Title: Cancer Cervix Vaccine
1Our memories of Mahabaleswar
2- CDC - Immunization Update 2006
- Satellite Internet Broadcast
- December, 2006
- Cervical Cancer Vaccine - HPV
Summarized from the CDC Broadcast by Dr.
R.V.S.N.Sarma. M.D., M.Sc.,
3Cervical Cancer
- Cervical cancer is the 2nd leading cancer
amongst women worldwide - 500,000 new cases and 300,000 deaths due to Ca Cx
- gt99 related to human papilloma virus (HPV)
infec. - HPV infect epithelial cells including the genital
tract - HPV type 16 related to half of these cases
- HPV 18, -45, -31, -33, -52, -58 and -35 together
with HPV-16 responsible for 90 of all cervical
cancers worldwide
4Human Papillomavirus
- More than 100 types
- More than 60 cutaneous types
- Can lead to skin warts
- 40 mucosal types
- High risk types (particularly 16 and 18)
- cervical cell abnormalities
- certain anogenital cancers
- Low risk types (particularly 6 and 11)
- cervical cell abnormalities- usually resolve
spontaneously and do not lead to cancer - genital warts
- respiratory papillomatosis
5Natural History of HPV Infection
InitialHPV Infection
Cleared HPV Infection
6Cancer Attributable to HPV - 2006
Cancer Cases 12,000 3,700 4,480 1,000 10,000
Attributable Fraction 100 90 40 40 12
Cancer Cervical Anal Vulvar/vaginal Penile Oral/ph
arynx
7HPV-associated Conditions
Estimated 70 30-50 10
- HPV 16, 18
- Cervical cancer
- - High/low grade cervical
- abnormalities
- Anal, Vulvar, Vaginal, Penile
- Head and neck cancers
- HPV 6, 11
- Low grade cervical
- abnormalities
- Genital warts
- RRP
10 90 90
8Global distribution of HPV types in cervical
cancer
9Human Papilloma Virus Vaccine
- Contains the L1 protein from four types of HPV
(16, 18, 6, 11) - Produced using recombinant DNA technology
- L1 proteins self assemble into non-infectious
units called virus-like particles (VLPs) - VLPs are highly immunogenic
10HPV Vaccines
- L1 VLPs made in insect cells
- GSK 16 and 18 - Cervarix
- i.m. 3 shots 0, 1 and 6 month
- VLPs made in yeast cells
- Merck 16,18,11 and 6 -Gardasil
- i.m. 3 shots 0, 2 and 6 month
11HPV vaccine news headlines
- Vaccine prevents most cervical cancers. - New
York Times, October 7, 2005. - Vaccine proves 100 percent effective in
preventing cervical cancer Seattle Times,
October 6, 2005. - Promising new vaccines could wipe out cervical
cancer. But they must be administered to
preteens, and some groups oppose that.
Philadelphia Inquirer, July 4, 2005. - OK Roll up your sleeve new vaccines are
arriving but the economics are still a challenge
Business Week, July 25, 2005.
12Efficacy of HPV Vaccine Among 16-26 year-old
Females
Package insert Gardasil . Integrated dataset
results in the per-protocol populations CIN
cervical intraepithelial neoplasia AIS
adenocarcinoma in situ
13Human Papillomavirus Vaccine Efficacy
- High efficacy among females without evidence of
infection with vaccine HPV types - No evidence that the vaccine had efficacy against
existing disease or infection - Prior infection with one HPV type did not
diminish efficacy of the vaccine against other
vaccine HPV types
14HPV Vaccine Schedule
- Approved for females 9-26 year of age
- 3 doses at 0, 2, and 6 months
- Minimum intervals
- 4 weeks between doses 1 and 2
- 12 weeks between doses 2 and 3
15HPV Vaccine Provisional ACIP Recommendations
- Routine vaccination of ? at 12 years of age
- The vaccination series can be started as young as
9 years of age at the clinician's discretion - Vaccination is recommended for females 13-26
years of age who have not been previously
vaccinated - Ideally vaccine should be administered before
onset of sexual activity - Females who are sexually active should be
vaccinated
16HPV Vaccine Special Situations
- Females 26 years of age or younger with,
equivocal or abnormal Pap test, positive HPV DNA,
and genital warts may be vaccinated - Vaccine will have no effect on existing disease
or infection
Provisional ACIP recommendation, June 2006
17HPV Vaccine Special Situations
- Females 26 years of age or younger who are
lactating/breastfeeding or are immuno-compromised
may be vaccinated - NOT recommended for pregnant women
Provisional ACIP recommendation, June 2006
18Screening for Cervical Cancer
- Why get screened?
- Screening was developed to detect abnormal
cervical cells in the early stages when it is
easy to remove them - Who should be screened?
- Women from 25-65 years
- Once every 3 years
19HPV Vaccine and Cervical Cancer Screening
- Cervical cancer screening recommendations have
NOT changed for females who receive HPV vaccine - 30 of cervical cancers caused by HPV types are
not prevented by the quadrivalent HPV vaccine - Vaccinated females could subsequently be infected
with non-vaccine HPV types - Sexually active females could have been infected
prior to vaccination - Providers should educate women about the
importance of cervical cancer screening
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21Adding up the facts
- HPV is present in the majority of sexually active
adults - Presence of HPV does not indicate promiscuity
- HPV is short lived and asymptomatic in most
adults - If high risk HPV (16 and 18) persists can cause
Ca CX - Cervical cancer kill 200,000 women worldwide
annually - 70 of Ca Cx is due to HPV 16 and 18 types
- HPV vaccine given at age 11, eliminates 70 of Ca
Cx - HPV vaccine does not replace screening for Ca Cx
- HPV vaccine in men prevents Ca Penis and genital
warts - Rapid adoption of HPV vaccine is right and
essential
22US National Immunization Program
- Hotline (800) CDC-INFO
- Email nipinfo_at_cdc.gov
- Website www.cdc.gov/nip
- Broadcast Updates and Resources Web Page
- www.cdc.gov/nip/ed/UpdatesandResources.htm
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