HPV vaccination: Primary prevention of cervical cancer

HPV vaccines

Human Papilloma vaccine (HPV) is a unique vaccine as this is intended against the virus amidst many available vaccines that are produced against bacteria. HPV, in abbreviated form, is given to develop immunity against the Human Papilloma virus. Available HPV vaccines are recombinant vaccines, which include genetically engineered HPV like virus particles.
Two doses of HPV vaccines at 6 months’ interval is recommended for girls of age 9 to 13 years by WHO. The age of the girls is specified to make sure that the girls get this vaccine before they contract HPV viruses by any means or sexual transmission.

Currently Available HPV vaccines

Ceravix : Effective against HPV STRAINS of 16, 18

Quadrivalent Gardasil: This is effective against HPV strains of 6,11, 16, 18

Gardasil 9: This includes antigens against 9 different strains of Human Papillomaviruses

All of these HPV vaccines are given intramuscularly.

Cervical cancer, caused by HPV, is one of the commonest cancers in women of developing countries. Thanks to human intelligence, this life threatening malignancy can be prevented by comprehensive implementation of preventive approaches, one of them being HPV vaccination.

Human Papilloma Virus

Human Papilloma virus infection leads to a range of manifestations from some epithelial lesions, warts to life threatening malignancies. Though Papillomavirus can cause other ano-genital, oropharyngeal cancers, cervical cancer has been extensively studied in relation to Human Papilloma virus because of its high magnitude among women especially in developing regions.
Most of the cancers of anal, oropharyngeal, cervix, are caused by human papilloma virus infection. These cancers are preventable if we could prevent and manage Human Papilloma Viruses infection.

Which Human Papilloma virus is responsible for cervical Cancer?

There are different strains of Human Papilloma viruses, however, mainly the strains HPV 16, 18 are attributed to cause cervical cancer. They can also cause premalignant genital lesions and other many strains cause genital warts, lesions of cervix, vulva, vagina.

What makes Nepalese women more vulnerable to HPV infection?

HPV infects not only women, rather it can affect both male too. However, the prevalence of high cervical cancers and susceptibility of women demands solemn attention.

Low awareness on HPV: women of this generation hardly knew about the relation of infection with human papillomavirus and cervical cancer. This lack of awareness prevented us from taking measures that would have helped in management of HPV infection. Nevertheless, upcoming new generation will be more aware and have means to prevent HPV infection

Reproductive health, hygiene and rights: Early marriage, sexual violence can lead to exposure to HPV viruses. Reproductive health especially sexual health is not much talked issue in developing countries due to stigma, hesitancy, and traditional mindsets. Sexual problems are like the iceberg in the sea, much of large chunk still under sea as people don’t want to expose about reproductive health problems and people are shielded from the right information on reproductive health.

HPV vaccination in Nepal

Government of Nepal has forwarded this important step with piloting of HPV vaccinations with support from GAVI alliance. This will be scaled up subsequently nationally. this vaccine is relatively novel and expensive vaccine. Hence, the feasibility of the sustainable inclusion in the national immunization program requires strong commitment from the government and generosity of the donors and International organizations.
Other primary preventive approaches such as sexuality education to both girls and boys, male circumcision, condom use, health information and warnings about tobacco use should be implemented effectively to curtail the cervical cancer burden.

“मेरो बर्ष २०७४: म स्वस्थ, मेरो देश स्वस्थ”

Healthy Year 2074: A New Start in Nepal's Health System

This is a promising start from health minister Mr. Gagan Thapa in Nepalese Public health sector. It triggered many of us; It impressed many forerunners in health profession. Indeed, we need something, be it some goals, deadlines or slogans to keep us moving. Let’s remember, we are so much driven by millennium development goals and sustainable development goals to meet their targets. So, this new campaign of “My Year 2074: I am Healthy, My country is healthy” (this is my unofficial translation of the slogan) will surely motivate us to remain committed for keeping ourselves and our people healthy.

Our health system was quite sensitive towards tobacco related products but the alcohol drinking was overlooked issue and this commitment is expected to aware people of harmful effects of alcohol resulting reduced consumption. Our country is being rapidly urbanized and many of us live sedentary lives in a chair so the slogan of remaining physically active will surely benefits many of us, who are living sedentary lives.

Another slogan refers to appropriate and right consumption of locally available healthy and balanced diet. As we say, ‘We are what we eat’, this will encourage us in supplementing the diet required for growth and development and regeneration of people in every age group. Regular health checkup screens diseases in its early phases making primordial, and primary prevention enough. This further reduces cost of individual and the health system. The fifth slogan tries to accommodate all the health issues related to family planning, child bearing and rearing, neonates, infants and children and old age people.

Some addition in set of commitments

If we critically see the slogans of this campaign, it is much oriented towards preventing the non-communicable diseases. It has proactively attempted to capture the transition of our communicable disease burden to non-communicable diseases. But, we still have pre-existing conditions that trigger the transmission of communicable diseases such as lack of improved sanitation and safe drinking water. This bothers us many of public health professionals including me, much than remaining physically active. Though, we have come in the 21st century, only the time passed, we are still far behind.
In some parts of the country, people live the lifestyle of early twentieth century and some live like in 21st century. Because of this vast differences in life styles, living standards, awareness level, I seriously want to include the components of waste management, personal hygiene, sanitation facilities, clean city and improved housing, improved drinking water in this slogan. Let’s quit the use of tobacco product and alcohol drinking; Let’s remain physically active; Let’s have healthy and balanced diet; Let’s perform regular health check up; Let’s spread awareness on Family and community health issues.

“My commitment to My Year 2074”

I will Commit to following points in Year 2074 and onwards..

I will quit the use of tobacco product and alcohol drinking.

I will remain physically active.

I will have healthy and balanced diet.

I will perform regular health check up.

I will remain aware of Family and community health.

Yes,

I will keep personal hygiene.

I will keep my house and city clean.

I will have improved sanitation and safe drinking water.