viral loads, unlike CS algorithms.3)Comp treats the measurements in In fact, unlike CS algorithms, 4)Comp preserves the RIP-1, RIP-2, RNSP, and Note that the CS stage following Comp algorithm prior to applying the CS algorithm is also very important for the following reasons:1)Comp identifies the sure negatives in Viral load in negative pools is exactly 0. sy Eqns. . It is i2)Comp identifies the sure negatives, therefore, it effectively reduces the size of the problem to be solved by the CS step from Since 3)Comp. Such a sample is called a ‘high-confidence positive,’ and we denote the list of high-confidence positives as In a few cases, a (positive) pool in mentclass2pt{minim For CS recovery, we employ one of the following algorithms after Comp: the non-negative LASSO (Nnlasso), non-negative orthogonal matching pursuit (Nnomp), Sparse Bayesian Learning (Sbl), and non-negative absolute deviation regression (Nnlad). For problems of small size, we also apply a brute force (Bf) search algorithm to solve a problem similar to P0 from Eqn. However, the 1)P1 in Eqn. The LASSO (least absolute shrinkage and selection operator) is a penalized version of the constrained problem Selection of : There are criteria defined in cross-validation (CV) can be used for optimal choice of 2)all the coefficients extracted so far (i.e. in set Nnomp) has been developed in Orthogonal Matching Pursuit (OMP) 3)Sbl) Sbl, we consider the case of Gaussian noise in Sbl procedure can also be modified to dynamically update the noise variance Nnlasso or Nnomp, the Sbl algorithm from Nnomp or Nnlasso, there is no explicit non-negativity constraint imposed in the basic Sbl algorithm. In our implementation, the non-negativity is simply imposed at the end of the optimization by setting to 0 any negative-valued elements in Sparse Bayesian Learning (4)Nnlad) Nnls) Nnlad is sparsity promoting for certain conditions on the sensing matrix Nnlad/Nnls is that they do not require any parameter tuning. This property makes them useful for matrices of smaller size where cross-validation may be unreliable.The Non-Negative Absolute Deviation Regression (E.adaptive group testing techniques which can determine There exist F.1)The sensing matrix 2)expander graphs. A left-regular bipartite graph unbalanced expander graph for some integer The Restricted Isometry Property (RIP-2) of sensing matrices is a sufficient condition for good CS recovery as described in mentclass2pt{minim3)particular such graph is a good expander, which may take prohibitively long in practice Kirkman triples We show that Kirkman matrix bipartite graphs are egatives .5)4defined as the number of 1 entries in a column is more than 2, for them to have high girth and consequently satisfy RNSP of order A Steiner Triple System bipartite graph does not have a cycle of length 4. If it did, then there would exist two rows entclass1pt{minima6)Comp. Kirkman matrices are 2-disjunct, and can recover up to 2 defects exactly using Comp. In a Comp  on the full Kirkman matrix does not perform as well, as shown in the supplemental Section S.IX.Empirically we find that even for matrices . In Sect7)mutual coherence of the matrix, defined as:As we have seen in earlier sections, Kirkman matrices are suitable for use in compressed sensing due to their expansion, RIP-1 and high girth properties, as well as for binary group testing due to disjunctness. Furthermore, the dot product between two columns of a Kirkman matrix being at most 1 ensures that no two samples participate in more than one test together. This has favourable consequences in terms of placing an upper bound on the A practical benefit of Kirkman triples that is not shared by Steiner triples is that the former can be served for number of samples far less than Column weight: Kirkman matrices have column weight equal to 3 - that is, each sample goes to 3 pools. It is possible to construct matrices with higher number of pools per sample While Kirkman matrices which satisfy RNSP of order SP Defn.  of orderComp. That is, the reduced matrix Comp –  shows that BernoulliAs mentioned earlier, the mutual coherence from Eqn. IV.In this section, we show a suite of experimental results on synthetic data as well as on real data.A.1)Recall from We also present results with a 2)For the case of synthetic data, we generated 3)1)Comp (see Comp see 2)Comp followed by Nnlasso (see asso see 3)Comp followed by Sbl (see  Sbl see 4)Comp followed by Nnomp (see nomp see 5)Comp followed by Nnlad (see nlad see 6)Comp followed by Nnls (see Table S.VI in the Supplementary) For each algorithm any positives missed during the CS stage but caught by Dd were declared as positives, as mentioned in Comp-Bf, i.e. Comp followed by brute-force search for samples in The following algorithms were compared:4)Sbl, we set Nnomp, such thresholding was inherently not needed. The various algorithms were compared with respect to the following criteria:1)RMSE := 2)Number of false positives (FP) := 3)Number of false negatives (FN) := 4)Sensitivity  := 5)Specificity  := In the following, 5)Comp followed by Nnlasso/Sbl/Nnomp/Nnlad/Nnls significantly reduces the false positives at the cost of a rare false negative. The RMSE is also significantly improved, since Comp does not estimate viral loads. At the same time, Comp significantly reduces the size of the problem for the CS stage. For example, for the Comp filtering is Comp step did not perform as well, results for which are presented in the supplemental Section S.IX. We observed that the advantages of our combined group testing and compressed sensing approach holds regardless of the sensing matrix size. For comparison, results of running our algorithms using a It should be noted that all algorithms were evaluated on 1000 randomly generated sparse signals, given the same sensing matrix. The average value as well as standard deviation of all quality measures  are reported in the 6)Comp-Nnlasso, Comp-Nnlad, Comp-Nnomp, etc. are estimated via cross-validation. For these estimators, we therefore do not require knowledge of the As mention earlier, the regularization parameters in various estimators such as see Eqn.  - we do 7)We also performed a comparison of our algorithms with the popular two-stage Dorfman pooling method (an adaptive method), with regard to the number of tests required. In the first stage of the Dorfman pooling technique, the 8)particular problem instance. To address this, we adopt the technique from The number of CS measurements for successful recovery depends on the number of non-zero elements  in India, and the other at the Wyss Institute at the Harvard Medical School, USA. In both cases, viral RNA was artificially injected into ence see , startinC.Comp provides us with sensitivity equal to 1, it suffers many false positives, especially for higher Comp-Nnomp , as provided in this document Comp-Sbl for comparison, since we consider it to be our best method.For ‘Testing patients suspected of COVID-19 by their healthcare provider’ Real/Synthetic data: Our work as well as that in 2)Quantitative Noise model: Our work uses the physically-derived noise model in Eqn. 3)Algorithms: The work in Bpdn technique Sensing matrix design: The work in 5)Sparsity estimation: Our work uses an explicit sparsity estimator and does not rely on any assumption regarding the prevalence rate.6)Numerical comparisons: We found that Comp-Nnlad works better than the Nnlad method used in Comp-Nnlasso and Comp-Sbl have better sensitivity and specificity than Comp-Nnlad Number of Tests: We use 93 tests for 961 samples while achieving more than 0.99 sensitivity and specificity for Comp-Sbl. In a similar setting, We review some recent work which apply CS or combinatorial group testing for COVID-19 testing. The works in VI.1)Testing of 105 symptomatic individuals in 45 tests.2)Testing of 195 asymptomatic individuals in 45 tests assuming a low rate of infection. A good use case for this is airport security personnel, delivery personnel, or hospital staff.3)Testing of 399 individuals in 63 tests. This can be used to test students coming back to campuses, or police force, or asymptomatic people in housing blocks and localities currently under quarantine.4)Testing of 961 people in 93 tests, assuming low infection rate. This might be suitable for airports and other places where samples can be collected and tested immediately, and it might be possible to obtain liquid handling robots.We have presented a non-adaptive, single-round technique for prediction of infected samples as well as the viral loads, from an array of Outputs: We have designed an Android app named Byom Smart Testing to make our Tapestry protocol easy to deploy in the future. The app can be accessed at Future work: Future work will involve extensive testing on real COVID-19 data, and extensive implementation of a variety of algorithms for sensing matrix design as well as signal recovery, keeping in mind the accurate statistical noise model and accounting for occasional pipetting errors.


Tumor viruses gain control of cellular functions when they infect and transform host cells. Alternative splicing is one of the cellular processes exploited by tumor viruses to benefit viral replication and support oncogenesis. Epstein-Barr virus (EBV) participates in a number of cancers, as reported mostly in nasopharyngeal carcinoma (NPC) and Burkitt lymphoma (BL). Using RT-nested-PCR and Northern blot analysis in NPC and BL cells, here we demonstrate that EBV promotes specific alternative splicing of TSG101 pre-mRNA, which generates the TSG101∆154-1054 variant though the agency of its viral proteins, such as EBNA-1, Zta and Rta. The level of TSG101∆154-1054 is particularly enhanced upon EBV entry into the lytic cycle, increasing protein stability of TSG101 and causing the cumulative synthesis of EBV late lytic proteins, such as VCA and gp350/220. TSG101∆154-1054-mediated production of VCA and gp350/220 is blocked by the overexpression of a translational mutant of TSG101∆154-1054 or by the depletion of full-length TSG101, which is consistent with the known role of the TSG101∆154-1054 protein in stabilizing the TSG101 protein. NPC patients whose tumor tissues express TSG101∆154-1054 have high serum levels of anti-VCA antibodies and high levels of viral DNA in their tumors. Our findings highlight the functional importance of TSG101∆154-1054 in allowing full completion of the EBV lytic cycle to produce viral particles. We propose that targeting EBV-induced TSG101 alternative splicing has broad potential as a therapeutic to treat EBV-associated malignancies. DNA polymerase and Early antigen-diffuse (EA-D), for viral DNA replication. They then sequentially activate the late lytic genes, e.g., viral capsid antigen (VCA) and gp350/220, which encode structural proteins to form viral capsids and envelopes -labeled full-length TSG101 and TSG∆154-1054 probes were hybridized individually overnight to the blots in the ULTRAhyb at 42 °C. Finally, the blots were stringently washed in 0.1% SDS-containing 2× SSC for 10 min at 65 °C, four to six times, and the signals were visualized by autoradiography with X-ray films.Thirty μg of total RNAs were denatured at 65 °C for 15 min and subsequently separated in a 1% agarose gel containing 1x MOPS buffer  and 6% formaldehyde . Capillary transfer of RNA from agarose gel to Immobilon-NY+ membrane  was performed with 20× SSC, and the complete process took at least 18 h. Following UV cross-linking, the blots were pre-hybridized at 42 °C for 2 h in ultrasensitive hybridization buffer ULTRAhyb . Then, 1 × 10Cell lysates harvested by a RIPA lysis buffer were separated by 10% SDS-polyacrylamide gel electrophoresis. The electrophoretic transfer of proteins from SDS-polyacrylamide gel to nitrocellulose membranes  was successively performed. The blots were blocked in washing buffer  containing 4% skim milk at 37 °C for 30 min. Then, the blots were incubated at 4 °C overnight with primary antibodies against TSG101 , Rta  , Zta  at 18 h post-transfection. Then, cell lysates were harvested at serial time points. The degradation of TSG101 protein was visualized by immunoblotting. To determine the half-life of TSG101, the blots were scanned by densitometry and analyzed after normalization to the corresponding β-actin levels.p < 0.05. Densitometric analysis was achieved using Image J software .The statistical significances of the differences and correlation coefficients were calculated using GraphPad PRISM version 8.0.2 . The statistical significance was set at


It is important to provide information on HPV vaccination and on early detection and early treatment for cervical cancer. Readability is a key aspect in the success of cancer communication using written health information. We reviewed studies assessing the readability of information on HPV vaccination and cervical cancer. We conducted a systematic literature search in June 2021 using four online databases . Studies that assessed the readability level of online and offline information regarding HPV vaccination and cervical cancer were included in the review. Twelve articles were deemed fit for study inclusion. Our results showed that most of the materials assessed were difficult to read and higher than eighth-grade reading level. Few of the materials assessed were at the recommended grade 5–6 level or below. Readability assessments of HPV vaccination and cervical cancer information are scarce. Additional studies on the readability of information regarding HPV vaccination and cervical cancer are recommended. Health professionals should develop health information on HPV vaccination and cervical cancer that is easy to read. More than 570,000 new cases of cervical cancer are diagnosed and approximately 311,000 women die from the disease annually worldwide  and as dHealth literacy is “the degree to which individuals have the capacity to obtain, process, and understand basic health information” . A lowerReadability is the reading comprehension level required for a person to understand written materials . Some exp < 0.001, 15.1 vs. 11.3, p < 0.001, respectively) [p = 0.007) [Studies indicate that the readability of information can influence individuals’ understanding and behavior regarding prevention, early detection, and early treatment of cervical cancer. For example, one intervention study showed that participants who were given easy-to-read vaccine information had significantly higher scores of comprehension and recall than those who were given standard materials to read  . Thus, rTo our knowledge, there are no reviews of readability studies on HPV vaccination and cervical cancer-related information; thus, knowledge on this subject is limited. Therefore, we conducted the present study to provide the first systematic scoping review focused on studies that objectively assessed the readability levels of online and offline information materials related to HPV vaccination and cervical cancer using readability formulas. Our study aims were to create an overview of the published literature and to identify the content and gaps in published studies to help guide future research and practice regarding improvement in HPV vaccination and cervical cancer-related written information. Our research questions were as follows: (1) What is the content and gaps in previous studies assessing the readability of HPV vaccination and cervical cancer information? (2) What was revealed in previous studies regarding the readability levels of HPV vaccination and cervical cancer-related information? (3) What factors affecting the appropriateness of HPV vaccination and cervical cancer information, other than readability level, were evaluated in previous studies, and what were the findings?We carried out a systematic literature search on 15 June 2021, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement . We usedThe inclusion criteria were studies that assessed the readability levels of online and offline informational materials related to HPV vaccination and cervical cancer using readability formulas. The exclusion criteria were studies that did not assess the readability levels of HPV vaccination and cervical cancer-related informational materials, such as those focusing on instrument development and curriculum development see . The firFor each study, we extracted relevant data, including the year of publication, the country in which the study was conducted, the language in which the study was conducted, the readability formula used, the material evaluated, the provider of the material, and the main results regarding readability level evaluation. When the included studies reported the characteristics of factors affecting the appropriateness of information other than readability level , we also extracted those data. The first author (TO) extracted the data using Microsoft Excel . The second author (HO) then checked for accuracy and completeness and verified all data extraction. Any differences in data extraction between the authors were resolved through discussion. We aggregated and analyzed the data in line with the study aims. We conducted a descriptive analysis of the included studies, identifying the study characteristics, the results of readability assessment, and other results affecting the appropriateness of information on HPV vaccination and cervical cancer.The search yielded 69 articles published between 1992 and 2021. After scrutinizing the relevant titles and abstracts, as well as the full texts, we identified 12 papers that were suitable for inclusion and were subsequently reviewed see .As All 10 studies from the United States and Canada reported that most of the information assessed was higher than eighth-grade reading level ,26,27,28As We systematically reviewed studies assessing readability of HPV vaccination and cervical cancer-related information using readability formulas. We discuss our findings below, in line with our research questions: study characteristics (research question 1); readability level (research question 2); and assessment of factors other than readability level (research question 3).Regarding study characteristics, readability studies of HPV vaccination and cervical cancer information began relatively recently, in 2009, despite the history and richness of readability studies in the field of public health. Compared with the wealth of readability studies evaluating written health information ,32, the The readability levels of most HPV vaccination and cervical cancer-related information were higher than an eighth-grade level. However, it is recommended that health information should be written at a fifth- to sixth-grade level or lower . Our finThe ease of reading information about HPV vaccination and cervical cancer is also important in terms of processing fluency. Processing fluency refers to the ease with which information can be processed . StudiesRegarding the evaluation of factors other than readability level, we found that six of the twelve included studies evaluated readability levels only. However, multiple factors affect the ease of reading and understanding information on HPV vaccination and cervical cancer, in addition to readability levels assessed using readability formulas. Three studies used the SAM ,24,25. TA study in China evaluated the content and DISCERN score as well as readability of HPV vaccine-related online messages . ContentAs these studies show, using broader assessment tools such as the SAM , the PEMWritten information is widely used in cancer communication provided by health professionals to their patients and to the general public regarding prevention, early detection, and early treatment. Readability is one of the keys to successful communication regarding cervical cancer using written information. We call for further studies on improving the readability of HPV vaccination and cervical cancer-related information and suggest the following questions, which should be addressed in future research. What is the readability level of HPV vaccination and cervical cancer-related information materials that have not been assessed in previous studies? What is the readability level of non-English, non-Chinese, and non-Japanese HPV vaccination and cervical cancer-related information? What is the readability level of HPV vaccination and cervical cancer-related information materials in low-and middle-income countries? What factors are present apart from readability level, such as ease of understanding and appropriateness of HPV vaccination and cervical cancer-related information? What is the gap between the reading level of the target audiences and the level needed to read HPV vaccination and cervical cancer-related information? Future studies should answer these research questions.Regarding practices to make information on HPV vaccination and cervical cancer easier to read, guidelines are available such as the SAM , the PEMThere are several limitations in this study. Although we systematically searched for related studies in multiple databases using a combination of appropriate keywords, we may have missed some publications, such as studies that assessed readability as part of a larger analysis. In this study, we focused on the level of readability as calculated using a readability formula. However, there are other factors affecting the readability and understandability of HPV vaccination and cervical cancer-related information. Because the readability formulas used were different for English, Chinese, and Japanese, the way in which the readability level was judged differed depending on the language. Despite these limitations, this was the first systematic scoping review of readability assessment studies on HPV vaccination and cervical cancer-related information. The present study findings have implications for further research and practice aiming to improve written health information on HPV vaccination and cervical cancer.This systematic literature review showed that readability assessment of HPV vaccination and cervical cancer-related information is scarce. This review also found that the readability level of most HPV vaccination and cervical cancer-related information is higher than what is recommended. In addition to readability levels as assessed using various formulas, issues related to multiple factors that affect readability, understandability, and suitability of HPV vaccination and cervical cancer-related information are proposed. More extensive research is needed to understand the current status regarding readability of HPV vaccination and cervical cancer-related information. Improving the readability of HPV vaccination and cervical cancer-related information will help patients and the general public to make the best decisions and adopt optimal behaviors regarding prevention, early detection, and early treatment of cervical cancer.


Human papillomavirus (HPV) vaccination is a form of primary prevention for cervical cancer. The HPV vaccination rate of female university students is not high in Korea and China. Therefore, the purpose of this study was to identify and compare the factors associated with intention to receive HPV vaccination between Korean and Chinese female university students.The participants were 273 Korean and 317 Chinese female university students who had not been vaccinated for HPV, and data were collected using a self-reported questionnaire about attitudes toward HPV vaccination, HPV knowledge, perceptions of HPV infection, and intention to receive HPV vaccine.There were no significant differences between the Korean and Chinese female university students in HPV knowledge, attitudes, perceptions, and vaccination intention. The factors influencing the intention of HPV vaccination in Korean students were a positive attitude toward the HPV vaccine and a high HPV knowledge score. For Chinese students, sexual experience, awareness of genital warts, a positive attitude toward the HPV vaccine, a high HPV knowledge scores, a perception of the seriousness of HPV infection, and negative emotions regarding HPV infection were significant factors.It is important to improve attitudes and knowledge about HPV and the HPV vaccine in order to enhance HPV vaccination both in Korea and China. Perceived seriousness and negative emotions regarding HPV infection should be used as a framework to develop subject-tailored interventions in China. Human papillomavirus (HPV) is a very common sexually transmitted infection worldwide, and persistent genital infection with high-risk HPV types can lead to the development of anogenital precancers and cancers . CervicaBy 2017, 30 of the 35 Organization for Economic Co-operation and Development countries had introduced HPV vaccination into the national immunization program for girls . In KoreThe HPV vaccination rate of Korean female university students has been reported to be 12–28%  and thatVaccine hesitancy is strongly associated with the decision of vaccine acceptance, and knowledge, attitudes, and beliefs are factors significantly related to vaccine hesitancy , 14. HigAccording to statistics in 2019, the proportion of Chinese students among international students in Korea was 44.4%, accounting for the largest percentage. The proportion of Korean students studying in China among Korean students abroad was 23.8%, and China ranked in the top two international destinations for Korean students . ExchangThis study was conducted using a cross-sectional survey. The participants of this study were selected through convenience sampling and recruited at C university in Korea and Y university, a sister university of C university, in China. The inclusion criteria were female university students (1) who were not married and had not been vaccinated against HPV and (2) who were adults (age 19 or older in Korea and age 18 or older in China). The sample size for multiple logistic regression was calculated using the G*Power version 3.1 program. For sample size calculation, the odds ratio (OR) of 1.47–2.23 in previous studies , 19 was The questionnaire consisted of the following topics: general characteristics of subjects, positive attitude toward the HPV vaccine, knowledge about HPV, perceptions of HPV infection, and intention to receive HPV vaccination.Nine questions elicited information on participants’ age, religion, history of smoking and alcohol use, sexual experience, and history of sexually transmitted infections (STIs), as well as whether they had heard of HPV and genital warts before the survey and whether they were possible candidates for HPV vaccination.The instrument for assessing positive attitudes toward the HPV vaccination was developed by the researchers and consists of three items on the beneficial effects of the HPV vaccine  and its safety (asking about trustfulness in vaccine safety). The responses to each item are on a 5-point Likert scale and the range of scores is 3–15. Higher scores reflect a more positive attitude toward HPV vaccine. The Cronbach α in this study was 0.80.HPV knowledge was measured through the tool developed by Kim . The scaPerceptions of HPV infection were assessed through a tool developed by the researchers based on previous studies , 21. TheThe scale used to assess the likelihood of positive HPV vaccination intentions was developed by researchers. The tool consists of six items that directly assess willingness to receive the vaccine (1) in the near future, (2) if it is recommended by one’s parents, a health professional, one’s sexual partner, or one’s friends, and (3) if financial support is available. Each item is answered on a 5-point Likert scale and the range of possible total scores is 6–30. The Cronbach α in this study was 0.91.This study was approved by the Institutional Review Board (IRB) of C university (no. CKU-15-01-0109) in Korea. For Chinese participants, we received the permission to conduct this survey from J university, which stated that IRB approval was not necessary. Study participants read and signed the informed consent form in Korean or Chinese depending on their nationality. Potential study participants were informed that study participation was voluntary and that they could withdraw their decision to participate at any time. Participants were also informed that the data would be collected anonymously and used only for this study.The survey was conducted from November 10, 2015, to December 21, 2015. A pilot study was not conducted. The researcher or research assistant visited several departmental offices to explain the purpose of the study and recruited participants by posting a recruitment notice on the office message board. The researcher or research assistant explained the study to each student, giving them information on the study and its purpose. After participants voluntarily signed a consent form, we distributed questionnaires in an envelope individually and collected them in the same way to ensure absolute confidentiality of the research data. We informed the participants that they could skip any item that they could not answer and proceed to the next question. Prior to answering the questionnaire, the following simple information about HPV vaccination was provided: “the HPV vaccine is currently administered via intramuscular injection, and was developed to prevent cervical cancer and a sexually transmitted infection”. It took 15 min for each participant to finish the questionnaire. Participants were provided small stationary as a gift after finishing the questionnaire.p < 0.05 (2-tailed test). The dependent variable (intention) was converted into a dichotomous scale according to the mean scores of total intention, as follows: 0 for scores of 6–21, corresponding to no intention , and 1 for scores of 22–30, corresponding to intention(responses of “intend” and “very much intend”) for both Korean and Chinese students.All statistical analyses were performed using SPSS version 23.0 . The chi-square test, t-test, and Mann–Whitney test were utilized to compare general characteristics; attitudes, knowledge, and perceptions of HPV; and intention of HPV vaccination between Korean and Chinese participants. The influencing factors of the intention of HPV vaccination were determined by logistic multivariate regression, in which adjusted odds ratios (AORs) and their corresponding 95% CIs were calculated. Statistical significance was set at Table p = 0.009). When subjects were asked “who needs HPV vaccination?”, 183 (67.0%) Korean students responded with both males and females, 47 (17.2%) responded with only females, and 43 (15.8%) responded that it was not necessary if there were no symptoms of infection. For Chinese students, 165 (52.7%) responded that both men and women should receive HPV vaccination, 97 (31.0%) responded that it was not necessary if there were no symptoms of infection, and 51 (16.3%) responded that only women should be vaccinated. There was a significant difference between Korean students and Chinese students (p < 0.001) (Table There were 69 (25.4%) female college students in Korea and 67 21.1%) female college students in China who answered “I have heard of HPV before”. There was no significant difference by nationality with regard to this item. Furthermore, 61 (22.4%) Korean students and 44 (13.9%) Chinese students had ever heard of genital warts, and this was a significant difference .The results of the analysis of attitudes, knowledge, and perceptions about HPV and the HPV vaccine are shown in Table p = 0.048)  than their Korean counterparts’ score of 2.88± 0.96 points (p < 0.001). For the item “If my friend receives the vaccination, I intend to receive HPV vaccination”, Chinese students also expressed a significantly higher intention, with a mean score of’ 3.60 ± 0.77 out of 5 points, compared to 3.31 ± 0.87 points in Korean students (p < 0.001). However, for the item “If financial support is available, I intend to receive HPV vaccination”, Korean students showed a significantly higher intention, with a mean score of 3.73 ± 0.98 out of 5 points, compared to 3.58 ± 0.85 points in Chinese students (p = 0.013) , having heard of genital warts , a positive attitude toward HPV vaccine , a high HPV knowledge score , perception of the seriousness of HPV infection , and negative emotions about HPV infection .In this study, both Korean and Chinese female college students showed a moderate level of intention to receive the HPV vaccine. The HPV vaccine intentions of Spanish nursing students increased from 4.14 out of 10 before a survey to 6.02 out of 10 post-survey , and thoPositive attitudes toward the HPV vaccine and HPV knowledge were identified as significant factors influencing intention of HPV vaccination in Korean female college students, while sexual experience, awareness of genital warts, positive attitudes, HPV knowledge, perceptions of the seriousness of HPV infection, and negative emotions toward HPV infection were identified as significant factors influencing intention of vaccination among Chinese female college students. Positive attitudes and HPV knowledge were common factors between both countries. This is consistent with the findings of previous studies that a more positive attitude toward the HPV vaccine and a higher level of HPV knowledge were associated with a higher level of intention of HPV vaccination , 25, 26.In addition, only 23.1% of female college students in the two countries responded that they had heard of HPV, and only 17.8% reported that they had heard of genital warts. Since improving knowledge and awareness can induce changes in attitudes and perceptions, above all, it is necessary to actively implement educational programs that provide accurate knowledge in order to increase HPV vaccination rates. HPV vaccination campaign programs should include a variety of content to meet the needs of the target population and should include information appropriate for their knowledge levels, and it would be an effective strategy to deliver such interventions for college students through the internet and mass media considering their patterns of media consumption , 10. HeaIn Chinese female college students, perceptions of the seriousness of HPV infection and negative emotions toward HPV infection were found to have a significant effect on vaccination intention. This result is consistent with the results of prior studies that a higher level of perceived severity among health beliefs was correlated with a higher level of HPV vaccination intention , 29.In this study, negative emotions regarding HPV infection were found to influence the intention to receive the HPV vaccine, but previous studies reported that emotions related to HPV infection, such as shame, anxiety, and depression, did not have an effect on intentions to be tested or vaccinated for HPV , 22. ThuIn Chinese female college students, sexual experience was significantly related to HPV vaccination intention, but prior studies did not show a significant association between these variables , 9. Yet,This study had some limitations. Firstly, since the present study examined variables at a single point in time, it should be considered that participants’ characteristics and social environment could have affected the results. Secondly, the participants of this study were selected by convenience sampling among students at a single university in Korea and China, respectively, and the reasons for non-participation were not analyzed; therefore, the representativeness of the sample is limited. Additionally, typical forms of survey bias, such as inaccurate recall and social desirability, should be taken into account. Recall bias in this study is expected to have been minimal because the survey did not require participants to recall events from the distant past. However, since the study contained items on sensitive topics, such as smoking, alcohol drinking, sexual experience, and STI experience, social desirability bias may have affected participants’ responses. Nonetheless, the use of anonymous questionnaires is expected to have minimized this issue. Therefore, some caution should be taken in interpreting the study results. In particular, since HPV vaccines have been recently introduced into China and HPV vaccination has not yet been included in China’s national immunization program, basic data should be gathered by conducting research on vaccination in multiple regions. In addition, to effectively prevent cervical cancer in both countries, active research is required to identify the factors influencing the association between HPV vaccination intention and the likelihood of getting vaccinated against HPV.The intention of HPV vaccination was moderate among Korean and Chinese female undergraduate students, despite these participants being in the age range with the highest HPV infection rate. The factors influencing intent to receive HPV vaccination in Korean students were a positive attitude toward a vaccine and a high HPV knowledge score. For Chinese students, sexual experience, awareness of genital warts, positive attitude toward the HPV vaccine, HPV knowledge scores, perceptions of the seriousness of HPV infection, and negative emotions regarding HPV infection were significant factors. This study underscores the need to organize an educational program to improve knowledge and awareness about HPV and HPV vaccines. The findings of this study facilitate the understanding of cultural differences and underscore the need to establish culturally sensitive interventions for women’s health promotion for Korean and Chinese young women.