The Ministry of Health in Anguilla will shortly introduce HPV vaccination in Anguilla. This is great news and is another step in preventing a number of cancers especially cancer of the cervix. The World Health Organization (WHO) recommends HPV vaccines as part of routine vaccinations in countries that can afford them, along with other prevention measures. HPV vaccination before sexual activity can reduce the risk of infection by the HPV types targeted by the vaccine.
What are human papilloma viruses?
Human papilloma viruses (HPVs) are a group of more than 200 related viruses. More than 40 HPV types can be easily spread through direct sexual contact, from the skin and mucous membranes of infected people to the skin and mucous membranes of their partners. They can be spread by vaginal, anal, and oral sex. Other HPV types are responsible for non-genital warts which are not sexually transmitted. Two types of HPV viruses namely, types 16 and 18, are responsible for most HPV- caused cancers.
HPV infections
HPV infections are common in many countries including Anguilla. Most high-risk HPV infections occur without any symptoms, go away within 1 to 2 years, and do not cause cancer. Some HPV infections, however, can persist for many years. Persistent infections with high-risk HPV types can lead to cell changes that, if untreated, may progress to cancer.
Preventing HPV infections
Individuals who are not sexually active almost never develop genital HPV infections. Anyone who has ever been sexually active (that is, engaged in skin-to-skin sexual conduct, including vaginal, anal, or oral sex) can get HPV infections.
Correct and consistent condom use is associated with reduced HPV transmission between sexual partners, but less frequent condom use is not. However, because areas not covered by a condom can be infected by the virus, condoms are unlikely to provide complete protection against HPV infection. A number of vaccines given before the onset of sexual activity have been shown to be effective in preventing HPV infection. They are not effective at treating established HPV infections.
Types of HPV vaccines available
The three most widely available vaccines for preventing HPV infections are Gardasil, Gardasil 9 and Cervarix. All three vaccines prevent infections with HPV types 16 and 18 – two high-risk HPVs that cause about 70 percent of cervical cancers. Gardasil also prevents infection with HPV types 6 and 11 which cause 90 percent of genital warts. All three vaccines are given through a series of injections into muscle tissue over a 6-month period.
How effective are HPV vaccines?
HPV vaccines are highly effective in preventing infection with the types of HPV they target when given before initial exposure to the virus – which means before individuals begin to engage in sexual activity. In the trials that led to approval of Gardasil and Cervarix, these vaccines were found to provide nearly 100 percent protection against persistent cervical infections with HPV types 16 and 18, and the cervical cell changes that these persistent infections can cause. To date, protection against the targeted HPV types has been found to last for at least 8 years with Gardasil and at least 9 years with Cervarix. Individuals having these vaccines should still have their cervical screening tests (Pap tests) at regular intervals.
How safe are the HPV vaccines?
All HPV vaccines have been tested in thousands of individuals and have been found to be safe and effective. So far no serious side effects have been noted. The most common problems have been brief soreness and other local symptoms at the injection site. These problems are similar to those commonly experienced with other vaccines.
Do women who have been vaccinated still need to be screened for cervical cancer?
Yes! HPV vaccines do not protect against all HPV types that can cause cancer. Screening continues to be essential to detect precancerous changes in cervical cells before they develop into cancer.
PREVENTING CANCER OF THE CERVIX
Despite the many advances, women in Anguilla continue to die from cancer of the cervix. Measures must continue to decrease this deadly cancer. Widespread vaccination with HPV vaccines has the potential to reduce cervical cancer incidence around the world by as much as two-thirds. The combination of HPV vaccination and cervical screening can provide the greatest protection against cervical cancer in Anguilla.
The Ministry of Health in Anguilla will introduce HPV vaccination in April 2016, into the national vaccination schedule. The target group is girls from 9 to 13 years of age who will receive two doses six months apart of the bivalent HPV vaccine. This age group has been targeted because the HPV vaccine is most effective when administered prior to sexual debut. There is strong evidence in Anguilla and around the region that children have had their sexual debut as young as age ten. (Global School Health Survey 2009; PAHO Adolescent Health Survey 2002, A Portrait of Adolescent Health in the Caribbean 2000). Administering the drug at this age provides the body sufficient time to produce the protective antibodies to HPV conferred by the vaccine.
Conclusion
The introduction of HPV vaccination in Anguilla this year is wonderful news for many as it would greatly help to decrease the incidence of cancer of the cervix ad other cancers in Anguilla, thereby preventing untimely deaths. These vaccines, for young people who are not sexually active, would help to decrease the incidence of HPV infections which are associated with cervical cancer. The vaccines are safe and effective. Other strategies to combat cervical cancer must continue – such as regular medical check-ups and screening and safe and healthy lifestyles.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge MB BS DGO MRCOG, is an Obstetrician/Gynaecologist and Family Doctor who has over thirty-two years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
