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.

Pandemics!

When there was outbreak of SARS, Ebola, H1N1 influenza, HIV and other certain diseases in the past such as Cholera, Plague (Black death), everyone all around the world were concerned about those diseases.  They spread over many countries in a short span of time, claiming many lives, causing anxiety, panics, terrors and sufferings. Whereas, there are other diseases, which are contained within certain geographic spaces. 

The recall of HIV/AIDS Pandemic as a child in rural Nepal

The first pandemic I became aware of was HIV/AIDS. After its spread from one country after another country, it also invaded the border of Nepal along with identification of the first case of HIV in 1988. HIV contracted one after another since then fueled by stigma, scarce knowledge about disease pathology, lack of management facilities. I have vivid image of my childhood where HIV was so stigmatized and people's perception about its mode of transmission: the illicit sexual act. When I was in middle school, it became more apparent due to its coverage in news and media, educational forums, debates. As I saw the epidemic rise of HIV/AIDS during my childhood, this childhood memory of HIV/AIDS as fear producing factor always relates to subsequent pandemics. 

Conditions favoring Pandemics

1. New antigens or infectious diseases: as people are not immune to new antigens or infectious diseases, there is possibility. Sometimes, the diseases are under researched or so new that we become unaware of its route of transmission. As in case of HIV/AIDS, at first it was thought it was transmitted among gay men only. It took several years to identify the modes of disease transmission.
2. Antigenic shift
3. Globalization: global diffusion of SARS traces back to the visit of a case (from Guangdong China) of SARS in Hong Kong in 2003 thereby spreading SARS to other people staying in the same hotel. Then the infectious agents of SARS travelled to different countries along with those people.
4. Bioterrorism: Use of biological agents as a means of war can bring pandemics.

Disease outbreak Vs Epidemic Vs Pandemic

Disease outbreak occurs when the disease occurs in many people at a time more than expected at that point of time or more than usual occurrence. However, sometimes there shouldn’t necessarily be occurrence in large number of people, a single disease case is still considered outbreak. For example, one case of yellow fever in Nepal is considered outbreak/epidemic as there is no occurrence of yellow fever in the past. Public health professionals and the disease surveillance system should be effective enough to identify such outbreaks to tackle its spread and management in time. Outbreak is usually used to refer to a small geographical region.

Epidemic: If the disease outbreak is concentrated in a certain geography or within certain communities and if there is no possibility of spread in other regions or countries, then it is called disease epidemic.

Pandemic: When the disease spreads over several countries, continents or all around the world, usually affecting large number of people, this is termed as Pandemics.