Human Papilloma Virus or HPV is the main cause of cervical cancer. This virus has more than 100 types that can also cause various other cancers such as anal cancer, vaginal cancer, and oral cancer. HPV types 16 and 18 are high-risk viruses that lead to cancerous changes. Cervical cancer can only occur in women who have been sexually active, especially if their sexual activity involves more than one partner.
The HPV vaccine has been developed since 2006 to reduce the incidence of cervical cancer, which remains a leading cause of cancer in women after breast cancer. This vaccine has been widely introduced in Western countries over the past decade. It has been proven effective in preventing cervical cancer in women aged 12 to 40 years after this country made HPV vaccination mandatory as part of their routine immunisation in 2013. Women who received the HPV vaccine have been closely monitored for nine years during this immunisation programme to ensure no serious side effects occur.
There are three types of HPV vaccines currently available on the market. The widely administered vaccines are bivalent and quadrivalent. The bivalent HPV vaccine provides immunity against HPV types 16 and 18, the main causes of cervical cancer. Meanwhile, the quadrivalent vaccine provides immunity against HPV types 16 and 18, as well as types 6 and 11, which cause genital warts. Both vaccines can provide immunity of over 90 percent. If given to girls who have never experienced sexual intercourse in their lifetime, the immunity percentage is expected to be higher than others. Recently, the nonavalent vaccine has been introduced to the market, providing immunity against 9 types of HPV (6, 11, 16, 18, 31, 33, 45, 52, 58) with the hope of reducing more infections of HPV that cause cervical cancer.
This vaccine has been integrated into the Malaysian vaccination schedule for all 14-year-old female students in secondary schools. This group is selected because most Asian girls at this age start to experience physical changes such as breast growth and pubic hair growth. They also begin to experience emotional changes to become adult women, such as embarrassment, wanting to make friends with men, and daring to explore new things. Therefore, it is very appropriate for the HPV vaccine to be mandatory for these girls in the hope of providing future protection against cervical cancer before they engage in sexual intercourse. Some countries also introduce HPV vaccination for boys because there is a theory that men are the main cause of HPV spread to women through indiscriminate sexual intercourse.
So far, the HPV vaccine has been reported as safe for people of all ages. This HPV vaccine should be taken in three doses (0, 2 months, 6 months) and is expected to provide immunity for more than ten years. Women who have been exposed to sexual intercourse or have been infected with HPV can also take this vaccine even though the immunity produced is not as high as those who have not been exposed to sexual intercourse. Mild side effects such as pain at the injection site, fever, body aches, dizziness, and itching have been reported. A small group experienced stomach pain and diarrhoea which disappeared in the short term. Speculations about death and neurological diseases caused by the HPV vaccine are completely untrue. Follow-up investigations have found that these incidents are not related to HPV vaccine side effects.
Because HPV is spread through sexual intercourse, there are other methods to reduce the risk of HPV infection in women. Using condoms can also help reduce the risk of HPV infection and can also prevent other sexually transmitted diseases such as syphilis and AIDS. It is also important to avoid indiscriminate sexual intercourse or changing partners so that women do not get HPV infections from men who have already been infected earlier. Women who have been infected or at high risk are advised to have a pap smear examination every year so that cervical cancer can be detected early.
Cervical cancer is a burden to all countries because it can cause death if detected at a late stage. Massive promotion of HPV vaccination in every country is expected to reduce the incidence of cervical cancer in the future. Therefore, it is very appropriate for girls who are still pure in school to be protected by the HPV vaccine so that they are given early immunity against HPV infections that can cause cervical cancer.
Dr Mardiana Kipli M.D (UNIMAS) is an Obstetrics and Gynecology specialist working in Kuching. This article is a translation of her article found here: https://www.mmgazette.com/vaksin-hpv-perisai-kanser-serviks-dr-mardiana-kipli/)
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]
Reference:
- European Centre for Disease Prevention and Control. Introduction of HPV vaccines in European Union countries – an Update. 2012
- CDC centre for disease prevention and control. USA 2014
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