Cancer Cervix Vaccine

1
Our memories of Mahabaleswar
2

• CDC - Immunization Update 2006
• Satellite Internet Broadcast
• December, 2006
• Cervical Cancer Vaccine - HPV

Summarized from the CDC Broadcast by Dr.
R.V.S.N.Sarma. M.D., M.Sc.,
3
Cervical Cancer

• Cervical cancer is the 2nd leading cancer
  amongst women worldwide
• 500,000 new cases and 300,000 deaths due to Ca Cx
• gt99 related to human papilloma virus (HPV)
  infec.
• HPV infect epithelial cells including the genital
  tract
• HPV type 16 related to half of these cases
• HPV 18, -45, -31, -33, -52, -58 and -35 together
  with HPV-16 responsible for 90 of all cervical
  cancers worldwide

4
Human Papillomavirus

• More than 100 types
• More than 60 cutaneous types
• Can lead to skin warts
• 40 mucosal types
• High risk types (particularly 16 and 18)
• cervical cell abnormalities
• certain anogenital cancers
• Low risk types (particularly 6 and 11)
• cervical cell abnormalities- usually resolve
  spontaneously and do not lead to cancer
• genital warts
• respiratory papillomatosis

5
Natural History of HPV Infection
InitialHPV Infection
Cleared HPV Infection
6
Cancer Attributable to HPV - 2006
Cancer Cases 12,000 3,700 4,480 1,000 10,000
Attributable Fraction 100 90 40 40 12
Cancer Cervical Anal Vulvar/vaginal Penile Oral/ph
arynx
7
HPV-associated Conditions
Estimated 70 30-50 10

• HPV 16, 18
• Cervical cancer
• - High/low grade cervical
• abnormalities
• Anal, Vulvar, Vaginal, Penile
• Head and neck cancers
• HPV 6, 11
• Low grade cervical
• abnormalities
• Genital warts
• RRP

10 90 90
8
Global distribution of HPV types in cervical
cancer
9
Human Papilloma Virus Vaccine

• Contains the L1 protein from four types of HPV
  (16, 18, 6, 11)
• Produced using recombinant DNA technology
• L1 proteins self assemble into non-infectious
  units called virus-like particles (VLPs)
• VLPs are highly immunogenic

10
HPV Vaccines

• L1 VLPs made in insect cells
• GSK 16 and 18 - Cervarix
• i.m. 3 shots 0, 1 and 6 month
• VLPs made in yeast cells
• Merck 16,18,11 and 6 -Gardasil
• i.m. 3 shots 0, 2 and 6 month

11
HPV vaccine news headlines

• Vaccine prevents most cervical cancers. - New
  York Times, October 7, 2005.
• Vaccine proves 100 percent effective in
  preventing cervical cancer Seattle Times,
  October 6, 2005.
• Promising new vaccines could wipe out cervical
  cancer. But they must be administered to
  preteens, and some groups oppose that.
  Philadelphia Inquirer, July 4, 2005.
• OK Roll up your sleeve new vaccines are
  arriving but the economics are still a challenge
  Business Week, July 25, 2005.

12
Efficacy of HPV Vaccine Among 16-26 year-old
Females
Package insert Gardasil . Integrated dataset
results in the per-protocol populations CIN
cervical intraepithelial neoplasia AIS
adenocarcinoma in situ
13
Human Papillomavirus Vaccine Efficacy

• High efficacy among females without evidence of
  infection with vaccine HPV types
• No evidence that the vaccine had efficacy against
  existing disease or infection
• Prior infection with one HPV type did not
  diminish efficacy of the vaccine against other
  vaccine HPV types

14
HPV Vaccine Schedule

• Approved for females 9-26 year of age
• 3 doses at 0, 2, and 6 months
• Minimum intervals
• 4 weeks between doses 1 and 2
• 12 weeks between doses 2 and 3

15
HPV Vaccine Provisional ACIP Recommendations

• Routine vaccination of ? at 12 years of age
• The vaccination series can be started as young as
  9 years of age at the clinician's discretion
• Vaccination is recommended for females 13-26
  years of age who have not been previously
  vaccinated
• Ideally vaccine should be administered before
  onset of sexual activity
• Females who are sexually active should be
  vaccinated

16
HPV Vaccine Special Situations

• Females 26 years of age or younger with,
  equivocal or abnormal Pap test, positive HPV DNA,
  and genital warts may be vaccinated
• Vaccine will have no effect on existing disease
  or infection

Provisional ACIP recommendation, June 2006
17
HPV Vaccine Special Situations

• Females 26 years of age or younger who are
  lactating/breastfeeding or are immuno-compromised
  may be vaccinated
• NOT recommended for pregnant women

Provisional ACIP recommendation, June 2006
18
Screening for Cervical Cancer

• Why get screened?
• Screening was developed to detect abnormal
  cervical cells in the early stages when it is
  easy to remove them
• Who should be screened?
• Women from 25-65 years
• Once every 3 years

19
HPV Vaccine and Cervical Cancer Screening

• Cervical cancer screening recommendations have
  NOT changed for females who receive HPV vaccine
• 30 of cervical cancers caused by HPV types are
  not prevented by the quadrivalent HPV vaccine
• Vaccinated females could subsequently be infected
  with non-vaccine HPV types
• Sexually active females could have been infected
  prior to vaccination
• Providers should educate women about the
  importance of cervical cancer screening

20
(No Transcript)
21
Adding up the facts

• HPV is present in the majority of sexually active
  adults
• Presence of HPV does not indicate promiscuity
• HPV is short lived and asymptomatic in most
  adults
• If high risk HPV (16 and 18) persists can cause
  Ca CX
• Cervical cancer kill 200,000 women worldwide
  annually
• 70 of Ca Cx is due to HPV 16 and 18 types
• HPV vaccine given at age 11, eliminates 70 of Ca
  Cx
• HPV vaccine does not replace screening for Ca Cx
• HPV vaccine in men prevents Ca Penis and genital
  warts
• Rapid adoption of HPV vaccine is right and
  essential

22
US National Immunization Program

• Hotline (800) CDC-INFO
• Email nipinfo_at_cdc.gov
• Website www.cdc.gov/nip
• Broadcast Updates and Resources Web Page
• www.cdc.gov/nip/ed/UpdatesandResources.htm

23
(No Transcript)