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 .
VACC-1156702-0000
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