Experts advocate universal HPV vaccination to save women from cervical cancer

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By Avinash Prabhakar

New Delhi, Jan 29 (IANS): Globally, 27 percent of cervical cancer cases come from India, which is home to 16 to 17 percent of the world’s population of women. Current estimates indicate approximately 100,000 new diagnosed cases and 60,000 deaths per year in India, representing almost one third of the world’s cervical cancer deaths.

Over the past 40 years, mortality from cervical carcinoma has decreased due to improved treatment and the introduction of national screening programs.

Dr. Abhishek Shankar, Assistant Professor, Department of Radiation Oncology, All India Institute of Medical Sciences (AIIMS), says that more than 7.4 million cases of cervical cancer and 6, 2 million deaths could be prevented in the next 100 years if 78 of the world’s poorest countries implement HPV vaccines, cervical cancer screening and cancer treatment reporting as key World Health Organization interventions.

According to the World Health Organization (WHO), 4.1 million women in India have died from the disease since 2019, and without intervention, up to 5.7 million will die by 2070.

Dr Shankar noted: “To eliminate cervical cancer, all countries must achieve and maintain an incidence rate of less than four per 100,000 women. Three important key pillars and related targets are 90 percent full vaccination of girls vaccinated against HPV by age 15; screening 70% of all women by high-throughput test at age 35, and again at age 45; and treating 90 % of women with invasive cancer and precancerous treated.”

The AIIMS professor said that the HPV virus is the leading cause of cervical cancer and is also associated with cancers of the vagina and vulva, head and neck cancer, anorectal cancer and penile cancer. In the case of cervical cancer, almost 90 percent of cases have the presence of HPV and the two most common strains are HPV 16 and 18.

“The HPV vaccine (Cervarix and Gardasil) prevents infection and reduces the risk of cervical cancer and other types caused by HPV,” said the professor.

“Cervarix,” he noted, “is a bivalent vaccine that protects against HPV types 16 and 18, the two most cancer-causing subtypes, responsible for 70 percent of all cervical cancer cases. Gardasil is available in forms tetravalent and 9-valent containing HPV subtypes 6, 11, 16, and 28 (and additionally 31, 33, 45, 52, and 58 in 9-valent form as Gardasil 9).

“The vaccine is reported to be 95-100% efficacious for HPV 16 and 18 and in reducing the risk of genital warts, precancerous lesions, and invasive cervical cancer.”

The Immunization Committee of the Indian Academy of Pediatrics (IAPCOI) recommends offering the HPV vaccine to all women who can afford it. Because protection is seen only when the vaccine is given before HPV infection, the vaccine should be given before the start of sexual activity.

The vaccine should preferably be presented to parents as a vaccine to prevent cervical cancer and not as a vaccine against a sexually transmitted infection, added Dr. Shubham Roy, a leading developmental pediatrician and director of Shining Stars Child Developmental. Center in Delhi.

Lack of knowledge about HPV vaccination, importance of the vaccine, and high cost reported as the main barrier to HPV vaccination in India. The low knowledge of the HPV vaccine among the people, along with the difficult access, the high cost of the vaccine, and the myths about the vaccines make the entire operation challenging.

Optimizing the HPV schedule and supply chain process along with planning and scheduling can improve access to the vaccine, offering the opportunity to expand the number of girls who can be vaccinated and ease the burden of the complicated vaccination process added Dr. Prerna Gautam, Assistant Professor, Department of Industrial Engineering and Management, Indian Institute of Technology, Kanpur.

WHO now recommends a one- or two-dose schedule for girls 9-14 years of age, a one- or two-dose schedule for girls and women 15-20 years of age, and two doses six months apart for women over 21 years of age. .

The government recently announced that it will start a nationwide immunization campaign in April for girls between the ages of 9 and 14 using a newly developed Cervavac vaccine against human papillomavirus (HPV). This new vaccine developed by the Serum Institute of India (SII) may be a game changer in achieving the goals of the WHO Eliminate Cervical Cancer, as it offers protection against four strains of HPV.

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