Saturday, 08 March 2008
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POST 01237E: Human Papillomavirus update 8 MARCH 2008 ******************************************* Cervical cancer has a devastating impact on women’s health around the world. Approximately, 500.000 women develop cervical cancer every year, and half of them do not survive it. Almost 80% of these cases occur in low-income countries. Of grave concern is the fact that while significant declines in both incidence and mortality measures have occurred in Canada, the United States and other established market economies over the last forty years, similar trends have not been observed in most countries of Latin America and the Caribbean. Although cervical cancer is a preventable disease, it still remains a major public health problem among women of the developing world. Most of the cervical cancer cases are linked to genital infection with human papillomavirus (HPV). The peak incidence of HPV infection generally occurs between the ages of 16 and 20 years. Until now, the best way to prevent cervical cancer was through regular gynecological screening and treatment of precancerous lesions. However, a new vaccine is now available, and a second one is expected to be approved soon, to prevent the HPV infection that causes a majority of cervical cancer cases. It is important to highlight that the new vaccine protects against four HPV types, which together cause 70% of cervical cancer and 90% of genital warts. Since the vaccine does not protect against all types of HPV, women will still need regular cervical cancer screening. For several years, secondary prevention had played an important role in the prevention of cervical cancer; however, this new technology offers a unique opportunity through control and vaccination. Public health professionals and health care policy makers will have to be aware that developed and developing countries face different challenges in the use of this technology for the control of cervical cancer. For example, prevalence of cervical cancer is much higher in developing countries than in developed ones. Some developing countries may not have full epidemiological information or mechanisms in place to deliver a vaccine. Proper screening and follow-up is particularly difficult in marginal rural areas within the countries where most low-income women live. Furthermore, the new HPV vaccine costs are higher in developing countries, making it more difficult for their governments to purchase vaccines for all eligible young women. ------------------------------------------------------------------- HPV Vaccines In 2006, the U.S. Food and Drug Administration (FDA) approved Gardasil®, a vaccine that is highly effective in preventing persistent infection with HPV types 16 and 18, two "high-risk" HPVs that cause most (70 percent) cervical cancers, and types 6 and 11, which cause virtually all (90 percent) genital warts. Gardasil is given through a series of three injections muscle tissue over a 6-month period. Another promising vaccine, Cervarix™, is produced and is being tested by GlaxoSmithKline (GSK), but is not yet approved by the FDA. This vaccine is called a bivalent vaccine. This vaccine is also given in three doses over a 6-month period. Early findings have shown that Cervarix also protects against persistent infection with HPV 16 and 18. Gardasil and Cervarix are highly effective in preventing infection with the types of HPV that they target. Both vaccines have been tested in thousands of people in the United States and many other countries. Thus far, no serious side effects have been noted. The most common problem has been brief soreness at the site of injection and other local injection site symptoms commonly experienced with other vaccines. Gardasil is proven to be effective only if given before infection with HPVs, so it is recommended that it be given before an individual is sexually active. The FDA’s licensing decision includes information about the age and sex for recipients of the vaccine. The FDA approved Gardasil for use in females 9 to 26 years of age. Neither of these HPV vaccines has been proven to provide complete protection against persistent infection with other HPV types, some of which cause cervical cancer. Therefore, about 30 percent of cervical cancers and 10 percent of genital warts will not be prevented by these vaccines. In addition, the vaccines do not prevent other sexually transmitted diseases, nor do they treat HPV infection or cervical cancer. Because the vaccines will not protect against all infections that cause cervical cancer, it is important for vaccinated women to continue to undergo cervical cancer screening as is recommended for women who have not been vaccinated. More information about the ACIP recommendations for vaccination against HPVs can be found on the CDC Web site at http://www.cdc.gov/od/oc/media/pressrel/r060629.htm and http://www.cdc.gov/mmwr/pdf/rr/rr5602.pdf on the Internet. The above information has been sourced from: www.paho.org and http://www.cancer.gov/cancertopics/fact ... PV-vaccine All members of the TechNet21 e-Forum are invited to send comments on any posting or to use the forum to raise a new discussion or request technical information in relation to immunization services. The comments made in this forum are the sole responsibility of the writers and do not in any way mean that they are endorsed by any of the organizations and agencies to which the authors may belong. Visit the TECHNET21 Website at http://www.technet21.org You will find instructions to subscribe, a direct access to archives, links to reference documents and other features. 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