Cervical Cancer Vaccination
Important facts about HPV vaccine:
HPV (human papilloma virus) vaccine for cervical cancer prevention.
What is HPV:
HPV (human papillomavirus) is a common virus that is passed via sexual contact. There is more than 100 HPV type and they infect genital areas and of which sometimes 15-20 serotypes are cancer causing. They cause no harm and the infection can go on its own. However, sometimes the virus persists and can cause cell to change there can lead to
- Cancer of the cervix vulva and vagina in women.
- Precancerous lesion in woman
- Genital warts in men and woman.
HPV vaccines have a well-established role in preventing cervical cancers as well as these other conditions.
What do HPV vaccines do??
HPV vaccines are vitally important medical advance and are the first vaccines able to help protect against a major cause of cancer.
Type of HPV vaccine:
Two vaccines licensed globally are available in India, Gardasil vaccine protects against 4 serotypes of HPV 6,11,16, and 18 and cervarix vaccine protect against 2 serotype of HPV 16 and 18. These vaccines do not protect against the serotype with which infection has already occurred before vaccination. That’s why the importance of starting vaccination at early age 9-12 years girls and can be given up to women aged 26 years.
Gardasil vaccine confers protection against both cervical cancer and genital cancer.
3 doses of vaccine needed at the interval of 0,2 and 6 months.
Cervarix vaccine confers protections against cervical cancer caused by serotype 16 and 18.
No protection against genital wart.
3 close of vaccine needed at the interval of 0,1 and 6 months.
Gardasil and cervarix vaccine available are prophylactic, not merapeutic mean they prevent the cervical cancer cause by these serotypes but cannot treat the condition.
99-100% efficiency was reported against vaccine type related genital wart, vaginal and vulvar intraepithelial neoplasia.
At 18 months POV vaccination anti HPV titer in younger patients were 2-3 times higher than that in older patients.
Dosage and schedule:
The vaccine dose is only 0.5m given by SM injection into the hand or thigh which way is comfortable to them.
The recommended age for initiation of vaccination is 9-12 years. Catch up vaccination is permitted to the age of 26years. A total of 3 doses 0, 2 and 6 months are recommended with Gardasil vaccine (or)
0, 1 and 6 months with Cervarix vaccine.(Minimum internal of week between the first and second dose, 12 weeks between the second and third dose and 24 weeks between first and third dose).
Side effects and contradictions:
- The most common reactions are local reaction line pain (mild to moderate) in 83%, swelling with redness in 25% and fever in 4% of vaccines. No serious vaccine related events have been reported. The vaccine is contraindicated in people with a history of immediate hypersensitivity.
- The vaccine is not recommended for use in pregnant women.
- Breast feeding women and immune suppressed female patient can receive the vaccine.
Recommendation of the vaccine in India:
- The HPV vaccination is a public health importance. Compliance with cervical pap smear screening is low in India. The currently available vaccines are safe and effective.
- Recommendation in India, offering HPV vaccine to all females who can afford the vaccine.
- Vaccines are not 100% protective against cervical cancer and not a replacement for periodic screening with PAP smear. Hence, screening programmer should continue as per recommendation.
- Both vaccines available are equally effective and safe for protection against cervical cancer and prececerois lesien.
- The advisory committee on immunization practice currently recommend routine vaccination of a girl aged 9-12 years with 3 doses of vaccine can be given to women aged 13-26 years who have previously completed vaccination. Routine cervical cancer screening should be continued.
- The two HPV vaccine are commercially available in India and approved by the drug controller general of India, us food and drug administration European medicine agency and prequalified by WHO.
- Routine screening with PAP smear should continue to detect and treat women who are infected prior to vaccination as with other HPV types not covered by the vaccine.
HPV vaccination through periodic cervical cancer screening should be in a place to use the existing infrastructure and cost effective screening methods such as PAP smear and HPV DNA test. There is no risk of getting an HPV infection from the vaccine as the vaccine does not contain live virus. HPV vaccination and regular cervical screening is the most effective way to prevent cancer.
Cervical cancer mainly caused by human papillae virus infection, is the leading cancer in Indian women and the second most common cancer in women worldwide.
Though there are several methods of prevention of cervical cancer, prevention by vaccination is emerging as the most effective options, with the availability of two vaccines, named Gardasil and cervarix. The worldwide incidence of cervical cancer is approximately 510,000 new cases annually with approximately 288,000 death worldwide. Unlike many other cancer, cervical cancer occurs early and strike at the production period of women’s life. The incidence rises in 30-30 years of age and peaks at 55-65 year, with a median age of 38 years estimate suggest that more than 80% of the sexually active women acquire genital HPV by 50 years of age. Hence, the adverse of vaccine against HPV has stirred much excitement.
Indian scenario of HPV infection:
Cervical cancer is ranked as the most frequent cancer in women in India. India has a population of approximately 365.71 million women above 15 years of age, who are at risk of developing cervical cancer. The current estimate indicate approximately 132,000 new cases diagnosed and 74,000 death annually in India, accounting to nearly 1/3rd of the global cervical cancer death.
HPV serotype 16 and 18 account for nearly 76.7% of cervical cancer in India. Genital warts have been reported in 2-25% in India.
Worldwide high risk type HPV 16 and 18 contribute over 70% of all cervical cancer cases.(the most prevalent being HPV -16 in at least 50-60% and HPV -18 in at least 10-12%) in Indian women, the most common prevalent genotype are HPV 16 and 18. Non cancer— HPV serotypes 6 and 11 contribute over 90% of being genital infection such as genital warts.
HPV cervical infection result in cervical morphological lesions ranging from normal to development of different stages of high grade prececerois lesien cervical intraepithelial neoplasia and subsequently invasive census. HPV infection is measured by means of HPV DNA detection in cervical cell by doing PAP smear test.