HPV vaccine for teenagers

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HPV vaccine for teenagers
Dr Sally Ferguson with thanks to MSD.. for most
of the slides
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What is HPV?

• HPV is a common virus (the human papillomavirus)
• Some HPV types can cause genital warts
• Other types can infect a womans cervix and lead
  to cervical cancer over many years

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The Problem

• Lifetime risk of genital /cervical HPV 1 in 2
• Lifetime risk of HGSIL is 1 in 25
• Lifetime risk of Cervical cancer is 1 in 31 (no
  pap smears done)
• Lifetime risk of Cervical cancer 1 in 125 (having
  pap smears)
• Lifetime risk of genital warts 1 in 8

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Natural history of HPV infection to Cervical
cancer

01yrs
05yrs
120yrs
High Grade Precancers (CIN 2/3)
HPV infection
Persistent infection
Cervical Cancer
Low Grade Precancers (CIN 1)
Recovery HPV clearance90
Pinto AP, Crum CP. Clin Obstet Gynecol.
200043352362.
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HPV related diseases in Male and Female
HPV Attributable

• Female cancers
• Cervix 100
• Vulva 40
• Vagina 40
• Anus 90
• Oro-pharynx 12
• Other illnesses
• RRP (larynx wart in children) 100
• Genital Wart 100

• Male Cancers
• Anus 90
• Penis 40
• Oro-pharynx 12
• Other illnesses
• RRP 100
• Genital Wart 100

Parkin DM Lacey CJN Vaccine 2006 S3/17 35
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HK Cervical Cancer (1996-2010)
10th among female cancers Lifetime risk 1 in
145
New Case 400 (2010)
Death 146 (2010)
Report of Hong Kong Cancer Registry HA
2010 http//www3.ha.org.hk/cancereg/
Crude rate 10.7 per 100,000
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Genital warts are common in Hong Kong

• New cases per year
• Genital Warts 11, 524
• 204 cases per 100,000 adults

Lin C BMC Infect Dis. 2010 Sep 17 10 272
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?????????
Prevention is better than Cure
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99.7 Cervical cancers are associated with HPV
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HPV Vaccine technology

• Empty Shell formed by recombinant biotechnology
  to mimic the viral 3D shape.
• Does not contain infectious DNA?
• Does not contain mercury (thimerosal)

Real Virus
Vaccine
GARDASIL is a trademark of Merck Co., Inc.,
Whitehouse Station, NJ, USA. VLP Virus-like
particle. 1. Villa LL, Costa RL, Petta CA, et
al. Lancet Oncol. 20056271278.
Image courtesy of Dr. Ian Frazer
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Dosing schedule

• GARDASIL Intramuscular injection (IM)
• Recommended schedule
• 3 doses at month 0,2,6
• Completed within 1 year will be considered as
  per-protocol
• CERVARIX Vaccine
• 3 doses at month 0,1,6

month
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4 in 1 vaccine 9 years Long Term follow-up
9 years Antibody report 8 years Efficacy report
Gardasil No breakthrough case up to 8 years
Nygård M IPC 2012 Nov 30 Dec 6, Puerto Rico,
EP-741
015 LONG-TERM FOLLOW-UP
015 LONG-TERM FOLLOW-UP
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How long is the duration of protection?Is booster
dose needed?

• US CDC 2012 Feb
• Gardasil vaccine information statement
• Protection from HPV vaccine is expected to be
  long-lasting
• Additional (booster) doses are not recommended.

http//www.cdc.gov/vaccines/pubs/vis/downloads/vis
-hpv-gardasil.pdf
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All women are at risk of HPV infection
All HPV High risk HPV Low risk HPV

Chan et al. Determinants of cervical human
papillomavirus infection differences between
high and low oncogenic risk types. J Infect Dis
2002 185 28-35.
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Gardasil / Silgard Approvals
GARDASIL approved in 127 countries (includes 24
GAVI-eligible)
Europe Germany Cyprus Ireland France
Czech Republic Latvia UK
Denmark Lithuania Spain
Estonia Luxembourg Italy
Finland Malta Austria Greece Netherlands Belgium
Hungary Norway Bulgaria Iceland Poland Portugal Ro
mania Slovakia Slovenia Sweden Serbia Montenegro S
witzerland Liechtenstein Bosnia Russia Belarus Cro
atia Turkey Ukraine Herzogovina Macedonia Albania
Caribbean Central America Costa Rica
Trinidad/Tobago Puerto Rico El
Salvador Guatemala Honduras Curaçao
Nicaragua Bermuda Panama Bahamas Cayman
Islands Barbados Aruba Jamaica Dominican Republic
North America USA Canada Mexico
Asia Pacific Japan Kyrgyzstan Uzbekistan Kazakh
stan Australia Indonesia Korea Taiwan Hong
Kong Singapore New Zealand Macau Malaysia Philippi
nes Thailand India Vietnam Fiji Bhutan Georgia JAP
AN Sri Lanka Brunei
42
3
South America Brazil Bolivia Argentina Uru
guay Peru Ecuador Colombia Chile Paraguay
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22
35
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Middle East Africa Gabon Namibia Israel C.A.R.
Morocco Mauritius Kenya Kuwait Mauritania UAE
Guinea Eq. Ethiopia Uganda Togo Malawi Congo
Brazzaville Jordan Egypt Cote dIvoire Burkina
Faso Chad Bahrain Botswana Lebanon Tanzania Zambi
a South Africa Cameroon Nigeria Pakistan Tunisia M
ali Guinea Conakry Saudi Arabia Rwanda
GAVI Eligible Registration Approvals (24)
Burkina Faso, Cameroon, Central African Republic,
Chad, Congo (DR), Cote dIvoire, Ethiopia, Guinea
(Conakry), India, Kenya, Kyrgyzstan, Malawi,
Mali, Mauritania, Nicaragua, Nigeria, Pakistan,
Rwanda, Tanzania, Togo, Uganda, Uzbekistan,
Vietnam, Zambia
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(No Transcript)
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Routine immunization of Male with Gardasil in US
and Australia ( and Canada)
US 11 - 21 Male
Australia 12 - 13 Male
Accessed 26 Oct 2011 http//www.cdc.gov/media/rele
ases/2011/a1025_ACIP_HPV_Vote.html http//www.merc
k.com/newsroom/news-release-archive/vaccine-news/2
011_1025.html http//www.pbs.gov.au/industry/listi
ng/elements/pbac-meetings/pbac-outcomes/ 2011-11/n
ov-2011-pbac-outcomes-positive-recommendations.pdf
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The near disappearance of genital warts in young
women 4 years after Gardasil program in Australia

• Female lt21 ? 90 Male lt21 ? 87

Read TR Sex Transm Infect. 2011 Oct 4
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Trend of genital warts after universal HPV
vaccination
2 in 1 HPV vaccine
4 in 1 HPV vaccine
UK
Australia
UK Health Protection Agency Report 2010
Read TR Sex Transm Infect. 2011 Oct 4
Data are NOT generated from head-to-head study
and results are NOT directly comparable because
of differences in the methodologies and analysis
populations.
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HPV vaccine is for men and women
To prevent vaccine type relatedFemale Cervical
?vaginal?vulvar Cancers and genital wartsMale
genital warts

4-in-1 HPV vaccination
Regular Pap screening