HPV, Cancer and the Vaccination Programme Dr Brenda Corcoran Consultant in Public Health Medicine HSE National Immunisation Office
What is HPV? Human papillomavirus Over 200 types identified Spread by direct contact (usually sexual) Most asymptomatic Affects males and females
How common is HPV infection? The most common sexually transmitted disease worldwide About 80% women are infected usually in their late teens and early 20s In the US 79 million infected with HPV 14 million new cases every year
What does HPV infection cause? Some HPV types cause common warts (veruccae) High risk HPV types cause cervical cancer other genital cancers anal cancer head and neck cancer Most infections clear naturally Some progress to pre cancer Some progress to cervical cancer
Worldwide 500,000 new cases 270,000 deaths Ireland Cervical cancer one of the highest rates in Western Europe every year 90 women die 280 women get cancer surgery/ chemotherapy/ radiotherapy infertility 4 in 10 die 6,500 need treatment for precancer
HPV vaccine Recommended by World Health Organization Ireland National Immunisation Advisory Committee (independent expert committee) Recommendation in 2008 All girls age 12-13 years Vaccine most effective at this age
HPV vaccination programme Commenced in 2010 Gardasil HPV vaccine used 2-3 doses required over 6-12 months Protects against 7 out of 10 cervical cancers and pre cancers School based programme 12-13 year old girls (1st year of second level school)
HPV vaccination age in girls in Western Europe Iceland 12 yo girls Finland 11/12 yo girls Norway 12 yo girls Sweden 10-12 yo girls Denmark 12 yo girls The Netherlands 12 yo girls Update: November 2015 United Kingdom 12-13 yo girls Ireland 12 13 yo girls Belgium Flemish community: 12 yo girls French community : 13 yo girls Austria 9 yo girls and boys Spain 11-14 yo girls Germany girls 9-17 yo Switzerland 11-14 yo girls Portugal 10 yo girls Greece 12-15 yo girls France Italy 11-14 yo girls 12 yo girls and boys in some areas 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
HPV vaccine uptake 2010/11-2014/15 Uptake Target target 80% 80% Highest uptake achieved in 2014/15 Excellent cohort retention 97% girls who started dose 1 completed the course
Timeline of Influential Events Japan suspends vaccine recommendation Danish TV documentary Minister questioned in parliament American College of Pediatrics Joint Committee on Health & Children Irish TV documentary 2013 June 2014 2015 Mar May Jun Jul Nov Dec 2016 Jan Jun Sept Anti-vaccine leaflet R.E.G.R.E.T EMA review Go fund me video High Court Action Anti Vaccine Group actions Anti-vaccine media coverage
HPV vaccine uptake 2010/2011-2016/2017 Target 80% ~15,000 girls not vaccinated in 2016/17 Estimated uptake 1 st dose only
Concerns Is HPV vaccine safe? Does HPV vaccine causes serious side effects? What about cervical screening? Does HPV vaccine work?
What about cervical screening? Cervical screening detects pre cancers or cancer of the cervix disease already present requires treatment HPV vaccine prevents 7 out of 10 pre cancers and cancers developing Cervical screening still required after vaccination
Does HPV vaccine work? Pre cancers reduced by up to 75% in countries with high vaccine uptake rates (e.g. Australia and Scotland) The number of new cases of cervical cancer has halved in Australia
Actions Social Video National Media Local Pharmacists Social Workers Nurses Schools Parents GPs Information Politicians Steering group National Immunisation Office Irish Cancer Society HSE Communications CervicalCheck World Health Organization Interested bodies Meetings Public National Parents Council Dept. of Education
Information for parents Actions Offer vaccine again in March/April Information to parents in April/May Short information videos Revised parents leaflet (with quotes)] Offer vaccine to unvaccinated girls
Impact Uptake stabilising No decline in HPV2 ~1-5% increase in HPV1?
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