HPV is the root cause for the 7 735 new cervical cancer cases every year and is the second leading cause of female cancer in SA. It is estimated that one woman dies from cervical cancer every 10 minutes in sub-Saharan Africa.
“Cervical cancer is the leading cause of cancer mortality in SA,” said gynaecology oncologist Dr Trudy Smith. With almost all cervical cancers are caused by longstanding infection with one of the HPVs, South Africans are in urgent need of education.
CANCERS LINKED TO HPV
More than 120 strains of HPV have been identified, and 30 of these are associated with below-the-belt cancer for both women and men. Globally, HPV is thought to be responsible for more than 90% of anal and cervical cancers, about 70% of vaginal and vulvar cancers, and more than 60% of penile cancers. HPV can also cause cancer in the back of the throat.
HPV: THE FACTS
HPV is a hardy virus resistant to heat and drying, and can survive on inanimate objects such as clothing and laboratory equipment that have come in contact with infected patients, although the precise survival time is unknown.
The virus causes a variety of diseases in both males and females including but not limited to cervical, vaginal, anal, vulvar cancer, and genital warts.
Infections may have no symptoms but the virus can still be transmitted. Once a HPV virion invades a cell, an active infection occurs, and the virus can be transmitted. Several months to years may elapse before lesions develop and can be clinically detected.
HPV is not only transmitted sexually and has been found quite frequently in young women without prior experience of sexual intercourse.
RISK OF HPV INFECTION
HPV infections are very common. “The cumulative risk of acquiring cervical HPV infection in women with only one sexual partner is 46%, said Dr Smith. “The risk of acquiring HPV infection is high even after first intercourse, and continues throughout a woman’s sexually active lifetime. Up to 80% of women will acquire an HPV infection in their lifetime. While most infections are cleared, women are less likely to clear infections as they get older.”
But there is a way to cut the risks associated with HPV. The HPV vaccine can help reduce the risk of HPV related cancers and is recommended for young women and men, aged 9-26.
“When it comes to vaccination, an informed consumer is a good consumer,” said specialist gynaecologist Prof Hennie Botha. “We want to change the way people think about the disease, leading towards a culture of trust.”
“The WHO recommends a comprehensive approach to cervical cancer prevention and control including screening and vaccination, said Dr Smith. While screening identifies existing precancerous lesions, vaccination potentially prevents them occurring in the first place.
WHAT IMPACT HAS THE HPV VACCINE HAD SO FAR?
HPV vaccination is having a clear impact in reducing the spread of HPV. According to the WHO the immediate signs of this are reductions in the number of women with cervical lesions and a dramatic drop in the number of men and women suffering from genital warts. Whenever HPV transmission is reduced, this will be followed over a period of several years or decades by a drop in cases of cervical and other HPV-related cancers.
HPV VACCINES IN SA
The Medicines Control Council (MCC) of SA approved two HPV vaccines in 2008. The bivalent (2) vaccine contains viral like particles (VLPs) of HPV types 16 and 18. The quadrivalent (4) vaccine contains VLPs of HPV types 6, 11, 16, and 18. “The two vaccines available in SA are very effective,” said Prof Botha.
- Vaccine licensed for boys and girls
- Age 9-14: need 2 doses (0 and then 6 months)
- Up to 13 months after last vaccine
- 15 years upwards: need 3 doses (0, 1 month, 6 months)
- Licensed for boys and girls
- Age 9-14: need 2 doses (0 and then 6 months)
- 15 years upwards: need 3 doses (0, 2 months, 6 months)
“There’s no doubt that HPV is the cause of cervical cancer,” said Dr Smith. “Through vaccination, cervical cancer is a preventable disease in the long term,”
MILESTONES IN SA
MAY 2013: Minister of Health announced two-dose programme in public schools to protect grade 4 girls.
February 2014: High level commitment: Department of Health (DoH) and Department of Education launched school-based HPV vaccination programme for all girls 9 years and older in grade 4 in public schools as part of the existing Integrated School Health Programme (ISHP). Targets almost half a million girls.
- 1st vaccine administered to grade 4 girls
- Teams visited over 90% of all public schools
- Over 87% (approximately 345 377) grade 4 girls immunised
There are many misconceptions about vaccination and you will no doubt face a number of questions from patients. Here are the answers to two of the big questions:
- HAS THE VACCINE BEEN PROPERLY TESTED?
Yes, both of the HPV vaccines available in SA were tested in extensive clinical trials before being licensed. The first HPV vaccine was licensed in 2006, and since then more than 270 million doses of HPV vaccines have been distributed in 74 countries.
- IS THERE ANY INDICATION THAT VACCINATION CAUSES AUTISM?
No. Many small and large-scale studies have looked for a link between any vaccination and autism, but no link has ever been found. Moreover, studies have shown that autism does not occur any more frequently in infants born to mothers who have received the HPV vaccine than in mothers who have not received the vaccine.