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HUMAN PAPILLOMAVIRUS (HPV) VACCINATION PROGRAM GARDASIL TM Cristi Froyman 4 th Year Pharmacy Intern University of Saskatchewan Email: cristi_froy@hotmail.com Mikki Millar RN (NP) Primary Care Nurse Practitioner Cypress Health Region mikki.millar@cypressrha.ca WHAT IS HPV?

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slide2
Cristi Froyman

4th Year Pharmacy Intern

University of Saskatchewan

Email: cristi_froy@hotmail.com

slide3
Mikki Millar RN (NP)

Primary Care Nurse Practitioner

Cypress Health Region

mikki.millar@cypressrha.ca

what is hpv
WHAT IS HPV?
  • Common virus: Human Papillomavirus
  • Many different types of HPV
    • Types 6, 11, 16, and 18
  • Can cause diseases of the genital area
    • cervical cancer
    • precancerous lesions
    • genital warts
prevalence of hpv
PREVALENCE OF HPV
  • Infects half of all sexually active women aged 18 to 22 in North America
  • ~75% of sexually active Canadians will have at least one HPV infection during their lifetime
  • Most common in women aged 20-24 years
how do people get hpv
HOW DO PEOPLE GET HPV?
  • Affects both men and women
  • Sexual contact with an infected person
  • INTERCOURSE IS NOT NECESSARY!
  • HPV is easily transmitted
    • may not show any signs or symptoms
    • can pass the virus on without even knowing it
what diseases are associated with hpv
WHATDISEASESAREASSOCIATEDWITH HPV?
  • Cervical cancer
  • Vulvar cancer
  • Vaginal cancer
  • Precancerous lesions
  • Genital warts
what is cervical cancer
WHAT IS CERVICAL CANCER?
  • Cancer of the cervix: the lower part of the uterus that connects to the vagina
cervical cancer continued
Cervical CancerContinued…
  • Is the second most common type of cancer in Canadian women ages 20 to 44
  • Over 1350 Canadian women were diagnosed with cervical cancer in 2001, and 400 women died from it
cervical cancer continued10
Cervical CancerContinued…
  • May be caused by certain types of HPV
  • Usually the HPV goes away on its own within 1 or 2 years
  • If infected with these types, and the virus does not go away on its own
    • abnormal cells  pre-cancerous  cancerous
possible symptoms
POSSIBLE SYMPTOMS
  • Early cervical cancer may not cause noticeable signs or symptoms
  • Signs and symptoms may include:
    • Vaginal bleeding not during period
    • Unusual vaginal discharge
    • Pain
    • Pain during sexual intercourse
screening for cervical cancer
SCREENING FOR CERVICAL CANCER

Tests that examine the cervix:

  • Pap Smear: a piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the cervix and vagina to be viewed under a microscope
  • Colposcopy: a thin, lighted tube is inserted through the vagina into the cervix to look for abnormal tissue
  • Biopsy: a sample of abnormal tissue is cut from the cervix and viewed under a microscope to look for cancer
screening for cervical cancer15
SCREENING FOR CERVICAL CANCER
  • Pelvic Exam: an exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. The doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and the other hand is placed over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. A speculum is also inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease.
  • Endocervical Curettage: a spoon-shaped instrument is used to collects cells or tissue from the cervical canal
cervical cancer treatment
CERVICAL CANCER TREATMENT
  • Cryosurgery: pre-invasive cancer cells frozen off
  • Laser Surgery: pre-invasive cancer cells burned off
  • Cone Biopsy: cone-shaped piece of tissue removed
  • Simple Hysterectomy: uterus is removed
cervical cancer treatment17
CERVICAL CANCER TREATMENT
  • Radical Hysterectomy:
    • uterus, and tissues next to the uterus, the upper part of the vagina, and lymph nodes from the pelvis are removed
  • Pelvic Exenteration:
    • uterus, lymph nodes, bladder, vagina, rectum, and part of colon removed
  • Radiation Therapy
  • Chemotherapy
what is vulvar cancer
WHAT IS VULVAR CANCER?
  • Vulva: the outside part of the vagina
    • Labia majora: two prominent skin folds
    • Labia minora: two small, hairless skin folds
    • Clitoris: found below the spot where the two

labia minora meet

  • Cancer of the vulva most often affects the inner edges of the labia majora or the labia minora, but it can also occur on the clitoris
what are genital warts
WHAT ARE GENITAL WARTS?
  • Flesh-colored growths that appear in or around the genital area:
genital warts continued
Genital WartsContinued…
  • Caused by different types of HPV than cervical cancer
  • Can occur on the penis, in and around the vagina, or in and around the anus/rectum
  • 2 out of 3 people who have sexual contact with a person who has genital warts will also get them
  • It can take weeks, months or years after contact with an infected partner for warts to occur
  • Lifetime risk of getting genital warts is > 10%
treatment for genital warts
TREATMENT FOR GENITAL WARTS
  • They can be treated
    • HOWEVER…25% of warts will come back within 3 months if HPV is still present in the body
  • Treatment depends on the size, amount, and location of the warts
    • applying a solution directly to the warts
    • freezing or burning
    • laser therapy
    • surgery
protection and prevention
PROTECTION AND PREVENTION
  • Protection:
    • avoid genital contact
    • always use condoms
  • Prevention:
    • GARDASIL
what is gardasil
WHAT IS GARDASIL?
  • New vaccine
  • Protects against HPV
  • Helps guard against diseases caused by:
    • HPV Types 16 and 18
      • 70% of cervical cancer cases
    • HPV Types 6 and 11

- 90% of genital warts cases

slide27
GOAL
  • PROTECT BEFORE EXPOSURE!
  • BEFORE SEXUALLY ACTIVE!
can the gardasil vaccine cause hpv
CAN THE GARDASIL VACCINE CAUSE HPV?
  • NO!
  • Made of virus-like particles prepared from HPV Types 6, 11, 16, and 18
  • Particles do not contain viral DNA
    • cannot infect cells
    • cannot reproduce
who should be vaccinated with gardasil
WHO SHOULD BE VACCINATED WITH GARDASIL?
  • Girls and women ages 9 to 26 years
  • To prevent infection caused by the Human Papillomavirus types 6, 11, 16, and 18
  • GARDASIL works when given before a person has any contact with HPV Types 6, 11, 16, and 18 (before sexually active)
how is gardasil given
HOW IS GARDASIL GIVEN?
  • Injected into the upper arm or thigh muscle
  • 3 separate 0.5-mL injections over 6 months:
    • First dose: At a date you and your doctor or healthcare professional choose
    • Second dose: 2 months later
    • Third dose: 6 months after the first dose
dosing schedule continued
Dosing ScheduleContinued…
  • Getting all 3 doses will allow you to get the full benefits of GARDASIL
  • All 3 doses should be given within 1 year
why is it important to be vaccinated early
WHY IS IT IMPORTANT TO BE VACCINATED EARLY?
  • To help prevent illness before there is any contact with HPV Types 6, 11, 16, and 18
  • To protect against future cervical cancer and genital warts
what if i already have hpv
WHAT IF I ALREADY HAVE HPV?
  • Vaccination is still beneficial
  • GARDASIL covers 4 types of HPV
  • It is unlikely that you have been infected with all 4 types of HPV
important information about gardasil
IMPORTANT INFORMATION ABOUT GARDASIL
  • GARDASIL is not for women who are pregnant
  • GARDASIL will not treat diseases
  • GARDASIL will not protect against diseases caused by other types of HPV
possible side effects of gardasil
POSSIBLE SIDE EFFECTS OF GARDASIL
  • Pain, swelling, itching, and redness at the injection site
  • Fever
  • Nausea
  • Dizziness
are pap tests still necessary after being vaccinated
ARE PAP TESTS STILL NECESSARY AFTER BEING VACCINATED?
  • YES!
  • Vaccination with GARDASIL does not take the place of Pap tests:
    • may not fully protect everyone
    • does not prevent all types of cervical cancer
  • It is important to continue regular cervical cancer screenings
  • Pap tests have been proven to help save lives.
pap tests
PAP TESTS
  • Cervical cancer screenings
  • Look for abnormal cells in the lining of the cervix before they have the chance to become precancerous or cervical cancer
abnormal pap tests
ABNORMAL PAP TESTS
  • The more severe the abnormality, the more likely it is that cervical cancer could develop in the future
  • Abnormal Pap? Don’t panic—it does not always mean that you are at risk for cancer or even have HPV
  • Your doctor or healthcare professional may repeat the Pap test or do other tests as needed
who should get pap tests
WHO SHOULD GET PAP TESTS?
  • Women 21 years or older
  • Females under 21 years of age who have been sexually active for three years or more
  • No age limit!
how often
HOW OFTEN?
  • Once you become sexually active
  • One year later
  • Every 2 to 3 years
    • if 2 normal pap tests and not on any birth control or hormones
  • Every year
    • if on birth control or hormones
slide41
Pap tests are an important part of taking control of your health—and taking care of yourself!
slide42

COST

  • GARDASIL is not included on any provincial vaccination programs
  • However, a doctor can provide a written prescription for the three required shots
  • One Dose = $169.52 ( x 3 doses)
  • Total cost / person = $508.56
slide43

COST

  • Gordon Stueck has chosen to sell the GARDASIL vaccine at cost + expense of refrigeration of the product
  • $156.42 x 3 = $469.26
slide44

COST

The benefit of vaccination with GARDASIL far outweighs the expense!

slide45

COST

  • In the long run, vaccination with GARDASIL will save the health care system money
  • The overall yearly cost of invasive disease and death in Canada from cervical cancer has been estimated to be ~ $270 million
consider
CONSIDER…
  • Travel time for treatments
  • Emotional turmoil and uncertainty associated with further testing and delays
  • More frequent monitoring is required if infected with HPV
    • Ex: Colposcopy every 6 months with HPV type 16 and 18
  • TESTS ARE NOT PLEASANT!
summary
SUMMARY
  • Human Papillomavirus infection can cause cancer and genital warts
  • It is important to protect yourself from HPV infection
  • Using condoms or abstaining from genital contact may help prevent infection
  • GARDASIL is a new vaccine that protects against HPV types 6, 11, 16, and 18
  • Pap tests are still important after vaccination
references
References:
  • 1) Merck. Gardasil [Online]. [cited 2007Jan 04]; Available from: URL:

http://www.gardasil.com

  • 2) Cervical cancer vaccine approved in Canada. CBC News [Online]. 2006 Jul 18. [cited 2007 Jan 04]; Available from:

URL: http://www.cbc.ca/health/story/2006/07/18/cervical-cancer.html

  • 3) Compendium of Pharmaceuticals and Specialties. Gardasil Product Monograph [online version (e-CPS)]. CPhA, 2007.

[cited 2007 Jan 04]; Available from: URL: https://www.e-therapeutics.ca

  • 4) American Cancer Society. Cancer Reference Information [Online]. [cited 2007 Jan 09]; Available from: URL: http.www.cancer.org
slide50
Cristi Froyman

4th Year Pharmacy Intern

University of Saskatchewan

Email: cristi_froy@hotmail.com

slide51
Mikki Millar RN (NP)

Primary Care Nurse Practitioner

Cypress Health Region

mikki.millar@cypressrha.ca