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HPV vaccine for teenagers. Dr Sally Ferguson with thanks to MSD.. for most of the slides. What is HPV?. HPV is a common virus (the human papillomavirus) Some HPV types can cause genital warts Other types can infect a woman’s cervix and lead to cervical cancer over many years.

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HPV vaccine for teenagers


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    1. HPV vaccine for teenagers Dr Sally Ferguson with thanks to MSD.. for most of the slides

    2. What is HPV? • HPV is a common virus (the human papillomavirus) • Some HPV types can cause genital warts • Other types can infect a woman’s cervix and lead to cervical cancer over many years

    3. The Problem: • Lifetime risk of genital /cervical HPV 1 in 2 • Lifetime risk of HGSIL is 1 in 25 • Lifetime risk of Cervical cancer is 1 in 31 (no pap smears done) • Lifetime risk of Cervical cancer 1 in 125 (having pap smears) • Lifetime risk of genital warts 1 in 8

    4. Natural history of HPV infection to Cervical cancer 0–1yrs 0–5yrs 1–20yrs High Grade Precancers(CIN 2/3) HPVinfection Persistent infection Cervical Cancer Low Grade Precancers(CIN 1) Recovery: HPV clearance…90% Pinto AP, Crum CP. Clin Obstet Gynecol. 2000;43:352–362.

    5. HPV related diseases in Male and Female HPV Attributable % • Female cancers: • Cervix 100% • Vulva 40% • Vagina 40% • Anus 90% • Oro-pharynx 12% • Other illnesses • RRP (larynx wart in children) 100% • Genital Wart 100% Male Cancers • Anus 90% • Penis 40% • Oro-pharynx 12% • Other illnesses • RRP 100% • Genital Wart 100% Parkin DM Lacey CJN Vaccine 2006 S3/17 35

    6. HK Cervical Cancer (1996-2010) 10th among female cancers Lifetime risk: 1 in 145 New Case 400 (2010) Death 146 (2010) Report of Hong Kong Cancer Registry HA 2010 http://www3.ha.org.hk/cancereg/ Crude rate: 10.7 per 100,000

    7. Genital warts are common in Hong Kong New cases per year: Genital Warts = 11, 524 204 cases per 100,000 adults Lin C BMC Infect Dis. 2010 Sep 17 10 272

    8. 子宮頸癌的預防方法 Prevention is better than Cure

    9. 99.7%Cervical cancers are associated with HPV

    10. HPV Vaccine technology • Empty Shell formed by recombinant biotechnology to mimic the viral 3D shape. • Does not contain infectious DNA。 • Does not contain mercury (thimerosal) Real Virus Vaccine GARDASIL is a trademark of Merck & Co., Inc., Whitehouse Station, NJ, USA. *VLP = Virus-like particle. 1. Villa LL, Costa RL, Petta CA, et al. Lancet Oncol.2005;6:271–278. Image courtesy of Dr. Ian Frazer

    11. Dosing schedule GARDASIL Intramuscular injection (IM) Recommended schedule 3 doses at month 0,2,6 Completed within 1 year will be considered as per-protocol CERVARIX Vaccine: 3 doses at month 0,1,6 month

    12. 4 in 1 vaccine: 9 years Long Term follow-up 9 years Antibody report 8 years Efficacy report Gardasil: No breakthrough case up to 8 years Nygård M IPC 2012 Nov 30 – Dec 6, Puerto Rico, EP-741 015 LONG-TERM FOLLOW-UP 015 LONG-TERM FOLLOW-UP

    13. How long is the duration of protection?Is booster dose needed? US CDC 2012 Feb: Gardasil vaccine information statement • Protection from HPV vaccine is expected to be long-lasting • Additional (booster) doses are not recommended. http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-hpv-gardasil.pdf

    14. All women are at risk of HPV infection All HPV High risk HPV Low risk HPV * Chan et al.Determinants of cervical human papillomavirus infection: differences between high and low oncogenic risktypes. J Infect Dis 2002; 185: 28-35.

    15. Gardasil / Silgard Approvals GARDASIL approved in 127 countries (includes 24 GAVI-eligible) Europe: Germany Cyprus Ireland France Czech Republic Latvia UK Denmark Lithuania Spain Estonia Luxembourg Italy Finland Malta Austria Greece Netherlands Belgium Hungary Norway Bulgaria Iceland Poland Portugal Romania Slovakia Slovenia Sweden Serbia Montenegro Switzerland Liechtenstein Bosnia Russia Belarus Croatia Turkey Ukraine Herzogovina Macedonia Albania Caribbean & Central America: Costa Rica Trinidad/Tobago Puerto Rico El Salvador Guatemala Honduras Curaçao Nicaragua Bermuda Panama Bahamas Cayman Islands Barbados Aruba Jamaica Dominican Republic North America: USA Canada Mexico Asia Pacific & Japan: Kyrgyzstan Uzbekistan Kazakhstan Australia Indonesia Korea Taiwan Hong Kong Singapore New Zealand Macau Malaysia Philippines Thailand India Vietnam Fiji Bhutan Georgia JAPAN Sri Lanka Brunei 42 3 South America: Brazil Bolivia Argentina Uruguay Peru Ecuador Colombia Chile Paraguay 16 22 35 9 Middle East & Africa: Gabon Namibia Israel C.A.R. Morocco Mauritius Kenya Kuwait Mauritania UAE Guinea Eq. Ethiopia Uganda Togo Malawi Congo Brazzaville Jordan Egypt Cote d’Ivoire Burkina Faso Chad Bahrain Botswana Lebanon Tanzania Zambia South Africa Cameroon Nigeria Pakistan Tunisia Mali Guinea Conakry Saudi Arabia Rwanda GAVI – Eligible Registration Approvals (24): Burkina Faso, Cameroon, Central African Republic, Chad, Congo (DR), Cote d’Ivoire, Ethiopia, Guinea (Conakry), India, Kenya, Kyrgyzstan, Malawi, Mali, Mauritania, Nicaragua, Nigeria, Pakistan, Rwanda, Tanzania, Togo, Uganda, Uzbekistan, Vietnam, Zambia

    16. Routine immunization ofMale with Gardasil in US and Australia ( and Canada) US: 11 - 21 Male Australia: 12 - 13 Male Accessed 26 Oct 2011 http://www.cdc.gov/media/releases/2011/a1025_ACIP_HPV_Vote.html http://www.merck.com/newsroom/news-release-archive/vaccine-news/2011_1025.html http://www.pbs.gov.au/industry/listing/elements/pbac-meetings/pbac-outcomes/ 2011-11/nov-2011-pbac-outcomes-positive-recommendations.pdf

    17. The near disappearance of genital warts in young women 4 years after Gardasil program in Australia Female <21: ↓90%Male <21: ↓87% Read TR Sex Transm Infect. 2011 Oct 4

    18. Trend of genital warts after universal HPV vaccination 2 in1 HPV vaccine 4 in1 HPV vaccine UK Australia UK Health Protection Agency Report 2010 Read TR Sex Transm Infect. 2011 Oct 4 Data are NOT generated from head-to-head study and results are NOT directly comparable because of differences in the methodologies and analysis populations.

    19. HPV vaccine is for men and women To prevent vaccine type relatedFemale: Cervical 、vaginal、vulvar Cancers and genital wartsMale: genital warts + 4-in-1 HPV vaccination Regular Pap screening