CLINICAL
VACCINATION
HPV: THE IMPORTANCE OF EDUCATION
It’ s important to remember that vaccines don’ t end with childhood.
The Human Papilloma Virus( HPV) vaccine is recommended for administration between the ages of 9 and 45, with more specific age recommendations dependent on gender and vaccine choice.
HPV is the most common infection of the reproductive tract. It can cause cervical cancer, other types of cancer and genital warts, in males and females. In SA, cervical cancer is the most common cancer in women aged 15 to 44 years. Two HPV vaccines are available in SA. Both vaccines are highly efficacious at preventing infection with virus types 16 and 18, which are responsible for approximately 70 % of cervical cancer cases globally. These are available for females aged 9 to 45. Additionally, one of the vaccines protects against genital warts, and is also approved for administration in males aged 9 to 26. Dosing is either a 2- or 3-dose regimen, depending on age. The HPV vaccine is preventive, and needs to be administered before
every one counts
Help protect your patients against more HPV-related cancers and diseases
cervical cancer 1 vulvar cancer 1 vaginal cancer 1 anal cancer 1 genital warts 1
caused by HPV Types 6, 11, 16, and 18
Important information about GARDASIL
GARDASIL is a vaccine indicated in girls and women 9 through 45 years for active substances or to any of the excipients of the vaccine. Individuals who the prevention of cervical, vulvar, vaginal and anal cancer, pre-cancerous develop symptoms indicative of hypersensitivity after receiving a dose of or dysplastic lesions, genital warts and infections caused by the Human GARDASIL should not receive further doses of GARDASIL. Pregnancy should Papillomavirus( HPV) Types 6, 11, 16, and 18. GARDASIL is indicated in boys be avoided during the vaccination regimen for GARDASIL. Vaccination with and men 9 through 26 years of age for the prevention of external genital GARDASIL may not result in protection in all vaccine recipients. This vaccine lesions and infection as well as anal cancer caused by HPV types 16 and 18, is not intended to be used for treatment of active external genital lesions; and genital warts( condyloma acuminata) caused by HPV types 6 and 11. cervical, vulvar or vaginal cancers; cervical intraepithelial neoplasia, vulvar GARDASIL should be administered in 3 separate intramuscular injections. intraepithelial neoplasia or vaginal intraepithelial neoplasia. This vaccine will Individuals are encouraged to adhere to the 0-, 2- and 6-month vaccination not protect against diseases that are not caused by HPV. The vaccine-related schedule. Alternatively, in individuals 9 through 13 years of age, GARDASIL adverse experiences that were observed among recipients of GARDASIL can be administered according to a 2-dose( 0, 6 months or 0, 12 months) at a frequency of at least 1.0 % and greater than placebo were pain at schedule. Syncope, sometimes associated with falling, has occurred after the injection site, swelling, erythema, headache, pruritus, bruising, pain in vaccination with GARDASIL. Therefore, vaccinees should be carefully extremity, fever, nausea and dizziness. observed for approximately 15 minutes after administration of GARDASIL. GARDASIL is contra-indicated in individuals who are hypersensitive to the Before administering GARDASIL, please consult the full package insert.
REFERENCE: 1. Package Insert approved MSD( Pty) Ltd( Reg. No. 1996 / 003791 / 07), Private Bag 3, Halfway House 1685 by the Medicines Control Council( MCC).
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exposure to the virus. In 2014, the South African National Department of Health implemented a school-based HPV vaccine programme for girls aged 9 and over in grade 4 in public schools. This continues as part of the
Protect & Prevent – Vaccinate.
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Integrated School Health Programme, with an estimated 91 % of girls in this group receiving HPV vaccines since the initiative began. Unfortunately, vaccination outside of this selected population is underutilised.
Dr Trudy Smith, a Johannesburgbased Gynaecologist, gives potential reasons for this as being a ' lack of education despite good quality evidence ' and says that the key to improving this is education of both healthcare providers and the general public. The cost of HPV vaccines has been reduced significantly, making it more affordable in the private sector.
Brief messages in support of the human papillomavirus vaccine might persuade parents to get their children immunised, according to a study in Cancer Epidemiology, Biomarkers & Prevention.
Researchers developed six brief versions of CDC messages aimed at encouraging parents to have their children vaccinated against HPV. They then surveyed some 1 500 parents and 780 physicians to determine which of the briefer and longer messages would be most persuasive.
Among parents who would ' probably ' or ' definitely ' not get their children vaccinated, about 50 % and 25 %, respectively, found some brief messages on the importance of the vaccine persuasive.
The importance brevity in a busy practice is significant. It might be that longer messages would convince some additional percentage of parents. However, compared with the brief messages, wordiness of the longer messages might also make them too complex to effectively reach other parents.
THE HPV VACCINATION ROLLOUT
One of the most important recent advances in cervical cancer prevention is the prevention of hrHPV infection through vaccination. HPV vaccination programmes will have the most significant impact in countries like SA with a high HPV prevalence, low compliance to screening, high lost to follow up, and limited resources for management of women with HPV associated precancerous lesions or cancer. The vaccines, approved by the MCC, are only effective when used as prophylaxis when administered before exposure. HPV is mainly sexually transmitted and therefore the ideal age for vaccination is before the sexual debut. The vaccines are approved to be administered to girls from 9 years of age. The quadrivalent vaccine contains VLPs of HPV types 16, 18, 6 and 11.
HPV vaccines protect against at least 70 % of cervical cancers caused by HPV types 16 and 18, with possible cross-protection against similar types like HPV 31, 33 and 45. The quadrivalent vaccine also protects against the 90 % of genital warts caused by HPV types 6 and 11 and is therefore also approved for boys 9 years and older.
HPV vaccines have been extensively evaluated in randomised control trails and are considered highly immunogenic and safe. Both vaccines were initially approved as a 3-dose series at 0, 1 or 2 and 6 months. Since the launch of the vaccines, some alternative and more flexible dosing schedules have been approved. Reducing the number of doses of the HPV vaccine needed could improve adherence and increase coverage. In the initial studies the highest antibody responses were observed in the age group 9-14 years using 3 doses of vaccine.
Subsequent studies showed that antibody responses to a 2-dose schedule in girls aged 9-14 years were immunological non-inferior to the 3-dose schedule in the 15-25 year age group in which efficacy was demonstrated initially. After WHO recommendations in 2014 a 2-dose schedule was approved for certain age groups in some countries.
HPV vaccines are approved in more than 170 countries, and are part of national immunisation programmes in at least 58 of these for girls and some also for boys.
References available on request.
38 MAY 2017 | MEDICAL CHRONICLE