{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T07:04:30Z","timestamp":1782975870995,"version":"3.54.5"},"reference-count":28,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"General Science and Technology Project of Xiamen, China","award":["3502Z20224014"],"award-info":[{"award-number":["3502Z20224014"]}]},{"name":"Major Scientific Research Project of Xiamen\u2019s Health High-Quality Development Technology Plan","award":["2024GZL-ZD11"],"award-info":[{"award-number":["2024GZL-ZD11"]}]},{"name":"Major health technology Projects of Xiamen","award":["3502Z20234012"],"award-info":[{"award-number":["3502Z20234012"]}]},{"name":"Xiamen Medical and Health Guidance Project","award":["3502Z20224ZD1074"],"award-info":[{"award-number":["3502Z20224ZD1074"]}]},{"name":"Xiamen Science and Technology Major Project","award":["3502Z20171006"],"award-info":[{"award-number":["3502Z20171006"]}]},{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2024YFC2311404"],"award-info":[{"award-number":["2024YFC2311404"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,6,1]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Global human papillomavirus (HPV) prevalence among women rose significantly from 14% (2019) to 24% (2024), underscoring the need to understand transmission dynamics and public health impact. Although multi-genotype infections are increasingly documented, evidence remains limited on their combined effect on cervical lesion severity and transmission, especially in regional populations. Using clinical datasets from Xiamen, China, this study evaluates co-infection patterns through integrated statistical and dynamical models to quantify associations with histological severity and transmissibility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were sourced from positive HPV nucleic acid tests at two hospitals in Xiamen. Genotyping employed multiplex PCR-based flow fluorescence hybridisation. Cumulative link models (CLMs) were used to assess associations between multi-genotype infections and cervical lesion severity. Concurrently, an ordinary differential equation transmission model was developed to estimate reproduction numbers, comparing transmission potential across infection types.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 1\u200933\u2009438 samples, 15\u2009939 (11.9%) were HPV-positive, covering 27 genotypes. HPV 16, 52 and 58 were the most prevalent high-risk types. Co-infections involving these genotypes showed strong inter-hospital correlation in pairing patterns (Pearson\u2019s\n                      <jats:italic>r<\/jats:italic>\n                      =0.851). Co-infection severity association was context-specific: the number of genotypes predicted severity in the screening population (eg, quadruple infections OR=1.47, 95%\u2009CI 1.23 to 1.71, p&lt;0.01) but not in the referral population. Conversely, co-infections exhibited consistently higher relative transmissibility indices in both settings (eg, high-low-risk co-infection median model-derived\n                      <jats:inline-formula>\n                        <m:math xmlns:m=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" overflow=\"scroll\">\n                          <m:mstyle>\n                            <m:mrow>\n                              <m:mstyle displaystyle=\"false\">\n                                <m:msub>\n                                  <m:mi>R<\/m:mi>\n                                  <m:mrow>\n                                    <m:mn>0<\/m:mn>\n                                  <\/m:mrow>\n                                <\/m:msub>\n                              <\/m:mstyle>\n                            <\/m:mrow>\n                          <\/m:mstyle>\n                        <\/m:math>\n                      <\/jats:inline-formula>\n                      : 2.57\u20136.82).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HPV co-infection impacts are modulated by patient population: relative transmission potential is broadly elevated, whereas histological severity effects are marked in screening cohorts but minimal in referral groups. Context-aware public health strategies\u2014adapting co-infection screening and interventions to clinical setting\u2014are urged for more effective and efficient disease control.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-002957","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T06:00:22Z","timestamp":1782972022000},"page":"e002957","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Co-infection of multiple human papillomavirus genotypes and its effects on symptomatic risks and transmission dynamics: an integrated epidemiological and modelling study in Fujian, China"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4160-8588","authenticated-orcid":false,"given":"Yue","family":"Tang","sequence":"first","affiliation":[{"name":"State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen, Fujian, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guzainuer","family":"Abudurusuli","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen, Fujian, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingwen","family":"Xu","sequence":"additional","affiliation":[{"name":"Health Emergency Office, Hefei Center for Disease Control and Prevention, Hefei, Anhui, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruiqin","family":"Tu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shishi","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, Fujian, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiming","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Fujian Key Clinical Specialty of Laboratory Medicine, Women and Childrens Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0710-5086","authenticated-orcid":false,"given":"Tianmu","family":"Chen","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen, Fujian, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yulin","family":"Zhou","sequence":"additional","affiliation":[{"name":"United Diagnostic and Research Center for Clinical Genetics, Women and Children\u2019s Hospital, School of Medicine and School of Public Health, Xiamen University, Xiamen, Fujian, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weihong","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, Fujian, China"},{"name":"Xiamen Clinical Research Center for Cancer Therapy, Xiamen, Fujian, China"},{"name":"Clinical Research Center for Precision medicine of abdominal tumor of Fujian Province, Clinical Research Center, Xiamen, Fujian, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"2026070123001612000_4.3.e002957.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2010.01.024"},{"key":"2026070123001612000_4.3.e002957.2","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-06-0129"},{"key":"2026070123001612000_4.3.e002957.3","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1097\/IGC.0b013e31829e9fb4","article-title":"Multiple-type human papillomavirus (HPV) infections: A cross-sectional analysis of the prevalence of specific types in 309,000 women referred for HPV testing at the time of cervical cytology","volume":"23","author":"Louise","year":"2013","journal-title":"International Journal of Gynecologic Cancer"},{"key":"2026070123001612000_4.3.e002957.4","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-023-08634-w","article-title":"Epidemiologic characteristics of high-risk HPV and the correlation 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trends in the management and prevention of human papillomavirus (HPV) infection","volume":"25","author":"Ioannis","year":"2020","journal-title":"J BUON"}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2025-002957","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T06:00:25Z","timestamp":1782972025000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2025-002957"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":28,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,7,1]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bmjph-2025-002957"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2025-002957","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}