Monday, September 17, 2012

EU Reccomendations on HPV Vaccines

   Cervical cancer is most commonly, if not entirely, caused by the human papillomavirus (HPV). Forty of the 100 strains are transmitted through sexual contact, including oral, vaginal and anal intercourse.  Of those strains, some cause genital warts (unsightly and uncomfortable but minor) and others are associated with cervical cancer.  Having the human papillomavirus may increase the risk of penile cancer for men.  There are other causes of penile cancer which itself is very rare.  Conversely, cervical cancer is the second most common cancer for women.  Breast breast cancer being the most common.  There were just over 12,000 cases of cervical cancer in the US in 2008.  Cervical cancer deaths are not common as the PAP smear is able to detect abnormalities and prevent the cancer.
   It is estimated that at least 50 percent of all adults have been exposed to HPV at one time or another.  The virus is usually cleared by the body's immune system, but can be a chronic condition in rarer cases.  One can transmit the virus to others through sexual contact in the acute state and if they do not clear the virus they will continue to risk transmission through sexual activity.  The lingering virus is a serious matter and transmission rates are very high.  For this reason, the two vaccines that are available have an important role (only for those not previously exposed).  Because so many sexually active people have been in contact with a person carrying the virus, the target of the vaccine is girls (maybe boys too) who have not yet begun sexual activity.
   The two vaccines, Gardasil and Cervarix, only target the most important strains of the 100.  Gardasil covers two that cause warts and two that cause HPV.  Cerarix only covers the HPV strains, however, Cervarix has also been shown to have an impact on oral cancer and this is important.  Most people think of smokeless tobacco as the main cause of oral cancer - actually it is smoking BUT the rise in new oral cancer cases is associated with HPV NOT tobacco at all.
   Earlier this month, European health officials with information from the European Centers for Disease Control, made a recommendation that ALL girls in Europe (ages?) be vaccinated.  Some countries in Europe have coverage rates as low as 17% while Portugal and Brazil had coverage rates as high as 80%.  The recommendations include more promotion of the vaccines and steps to make vaccination easier (logistics).  The article that I read did not indicate if the coverage rates 17-80% were for the full series (3 shots) or for any vaccination level.
    In the USA, the issue of HPV vaccines became a political firestorm when a presidential candidate made some erroneous statements regarding side effects. 
    According to the US CDC, all girls AND boys ages 11-12 should be started on the series of shots.  The coverage is low and more info about this can be found here.

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