Since the approval of HPV vaccination for form 1 students across malaysia, it has cause controversies. Lots of people are debating about the benefits, whether it outweighs the risk posed as well as the hefty cost imposed to our government. I found this topic is particularly interesting to do some research on. I’ve heard of it sometimes during my second year as a medical student. I’ve also heard about the vaccination against HPV, especially GARDASIL. Never did I do any research on this before, but now the curiosity is high. I did some research on websites, harrison’s online, PubMed as well as few other Malaysian authentic sites that gives statistics on this issues based on Malaysian population.
Introduction
Cervical cancer like other form of cancer is an uncontrolled division of cells. For this one in particular, HPV plays a major role causing 99.7% of all cervical cancer (Munoz N, Bosch FX, de Sanjose S, et al). There are many subtypes of HPV but two strains 16 and 18 cause >70% of the cases (Walboomers JM, Jacobs MV, Manos MM, et al). This virus is transmitted through sexual intercourse. Incidence is highly correlated with early onset of sexual activity, multiple sexual partners (>6) and cigarette smoking, low socioeconomic status, poor nutrition, oral contraceptive use, and immunosuppression. The incubation period from infection to cancer presentation is about 15 years.
Epidemiology
- In the US, the incidence of HPV cervical cancer is 1000-fold compare to CIN.
- Second most common cancer among women worldwide and contribute to 300,000 deaths annually.
- In the US alone there are 9700 new cases and 3700 deaths annually
- In Malaysia, cervical cancer was ranked 3rd among all cancers.
- The incidence is 21.5 per 100,000 population
- Incidence among the Chinese being highest at 33.6 per 100,000 and among Malays the lowest being 12.6 per 100,000 (Malaysian Cancer Registry 2002)
- Indians 27.7 per 100,000.
- In Kelantan, where the population of muslim is ~97% the incidence is much lower. 5.5 per 100,000
Sign and symptoms
These include pain around the pelvic area, vaginal bleeding and discharge as well as obstructive uropathy.
Prevention
There are many ways to prevent cervical cancer or HPV infection. The obvious one would be to avoid sexual intercourse with multiple partners. The other one is of course through vaccination against the viruses. There are two vaccines available in the current market; GARDASIL (quadrivalent) and Cervarix (bivalent). Gardasil covers HPV 6/11/16/18 whereas Cervarix covers only two subtypes 16 and 18.
Vaccination against HPV 16/18 will prevent >70% on cervical cancer (Evidence level A). In HPV naïve person, the efficacy of the vaccination proved to be 100% against HPV 6/11/16/18. The antibodies produce in our body may last up to 5 years.
Adverse effects of Vaccination
Common Reactions
- injection site rxn
- fever
- headache
- nausea
- dizziness
- diarrhea
- pharyngolaryngeal pain
- vomiting
Serious Reactions
- anaphylaxis/anaphylactoid rxn
- bronchospasm
- asthma
- syncope
- Guillain-Barre syndrome
Discussion
Since the introduction of vaccination program in malaysia for form 1 students, many debate about whether it’s a wise decision or not. But I’m sure that our ministry of health has done a thorough research before coming with this decision. Based on the statistic given and research done, this vaccination is proven relatively save compare to the danger of acquiring the cancer itself. Based on research I’ve outlined above, the incidence is significantly lower among muslims (only for those that avoid sex outside marriage) thus, abstaining from having sex with multiple partners is definitely the best way. So, to parents out there please weigh the benefits of having vaccination against not having it. If you are a muslim that practice the religion well this vaccination might not give any different at all because you are unlikely to have any contact with HPV.
http://thestar.com.my/news/story.asp?file=/2010/8/21/focus/6892915&sec=focus
consumer association of penang view -http://thestar.com.my/news/story.asp?file=/2010/8/20/focus/6879543&sec=focus
research in malaysia --> http://www.eimjm.com/Vol3-No1/Vol3-No1-L1.htm#_ftn1
malaysian family physician --> http://www.e-mfp.org/2007v2n2/human_papillomavirus_vaccine5.htm
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