Human papillomavirus vaccination: Where to now?

Department of Microbiology and Infectious Diseases, Royal Women's Hospital, Locked Bag 300, Parkville 3052, Australia.
Sexually transmitted infections (Impact Factor: 3.4). 12/2011; 87 Suppl 2(Suppl 2):ii23-4. DOI: 10.1136/sextrans-2011-050182
Source: PubMed
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    ABSTRACT: Clin Microbiol Infect 2012; 18 (Suppl. 5): 64–69 Two prophylactic human papillomavirus (HPV) vaccines have been recently approved: one quadrivalent and the other a bivalent vaccine. When administered in a three-dose course to HPV-naive individuals, both vaccines exhibited excellent safety profiles and were highly efficacious against targeted clinical endpoints in large-scale international phase III clinical trials. Where coverage has been high for the appropriate target population, a reduction of HPV-related diseases with the shortest incubation periods has already been seen. By March 2012, universal HPV vaccination had been introduced into national vaccination programmes in more than 40 countries, but only in a few low-income and middle-income countries. With the growing market for HPV vaccines and competition between manufacturers, negotiated prices are already beginning to decline although they still remain out of reach of many countries. The great majority of countries are struggling to reach a level of coverage that will have the most impact on cervical cancer rates. Increasing coverage and improving completion of the HPV vaccine schedule, particularly of sexually naive females, is now the most important public-health issue in HPV vaccine efforts. A clear strategy for integrating primary (HPV vaccination) and secondary (screening) cervical cancer prevention must be agreed as soon as possible. Several second-generation prophylactic vaccines are being developed with the aim of resolving some of the limitations of the two current HPV prophylactic vaccines.
    Preview · Article · Jun 2012 · Clinical Microbiology and Infection
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    ABSTRACT: Breast cancer is increasing 3.1 % annually. It is more deadly and more frequent in young women in developing countries compared to young women in the more developed countries. Important reasons for this increased incidence and lethality are poor nutrition (leading to decreased immunity to resist the advance of cancer), delayed access to health care, and poor quality of care when it is finally available. Early detection of breast cancer is the key to the control of its lethal effects. Increasing breast health awareness and clinical breast examination are key components of a screening program at the present time. Such a strategy is aimed at detecting Stage I and Stage II cancers and downstaging cancers from the now prevalent presentation at Stage III and Stage IV. For the future, however, a low cost methodology needs to be adopted in order to diagnose small node-negative cancers by screening the asymptomatic population. Organized screening mammography is not a feasible option for low and mid-resource countries, even in the future. A combination of low prevalence and the expensive infrastructure needed in terms of the equipment and trained health-care professionals makes this an unrealistic option and a potential drain and diversion of health-care funding resources in developing countries. The background of the situation that is currently in existence, problems thereof, and the potential for the use of whole breast ultrasound screening for breast cancer is discussed in this chapter.
    No preview · Chapter · Apr 2013
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    ABSTRACT: Objective: To provide background information for strengthening cervical cancer prevention in the Pacific by mapping current human papillomavirus (HPV) vaccination and cervical cancer screening practices, as well as intent and barriers to the introduction and maintenance of national HPV vaccination programmes in the region. Materials and methods: A cross-sectional questionnaire-based survey among ministry of health officials from 21 Pacific Island countries and territories (n=21). Results: Cervical cancer prevention was rated as highly important, but implementation of prevention programs were insufficient, with only two of 21 countries and territories having achieved coverage of cervical cancer screening above 40%. Ten of 21 countries and territories had included HPV vaccination in their immunization schedule, but only two countries reported coverage of HPV vaccination above 60% among the targeted population. Key barriers to the introduction and continuation of HPV vaccination were reported to be: (i) Lack of sustainable financing for HPV vaccine programs; (ii) Lack of visible government endorsement; (iii) Critical public perception of the value and safety of the HPV vaccine; and (iv) Lack of clear guidelines and policies for HPV vaccination. Conclusion: Current practices to prevent cervical cancer in the Pacific Region do not match the high burden of disease from cervical cancer. A regional approach, including reducing vaccine prices by bulk purchase of vaccine, technical support for implementation of prevention programs, operational research and advocacy could strengthen political momentum for cervical cancer prevention and avoid risking the lives of many women in the Pacific.
    Full-text · Article · May 2015 · Asian Pacific journal of cancer prevention: APJCP