http://learnonline.health.nz/course/category.php? id=83. IMAC e-learning module: http://www.immune.org.nz/education-and-
HPV Vaccine is Cancer Prevention NCSR update May 2016 Dr Jane Morgan, Waikato DHB
Disclosures & acknowledgements I have no conflicts of interest to disclose I gratefully acknowledge shared teaching materials from these sources:
75% coverage by 2017 75% dose-3 uptake for all 12-year old girls by Dec’17 With higher vaccine coverage, New Zealand would see similar benefits already achieved in Australia, including near eradication of genital warts in under 21s & less CIN in young women Move to primary HPV testing, with smears from a later age & less often
How to improve HPV vaccine uptake
I want to convince you: HPV vaccination is worth your passionate advocacy HPV vaccine is worth giving long before infection Your recommendation can make all the difference to the family’s acceptance We have an opportunity to prevent HPV related cancers. NOW is the time to protect our community
What is HPV? A virus that infects human skin and mucosal surfaces Transmitted easily by touching >80% of people are exposed during their lifetime Classified as a carcinogen
Why do we vaccinate? To prevent HPV-associated cancer Current screening is good but NOT enough to prevent all HPV-associated cancers To improve equity
In NZ, 160 women get cervical cancer each year & about 50 die from it
Treatment may cause problems Treatment is associated with obstetric morbidity Preterm delivery Preterm rupture of membranes Low birth weight Long term developmental outcomes
Why remove part of the cervix, when you can get a shot in the arm instead?
New Cancers likely caused by HPV, US 2006-10 Vagina n=600 3%
Vulva Anus n=2,200 n=2,600 13% 15%
Oropharynx n=1,800 10% Cervix n=10,400 59%
17,600 Women
CDC, United States Cancer Statistics (USCS), 2006-2010
Penis n=700 8% Anus n=1,400 15%
Oropharynx n=7,200 77%
9,300 Men
What about boys/men? Oropharyngeal cancers more common in men Smoking-related oral SCC is declining, HPV increasing 90% of HPV-related oral SS are due to HPV-16 HPV-related oral SCC responds better to treatment No screening test for oropharyngeal cancers
n o i t i s i u q c
a V P H f o PV k H s o t i d R se o p x g e lifelon ill be w be e y n a o y m r s ve n e o i t t s c o e inf Alm e m o S
HPV transmission ~ 80% of people will be infected with HPV Intimate skin-to-skin contact Most common route is sexual intercourse genital-genital, anal-genital, oral-genital, manual-genital Nearly 50% of high school students have engaged in intimate genital contact
HPV is found in ‘virgins’ Research studies of HPV & sexual behaviour 25% of young women infected with their 1st partner 10-46% of 14-17 year old ‘virgins’ had detectable genital HPV: intimate genital contact
Early vaccination to prevent initial infection
i c c a V V P H
y t e f a S e n
HPV vaccine is safe No virus in the vaccine, so vaccine cannot cause cancer Many millions of doses given worldwide already Most common adverse events are mild For serious adverse reported events, no unusual pattern or clustering to suggest caused by the HPV vaccine These findings are similar to the safety reviews of Tdap (Tetanus/Diphtheria/Pertussis) vaccines
HPV vaccine is safe
HPV vaccine is safe A 2011 study found women & girls who received Gardasil were no more at risk of allergic reactions, anaphylaxis, Guillain–Barre Syndrome, stroke, blood clots, appendicitis, or seizures than those who were unvaccinated or who received other vaccines. A 2013 study that included almost 1 million girls found Gardasil was not associated with blood clots or adverse events related to the autoimmune and brain systems. A 2015 study found women & girls who received Gardasil were not more likely than those who were unvaccinated to develop multiple sclerosis or other similar diseases http://www.cdc.gov/vaccinesafety/pdf/data-summary-hpv-gardasil-vaccineis-safe.pdf
e n i c c a v HPV s s e n e v i t c e f f e
12 10 8 6 4
Percent reporting genital warts
14
Near-disappearance of genital warts in Australia following introduction of HPV vaccination & 3-dose 70% coverage
93% reduction in girls