HPV Vaccination

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HPV Vaccination

• Sandra Holmes, GPR
• Academy Medical Centre
• Forfar
• 13th May 2008

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Overview

• Cervical Cancer an overview
• HPV the facts
• HPV Cervical Cancer
• Vaccination where we are now
• Implications for practice
• Future considerations

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Cervical Cancer

• 2nd most common female cancer lt35yrs1
• Incidence c. 3000 new cases/year1
• Mortality c. 1000 (899-1100) deaths/year1
• Aetiology HPV DNA detected in 99.72
• Co factors
• Smoking3
• (High Parity)
• (COCP use)
• Immunodeficiency
• ?Stress

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HPV

• Common infection
• non-systemic
• contact transmission
• majority spontaneously cleared
• gt 200 viral types
• Strong correlation with CIN
• Vulval/Vaginal/Anal Intraepithelial Neoplasia
• Genital warts
• Oropharyngeal cancer4

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HPV Cervical Cancer

• lt 1 HPV infections result in cervical cancer
• 99.7 cervical cancers are associated with HPV
• HPV 16 18 70
• 90 due to 8 HPV types5
• How?
• Integration of viral genome into host DNA
• Viral genes oncoproteins
• Host tumour suppressors inactivated
• Geddit?!

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Vaccination

• 2 licensed vaccines
• Gardasil
• HPV 16, 18, 6 11
• Sanofi Pasteur
• Cevarix
• HPV 16 18
• GSK
• Contraindicated
• Vaccine hypersensitivity
• Pregnancy
• 400 less cervical cancer cases/year

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Vaccination Proposals

• June 2007 Joint Committee on Vaccination
  Immunisation (JCVI) recommended vaccination in
  school girls
• November 2007 DoH announced programme
• commence September 2008
• delivered via schools
• catch-up autumn 2008/9

• NOT for 18-25 year olds

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Vaccination and Primary Care

• Likely delivered in schools
• Primary care team role
• School drop outs
• Migrants
• Special cases
• ?Others
• Funding remains unclear

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Future Considerations

• Which vaccine?
• Should it be more widely available?
• Efficacy sustained?
• Impact on
• cervical screening
• STIs
• replacement phenomenon

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Any Questions??
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References

• Office for National Statistics, Cancer Incidence
  Mortality in the United Kingdom 2002-04. 2007
• Walboomers, JM, Jacobs MV, Manos MM, et al. Human
  Papilloma virus is a necessary cause of invasive
  cervical cancer worldwide J PAthol
  1999189(1)12-9
• Plummer M, Herrero R, Francheschi S, et al.
  Smoking and Cervical Cancer pooled analysis of
  the IARC multi-centric case-control study. Cancer
  Causes Control 200314(9)805-14
• Parkin DM (2006). "The global health burden of
  infection-associated cancers in the year 2002".
  Int. J. Cancer 118 (12) 3030-44.
• Clifford G, Francheschi S, Diaz M, et al. Chapter
  3 HPV type-distribution in women with and
  without cervical neoplastic diseases. Vaccine
  2006 24 Suppl 3S26-34