Human Papillomavirus Vaccines - Coursework Example

Introduction Human papillomavirus (HPV) is one of the causative agents of sexually transmitted disease infecting the mucosal linings of cervix, anus,mouth and throat. This group of viruses contains more than 100 different subtypes in which around 40 HPV viruses affect reproductive area. Many times, the manifestations of HPV infection are not clear, and might vanish on their own without any treatment. Depending upon the person’s immunity, only 10% infected people display HPV infection related symptoms, remaining infected cases become auto disinfected within a span of two years (Genital HPV Infection - CDC Fact Sheet, Novemebr 24, 2009). The extent of infection depends upon the risk factor of HPV virus. HPV is responsible from low risk problems such as common skin warts and verrucas to high risk problems like cervical cancer, genital warts, vaginal cancer, vulval cancer, and oropharyngeal cancer (Human Papillomavirus (HPV) Vaccines, NCI, October22, 2009). In these cancers, normal cells grow abnormally and give rise to transformed cells which eventually spreads in the nearby area. These evade on healthy cells, tissues and organs by depriving them of essential nutrients and space. Though, genital warts are not as deadly as carcinoma caused by HPV, the individual suffer from emotional trauma due to the area affected and the treatment given. The transmission of HPV is generally via sexual contact of HPV carrying person who might not show any obvious symptoms. HPV is widely found in most sexually active individuals at some point in their lives, usually at the adolescent age. People might get infected with multiple HPV infection. Cervical cancer has inherent attributes which display socioeconomic and gender disparities. Public health measures should be effectively implemented to combat life threatening cervical cancer. Clinical manifestations of HPV infection Although almost all HPV infections are asymptomatic and transient, some infections might become persistent and carcinogenic (Steinbrook, 2006). Genital warts are small bumpy areas formed at the genital regions, which may vanish without any treatment or might grow up as flat or raised areas, but they would never turn into cancer. In the UK, genital wart is in the forefront of sexually transmitted infection (STI). An uncontrolled growth of cells causing lump or mass of tumor in the cervical region leads to cervical cancer. It is the second most leading cause of cancer worldwide, and secures twelfth rank among womens cancer in the UK. 0.86% of women suffer from life time risk of acquiring cervical cancer. It takes one to two decades to develop cervical cancer, and annual women mortality rate is 1000. From 200,000 women who are detected unusual growth of cells, annually 2,800 women are tested positive for cervical cancer (HPV vaccination: Introduction September 17, 2008). Worldwide in a 2009, 470,000 new cases of cervical cancer might be reported from which 233,000 might get killed (Information from CDC and FDA on the Safety of Gardasil® Vaccine, July 22, 2008). Diagnosis It is very important to diagnose cervical cancer as early as possible even before any clinical signs develop. Cervical cancers are diagnosed by cervical cancer screening. The screening tests at definite intervals from 21 years of age or within three years of first sex with regular follow-ups are able to prevent cervical cancer. The two tests which are commonly used for screening are: Pap test and HPV test. Precancerous growth can be easily detected by evaluating pap smear for abnormal cells, which are prone to cancer in the cervix. This reliable screening test also checks for infection or inflammation. The HPV test detects the virus responsible for abnormal cell shape and growth, after the age of 30 years or unclear pap test results in females of any age. NHS cervical screening programme for women between 25-65 years of age is an important step for early stage carcinoma detection (HPV vaccination: Introduction September 17, 2008). The advantages of vaccine therapy Past medicines and new emerging treatment research areas would always have great contributions in the intervention of HPV infection. Cost factor for the treatment is a major attribute when the economic background of any country is considered. Restricted financial resources limit the use of costlier medicine treatment policies and procedure in developing and undeveloped countries. HPV vaccines are generally used as preventive measures and to improve immunity against viral infections and associated carcinomas. Vaccines trigger immune response by recognizing unique surface proteins of the invader (noninfectious virus-like particles), and produced antibodies and are ready to combat with HPV infection. Thus, this vaccine helps in prohibiting abnormal cell changers in the cell which breeds cancer (Human Papillomavirus (HPV) Vaccines, NCI, October22, 2009). Gardasil® and Cervarix®, are U.S. Food and Drug Administration (FDA) approved vaccines currently available in the market. Gardasil and Cervarix are developed by National Cancer Institute (NCI) scientists and, manufactured by Merck & Co., Inc. (Merck), and GlaxoSmithKline (GSK) respectively. Both the vaccines are delivered into muscle tissue thrice within a span of six months, for prevention of cervical cancer, and other cancers in females from 9 to 26 years of age (Human Papillomavirus (HPV) Vaccines, NCI, October22, 2009). 60% of vaccinated women might not suffer from cervical cancer related deaths (Steinbrook, 2006). Both vaccines are used as safeguard against two high-risk HPVs type16 and 18, which are responsible for 70% cervical cancers. In addition to this, firstly approved Gardasil® is also effective versus (90%) genital warts causing HPV types 6 and 11. And, thus this quadrivalent vaccine can be administered in males (of age 9 to 25 years) as well for prevention of genital warts. It has been reported that Cervarix is also effective against some other oncogenic HPV types which has to be evaluated further, therefore uptil now it is a bivalent vaccine. These vaccines are highly effective in preventing precancerous cervical cell changes, and offers almost full protection up to 4 years after vaccination (Paavonen et al., 2009), ruling out 60% cancer related deaths. These vaccines prove economical, since they abate healthcare cost dramatically by cutting down expenses on medical care, biopsies, invasive procedures, and follow-up costs of abnormal Pap tests (Steinbrook, 2006). The Advisory Committee on Immunization Practices (ACIP) has established an information regarding the type and age of vaccine recipient, the frequency and the quantity of dosage, and contraindications to restrict its use in certain situations (Human Papillomavirus (HPV) Vaccines, NCI, October22, 2009). The cost of Gardasil is approximately $120 per dose which is covered under individual or group insurance plans, and Medicaid (Human Papillomavirus (HPV) Vaccines, NCI, October22, 2009). . Disadvantages The recipients of the vaccine should not be previously infected with HPV and offers protection only from potential HPV infection. The vaccines do not accelerate virus clearance in the HPV infected body (Hildesheim et al., 2007), and therefore, are not used for treating or eliminating any existing STIs and cervical cancer. FDA has recommended Gardasil and Cervarix for use in teenagers from the age of 9, and 10 years respectively, before the girl enters into sexually active stage. It is also to be noted that since these vaccines are ineffective against some other oncogenic HPV types, chances of 30% cervical cancers and 10 percent of genital warts still can not be eliminated after Gardasil and Cervarix vaccination. This fact also emphasises that vaccinated individuals are still required to continue with cervical cancer screening, and regular Pap exams. Safety FDA and CDC are diligently monitoring safety and efficacy of the vaccines (Information from FDA and CDC on Gardasil and its Safety (Archived), July 22, 2008) through Vaccine Adverse Event Reporting System (VAERS). It has been reported that uptil 2008, 94% of reported events were not serious. 6% of the serious events reported were mainly Guillain-Barré Syndrome (GBS), and thromboembolic disorder cases. The study indicated that vaccines benefits are more than its risks in preventing HPV infections including cervical cancer. Though, women with cervical cell irregularities can not be treated with vaccines, they can get vaccinated safely to prevent infections from other HPV types. The administration of vaccine to highschool girls is a controversial issue when ethical, religious, political, economic, and sociocultural aspects are considered (Vamos, Mcdermott, & Daley, 2008). Future Scope Community-based clinical trial conducted by national Cancer Institute (NCI) in the vulnerable cervical cancer area might deliver valuable information regarding vaccines long term safety and durability, the protection capacity, the immune defense mechanisms, and the natural history of infection with HPV types other than the types included in the vaccine. The ongoing research on second-generation preventive vaccines and on therapeutic HPV vaccines might soon dish out positive clinical outcome to prohibit carcinoma development in women with past HPV infections. The synergistic approach of cost effective preventive and therapeutic vaccine is a promising strategy to achieve healthy future in developed, developing and undeveloped countries (Sarin, 2008; Human Papillomavirus (HPV) Vaccines, NCI, October22, 2009). Cervical cancer Prevention National HPV vaccination programme in UK initiated in September 2008 aims to vaccinate the females from tennage (12-13 years), and primarily secondary schools are targeted. Uptil now, 1.4 million doses have been delivered. In this program, within a span of six months three vaccine shots are injected. A three-year catch up campaign or cervical cancer jab also provides HPV vaccine for girls between13-18 years (HPV vaccination: Introduction September 17, 2008). There is a need to focus on many vital aspects of responding to the STI. The objective of prevention technique should be reducing an individuals susceptibility to disease by teaching people, vulnerable groups and health care providers about the disease and transmission. Therefore, it is necessary to identify and focus high risk group population for targeting prevention programs. Early symptoms awareness should be created through health education promoting activities like campaigns, mass media, internet, pamphlets, poster, slide etc. Health talks should be given to public about safe sex, use of condoms and good personal hygiene to decrease risk of cervical cancer, and related HPV infections (Human Papillomavirus (HPV) Vaccines, NCI, October22, 2009). To reduce propagation of STI, legislative, political, and cultural factors should be considered to fund educational programs and improve living conditions of the most vulnerable population. Financial and nutritional back up, counseling, enhancing the public health infrastructure to effectively implement affiliated programs, and to reduce obstacles in prevention and treatment programs are also considered very important issues. Health care professionals, school health personnel, parents, consumers, scientists and governments should work cohesively to foster age-appropriate and responsible use of HPV vaccines to avoid any mishap (Sarin, 2008). Conclusion The cytology for cervical cancer is very helpful in early detection, and immediate treatment for curable cervical cancer. Despite the developments made in prevention, diagnosis, and treatment, HPV infection remain a significant public health problem worldwide. Treatment should able to provide virologic, immunologic, and clinical advantages with minimal side effects, toxicity, drug resistance to lead normal life in the future. Restricted financial resources limit the use of costlier pharmacology treatment policies and procedure in developing and undeveloped countries. Therefore, education, training and use of condoms with innovative approaches should be an integral part of their primary health care model along with costlier treatment drugs in the battle against HPV infection. Due to novel treatment strategies and prevention measures adopted HPV-infected women could deliver a normal healthy child if proper precautions are taken and right HPV medications are given. The coordinated efforts of local, state, and federal action with synergistic national as well as global strategy and availability of ample resources can deliver dramatic reduction in cervical cancer cases at the first half of the 21st century (Sarin, 2008). References HPV vaccination: Introduction September 17, 2008. http://www.nhs.uk/conditions/hpv-vaccination/Pages/Introduction.aspx. Vamos, C. A., Mcdermott, R. J. & Daley, E. M. The HPV Vaccine: Framing the Arguments FOR and AGAINST Mandatory Vaccination of All Middle School Girls. Journal of School Health 2008; 78(6): 302 – 309. Human Papillomavirus (HPV) Vaccines, National Cancer Institute (NCI), (October22, 2009). http://www.cancer.gov/cancertopics/factsheet/Prevention/HPV-vaccine Information from FDA and CDC on Gardasil and its Safety (Archived). Centers for Disease Control and Prevention, July 22,2008. http://www.cdc.gov/vaccinesafety/Vaccines/HPV/HPVArchived.html Steinbrook R. The potential of human papillomavirus vaccines. New England Journal of Medicine 2006; 354(11):1109–1112 Paavonen J, Naud P, Salmerón J, et al. Efficacy of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA): Final analysis of a double-blind, randomised study in young women. Lancet 2009; 374(9686):301–314. Hildesheim A, Herrero R, Wacholder S, et al. Effect of human papillomavirus 16/18 L1 viruslike particle vaccine among young women with preexisting infection: A randomized trial. Journal of the American Medical Association 2007; 298(7):743–753. Genital HPV Infection - CDC Fact Sheet. Centers for Disease Control and Prevention, Novemebr 24, 2009. http://www.cdc.gov/std/HPV/STDFact-HPV.htm Information from CDC and FDA on the Safety of Gardasil® Vaccine. Centers for Disease Control and Prevention, July 22, 2008. http://www.cdc.gov/Features/HPVvaccineSafety/ Sarin R. HPV vaccine for primary prevention of cervical cancer in developing countries: The missing links. J Can Res Ther 2008;4:105-6 Read More