HPV Vaccine

HPV Vaccine : A Fact File

There is lot of noise in media about HPV vaccine... Get the real picture!!!

The uterus consists of two parts, the body and the neck. The neck is called the cervix. This cervix has risk of getting cancer. It is called cervical      cancer, one of the common cancers in females.

A lot of research is going on in the world to prevent cervical cancer and early detection in order to reduce deaths from this disease.

Human papilloma virus (HPV) is implicated in causing cervical cancer, contracted through sexual intercourse.

There are hundreds of varieties of the papilloma virus, these are numbered, about 13 strains cause cancer, no. 16 and no.18 cause 70% of the      cancers, nos.31,35 etc. cause the rest 30%.Other strains like 6 and 11 cause the genital warts, the wart causing viruses do not cause cancer.      Most strains cause asymptomatic infection.

HPV is contracted through sexual intercourse, both anal and vaginal. It's a marker for sexual activity. Besides cervical cancer, it can also cause      anal and vaginal cancer but the incidence of these is less than that of cervical cancer.

Once someone contracts HPV infection, the immune system in the body mounts a response and it gets cleared within 2 years in most of the      people. It can lie dormant in the cells for years, without causing a problem, in a few it can initiate changes which can lead to cancer over a      period of time, how long it takes to cause cancer depends on the individual immunity.

Early age at first intercourse, multiple partners, multiparity {many children}, smoking, low socio-economic status, all increase the risk of      developing this cancer.

In my present urban practice in India, I see about 2 cases a year that come from a lower socioeconomic background, In the middle and higher      income group, where there is one to one relationship, limited family size, I have seen only 3 cases over a period of 18 years, the first had a 8      children, the second was the second wife and had 7 children, third was married 3 times.

When I was working in the U.K, 25% of our hospital work load involved cervical cancer screening and treatment of abnormal Pap Smears.      Their lifestyle is different, by the time they finally settle down with a partner, they would have had more than one partner, their partner      would have had more than one partner, and this compounds the risk of HPV infectionand the consequences. Smoking in women is also      quite prevalent in Western population.

In the Indian context, our tradition of chastity, sexual activity within the sanctity of the institution of marriage, non smoking, all contributes      to the low incidence of cervical cancer in the middle and higher income group. These values have to be emphasized as primary preventive      strategies against cervical cancer.

Primary prevention involves HPV vaccine, secondary prevention involves doing Papanicolou {Pap smears} to detect early changes in the shed      cervical cells leading to cancer.

HPV Vaccine is available, it prevents infections with 16 and 18 strains{GARDASIL],it does not prevent cancer directly, it may prevent indirectly      thru prevention of infections with 16 and 18 strain only, it does not prevent infection of other cancer producing strains.

CERVARIX also prevents infection with 6 and 11 strains which cause genital warts.

The vaccine should be ideally given to teenage girls well before they become sexually active. The vaccine course is over 6 months, expensive,      and long term results not known. It produces immunity for 4 years, whether booster is needed after this period or not, that data is still not      available. The irony is, it is afforded by people who do not need it; those who would actually benefit from it, cannot afford it.

In Australia, even boys are offered vaccination, it's a govt. initiated programme, to overall reduce HPV infection in the population.

Also, we assume promiscuity when we propose to vaccinate, Of course, our children are exposed to western lifestyles, they travel at a young      age away from home to study and /or to work, the media, the television exposes them to the permissive lifestyle, in anticipation, vaccine      may be given but its benefits are still not satisfactorily proven.

There is a possibility that security from cervical cancer risk after vaccination can backfire and can promote promiscuity.

Indian Govt. usually gives approval after it has been tested in the Indian population but in the context of HPV Vaccine, it has gone by the      western research and given sanction to market it.

Secondary prevention thru Pap Smears has to continue because other strains can still infect and cause cancer.

If you still have any queries, do fix an appointment so we can sort out individual concerns!


Dr. Fatima Poonawala MRCOG (UK)
October 2011

Waterbirth

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