HPV vaccination drives to prevent cervical cancers

By Dr. Ananya Mandal, MDAug 31 2011

HPV vaccination campaign in Mexico

Mexico plans to administer the vaccine against human papillomavirus (HPV), which can cause cervical cancer, to all girls beginning next year, the country's health ministry said Tuesday.

Starting 2012, the HPV vaccine will be part of the normal course of shots given to all girls at the age of nine, Health Minister Jose Angel Cordova announced. HPV is sexually transmitted and most of the time the body can clear it on its own. However, in some cases the infection remains and can eventually lead to cervical cancer. HPV types 16 and 18 account for 70 percent of cervical cancer cases worldwide, which number about 500,000 per year, according to the UN Population Fund (UNFPA). The vaccine can provide protection against these types of HPV.

Cervical cancer kills about 4,200 women in Mexico each year. The minister said while deaths from cervical cancer had fallen 47 percent in the country over the past two decades, there was still 13.4 cases for every 100,000 women last year.

Mexican health authorities hope that by making the HPV vaccine universal, they can cut the mortality rate from this type of cancer by 50 percent for women over the age of 25.

HPV vaccination Quebec

The provincial public health authority - Sante et Services Sociaux Quebec, has started a new HPV vaccination campaign.

As of 2008, the vaccine has been offered for free to pre-adolescent and teenaged girls (currently available for boys also). However, since then, the responsiveness of the targeted population has been only reducing. The complications and the secondary reactions have raised safety concerns, as well as the lack of accessibility to gynecologic specialists that should monitor any health changes accordingly, make the vaccine itself a risk as high as the HPV itself that most parents are not willing to take. About 325 cases of cervical cancer are diagnosed annually in Quebec; cervical cancer causes about 80 deaths a year in the province.

The vaccine is also being introduced for boys, and Dr. Giosi Di Meglio with the Montreal Children's Hospital said that is good news. “They are the carriers, and I think that it makes sense if you want to block the transmission of the virus to block it in as many ways as possible,” he said. In boys and men the vaccine is said to protect against genital and anal warts and oral cancers.

Public Health officials say there is conclusive evidence connecting cancer and HPV and that denying children the vaccine would be unethical.

HPV vaccination barriers

Barriers that hinder young African-American, Hispanic and poor women from completing a series of three vaccinations to prevent HPV leave them at higher risk for cervical cancer and death.

This comes from a new study from the Yale School of Public Health that extends previous findings of the disparity in a nationally representative group. The study appears online and in the October issue of the American Journal of Preventive Medicine.

Lead study author, Linda Niccolai, Ph.D., an associate professor of epidemiology said, “The degree to which these vaccines reduce disparities in cervical cancer is going to depend on adequate uptake by women who need them most.”

The team uses data collected from the federal government’s 2008-2009 National Immunization Survey on teen girls who received at least one dose of HPV vaccine. During that period, 55 percent of the adolescents received all three doses, 21 percent received one dose and 24 percent received two. While not ideal, the authors cited an “encouraging” annual completion rate increase from the first study year to the second.

In the United States, clinicians diagnose approximately 12,000 new cervical cancer cases each year, resulting in about 4,000 deaths, according to the CDC. The Advisory Committee on Immunization Practices recommends routine use of either vaccine in a three-dose series for girls ages 11 or 12. The committee recommends the second dose two months after the initial dose, and the third three to six months after the first dose.

African-American, Hispanic and poor adolescent women were as likely, if not more likely than white adolescents and adolescents who are not in poverty, to complete the first dose. Help is readily available, since the federal vaccine program for low-income families, Vaccines for Children, covers the cost - more than $100 each - of all three doses, Niccolai said. Women might be more likely to receive a vaccination during their annual recommended, preventive visit, when they connect with health care services, she said.

“However, to complete the series requires knowledge, motivation and the belief that it’s important, even though the cost is covered,” Niccolai said. Deterrents to vaccination completion at additional visits might include office visit co-payments, transportation issues or parents’ inability to take time off work. “Something keeps them from returning two more times.”

“It doesn’t surprise me that this has been a recurring issue for years,” said Lovell Jones, , director of the Dorothy I. Height Center for Health Equity and Evaluation Research at the University of Houston/University of Texas M.D. Anderson Cancer Center. “In terms of addressing health issues in minority and underserved populations, this is a multidisciplinary, multi-factorial problem.”

“I hear people say that ‘If these women truly cared about themselves, they’d find a way to do it [the vaccinations]. Clearly, these women have not,” Jones said. “Why not approach this in a more holistic fashion, looking at the non-health issues, the reasons that prevent completion of a second and third vaccination, and develop solutions to those? The overall economic cost of vaccinations pales when compared to the cost of treating Stage 3 or 4 cervical cancers,” Jones said.