College women, HPV genotyping and sexual behavior before HPV vaccination

Results from samples stored for a long time

This 2018 study was carried out from 2001 to 2005 in college women from Morelos State University in Mexico. Participants were related to the health science field (Medicine, Pharmacy, Psychology, Biology, and Education).. Students with ≥ 3 sexual partners and who did not use condom had 12.8 higher odds of being HPV positive.

Abstract

HPV is the sexually transmitted agent most common among young people, like college students.

The aim of study was to associate sexual behavior characteristics of women with HPV, detected in genital samples taken before the introduction of the HPV vaccine.

Female students during 2001–2005 donated genital samples and the samples were re-analyzed in 2013 for HPV genotyping by RT-PCR.

The frozen storage of the students’ genital samples allowed the detection of HPV DNA and its genotyping after years of sample collection. HPV prevalence was 22%, HPV16 3.9%, and HPV18 1.1%.

Age, multiple sexual partners and the partner’s age at first sexual intercourse were significantly associated to HPV. Students with ≥ 3 sexual partners and who did not use condom had 12.8 higher odds of being HPV positive.

In this report, we found that students with older partners at first sexual intercourse had a higher possibility of becoming positive for HPV DNA. This is relevant because it has been reported that sexual partner’s age is an important risk factor for HIV infection in homosexual men and it is thought that this is partially due to the low acceptance of condom use by older sexual partners. This behavior could also happen regarding HPV, for heterosexual partners. In fact, we found that 49.0% of the older sexual partners did not use condom, compared with 40.1% of younger sexual partners as reported by participating college women (p = 0.119). Additionally, there was a higher possibility of being positive for HPV DNA in women 26 years old or older, this group reported a higher number of lifetime sexual partners and lower frequency of condom use during last sexual intercourse.

The interaction between the number of sexual partners (main risk factor for HPV exposure) and condom use (barrier against HPV exposure) was clear in the studied population, and even though condom use effectiveness in preventing HPV infection has been inconsistent in cross sectional studies, a review of longitudinal studies shows that it protects against the infection.

Condom use in prevention of Human Papillomavirus infections and cervical neoplasia

Systematic review of longitudinal studies, 2014

HPV and cancer : the condom is much more effective than the vaccine in preventing cancer, including when dysplasias are already present. As a bonus, remember that the condom protects against a whole lot of other unpleasant infections or dangers…

Abstract

Objectives
Based on cross-sectional studies, the data on protection from Human Papillomavirus (HPV) infections related to using male condoms appear inconsistent. Longitudinal studies are more informative for this purpose. We undertook a systematic review of longitudinal studies on the effectiveness of male condoms in preventing HPV infection and cervical neoplasia.

Methods
We searched PubMed using MeSH terms for articles published until May 2013. Articles were included if they studied a change in non-immunocompromized women’s cervical HPV infection or cervical lesion status along with the frequency of condom use.

Results
In total, 384 abstracts were retrieved. Eight studies reported in 10 articles met the inclusion criteria for the final review. Four studies showed a statistically significantly protective effect of consistent condom use on HPV infection and on regression of cervical neoplasia. In the remaining four studies, a protective effect was also observed for these outcomes, although it was not statistically significant.

Conclusions
Consistent condom use appears to offer a relatively good protection from HPV infections and associated cervical neoplasia. Advice to use condoms might be used as an additional instrument to prevent unnecessary colposcopies and neoplasia treatments in cervical screening, and to reduce the risk of cervical cancer.

Cochrane HPV vaccine review not found to be ‘Trusted Evidence’

The Cochrane HPV vaccine review was incomplete and ignored important evidence of bias

In May 2018, the Cochrane Collaboration published its review of the human papillomavirus (HPV) vaccines. The review primarily assessed the vaccines’ effect on precursors to cervical cancer. Cochrane has high standards for its reviews; however, there were important limitations in its HPV vaccine review, which we address in this paper.

Key findings

  • The Cochrane human papillomavirus (HPV) vaccine review missed nearly half of the eligible trials
  • No included trial in the Cochrane review used a placebo comparator
  • The included HPV vaccine trials used composite surrogate outcomes for cervical cancer
  • The Cochrane review incompletely assessed serious and systemic adverse events
  • The Cochrane review did not assess HPV vaccine-related safety signals
  • Industry trial funding and other conflicts of interest
  • Cochrane’s public relations of the review were uncritical

Conclusion

Part of the Cochrane Collaboration’s motto is ‘Trusted evidence’. We do not find the Cochrane HPV vaccine review to be ‘Trusted evidence’, as it was influenced by reporting bias and biased trial designs. We believe that the Cochrane review does not meet the standards for Cochrane reviews or the needs of the citizens or healthcare providers that consult Cochrane reviews to make ‘Informed decisions’, which also is part of Cochrane’s motto. We recommend that authors of Cochrane reviews make every effort to identify all trials and their limitations and conduct reviews accordingly.

Read the author’s full paper on The BMJ.

On Twitter

 

Lessons learnt on transparency, scientific process and publication ethics

The short story of a long journey to get into the public domain unpublished data, methodological flaws and bias of the Cochrane HPV vaccines review

Abstract

Cochrane meta-analyses are considered the gold standard to assess public health interventions’ benefits and risks. Cochrane reviews shall apply evidence-based medicine (EBM) methodology on the best available evidence; they shall adhere to strict ethical guidelines as authors of Cochrane reviews are supposed to not have bias, nor conflicts of interest. Our 6 years’ documented case on the Cochrane human papillomavirus (HPV) vaccines review demonstrates that Cochrane guidelines can fail. According to EBM standards, such relevant methodological and ethical flaws void Cochrane positive conclusions on HPV vaccines efficacy.

Cochrane published a review of the human papillomavirus (HPV) vaccines on 9 May 2018. On 4 June, we submitted a detailed analysis of this review as a comment via the Cochrane website.

Our comment highlights serious methodological flaws in the review:

  • (A) studies’ quality not properly assessed;

  • (B) post hoc subgroup analyses presented as randomised controlled trial results;

  • (C) reporting bias not acknowledged;

  • (D) selective reporting not taken into consideration;

  • (E) biased trial designs;

  • (F) unpublished data not included;

  • (G) conflict of interests (COI) in the authors’ group;

  • (H) n=7 studies on Gardasil included, n=18 for Cervarix—the latter not being marketed in the USA anymore.

… continue reading on The BMJ, by Catherine Riva, December 2018.

visit re-check ref hpv-vaccination.

On Twitter :

Gardasil alert, imminent risk of unnecessary and sometimes dangerous HPV vaccination for girls and boys

Gardasil : the anticancer vaccination that increases the risk of cervical cancer in young women

Reference. Written by Gérard Delépine, MD, Orthopaedic Surgeon/Oncologist/statistician, July 23, 2018.

Open letter to parliamentarians, and to all citizens.

BE CAREFUL. While many doctors, foreign and French, citizens, patients sometimes victims, have been trying to inform for many years about the uselessness and the risks of the HPV vaccine, a new offensive of the pharmaceutical lobbies led again some MPs to try to introduce laws to make it a compulsory vaccination, already probably the most widespread in the world.

We have analysed the benefit-risk of this vaccine originally intended for women, but boys are likely to be targeted as well and denounced several times its uselessness coupled with its risks. both in women and in men. The time spent since FDA’s marketing authorization in June 2006 only adds new arguments against this vaccination, the strongest of which is the increase in the number of cervical cancers in the vaccinated population. which should encourage these countries to follow the example of Japan and Austria and to delete the recommendation.

Attention, some MPs want to impose a vaccination that can increase the risk of cervical cancer, as proven by international publications of national cancer registries.

ANALYSIS OF THE PROPOSED LAW WHICH MAY MAKE GARDASIL COMPULSORY

The preamble to the bill is based on the usual arguments of pharmaceutical companies widely disseminated by the media and their comfortably paid experts.

This preamble certainly recalls some indisputable true facts: there are more than one hundred HPV strains, the vaccines possibly protect against infection by the 4 to 9 strains included in the vaccine (only 2 to 5% of the 200 known strains ), against genital warts and some dysplasia’s without specifying that there is no evidence that it protects against cancer.

It is extremely disturbing to read in the presentation of opinion justifying the proposed law a number of known untruths:

« There are more than one hundred and twenty kinds of human papillomavirus (HPV), and fifteen are considered to be at high risk because they can cause cancers including HPV 16 and 18 causing 70% of infections. » But this only demonstrates a statistical correlation between presence of HPV and cancer, without anyone being so far able to demonstrate a direct CAUSALITY link.

« There are effective HPV vaccines. Current vaccines offer effective vaccination against 70% of carcinogenic HPV, and a new vaccine will soon increase this rate to 90%. » But, what do MPs mean by efficiency? the vaccine is effective on the infections of strains targeted by the vaccine (only 4 to 9 of the nearly 200 listed strains) but there is no evidence that it can prevent invasive cancer let alone avoid death by this cancer.

Citing Australia as a vaccine success story: « In Australia, where 80% of women and 75% of men are vaccinated, cases of HPV lesions have almost disappeared ». But, this statement is outrageous, as the following presentation will show you, because in this highly vaccinated country the number of cervical cancers (and other cancers attributed to HPV) continue to increase.

They also deny the risk of serious side effects that have led to protests in many countries (Denmark, Ireland, Japan, Colombia) and legal complaints from doctors against the EMA.

WHAT SHOULD IT EXPLAIN TO PARLIAMENTARIANS?

The regular smear (every three years) better guarantees early detection of cervical cancer.

In France, HPV infection is not a real public health problem in 2018, neither for women nor for men. In women, since smear screening has been used, the annual number of deaths from cervical cancer is consistently less than 1000 in France, and the women who die are almost exclusively those who have not been screened.

Diagnosis of HPV papillomavirus infection detected by systematic sampling should be avoided! Positive results often lead to unnecessary examination and very early conisation (biopsy) which is often useless.

The <1000 deaths per year from cervical cancer could all have been prevented by screening, Compare this with lung cancer (23,000 deaths), breast cancer (11,883 deaths), or prostate cancer (8,207 deaths) [15] .

Whilst efficacy of smear screening is proven, HPV vaccination not been proven to prevent a single invasive cervical cancer. The cancer registry records even suggest that this vaccine is sometimes likely to increase the risk.

INSTEAD OF REDUCING THE NUMBER OF CERVICAL CANCERS, IT INCREASES SOMETIMES

Curiously, the MPs who signed the bill do not talk about the proven results of the vaccine on the risk of invasive cancer of the cervix, its only official justification.

Instead of reducing the risk of invasive cancer of the cervix, HPV vaccines keep it at a high level or increase it!

After 12 years of use and more than 200 million girls vaccinated worldwide for a total bill of nearly $100 billion paid directly or indirectly by citizens , we can indeed draw a balance of effectiveness of vaccination in two ways:

  1. By examining the evolution of the incidence (annual frequency of new cases per 100,000 women) of the invasive cancer of the cervix in each country, before and after vaccination, a method already validated in 2003.
  2. World Standardised Rates: gross Incidence reported as « Standard World Population » to correct possible biases related to the demographic characteristics of each country.

The evolution of the incidence of cervical cancer before and after vaccination with Gardasil can be traced in a perfectly reliable way in the national cancer registries controlled and published by the ministries of health of the concerned countries.

 

Australia, according to the Australian Institute of Health and Welfare, the incidence of cervical cancer declined by almost 50%, from 12(/100,000) in 1995 to 7 in 2004 (before the vaccination campaign). Mortality also improved, thanks to smear screening and treatment. However, since the vaccination campaign started in 2007, there has been no further decrease in either incidence or mortality. In 2017, the incidence of cervical cancer is estimated at 7.1 and cervical cancer mortality has increased by almost 15% from 1.7 in 2014 to 2 in 2017. And our MPs quote Australian efficiency!

The Australian Ministry of Health estimates the number of new cases of cervical cancer is 912 in 2017 and 930 in 2018. Claiming, like our MPs, that « cases of HPV lesions have almost disappeared » in Australia is therefore not correct. One cannot imagine that these MPs lie voluntarily, so we can conclude that they are poorly informed and that they should have checked themselves the information provided by the experts related to laboratories before distributing this « fake news ».

Great Britain, according to Cancer Research UK, the Office of National Statistics (ONS), the incidence of cervical cancer had decreased (thanks to smear screening) from 12.4 in 1995 to 9.27 in 2004. But since vaccination, there is no longer any evidence of improvement, nor on the incidence stagnating from 9.3 in 2006 to 9.6 in 2015 nor on the mortality remaining at 3.

Canada. According to the Canadian Cancer Society, the incidence of cervical cancer has decreased (through screening) from 18 in 1972 to 8.1 in 2008. But since vaccination, there has been no further progress on incidence stagnating at 8.3 in 2017.

United States, according to the National Cancer Institute’s SEER cancer statistics review, the incidence of cervical cancer reduced from 14.8 in 1975 to 6.66 in 2007. But since vaccination, there has been no decrease in the incidence of cervical cancer reached 6.68 in 2015 .

Norway, according to the Cancer Registry of Norway, Oslo: before vaccination, the standardized incidence had fallen sharply thanks to smear screening from 24 in 1965 to 7 in 2004. But since the vaccination, it goes up to 13.9 in 2014 and 14.9 in 2015.

Sweden, according to the National Kvalitetsregister for Cervix Cancer prevention (NKCx ): before the vaccination campaign, the incidence of cervical cancer had decreased (thanks to screening) from 18 in 1967 to 7 in 2006. The worldwide standardized incidence of cervical cancer has increased significantly since vaccination rising to 10.3 in 2012 and 11.5 in 2015. This increase is almost exclusively due to the increase in the incidence of invasive cancer among women aged 23 to 49, which has reached more than 50% since 2006 (11 in 2006 versus 17 in 2015), whereas it is those who have the highest vaccination coverage rate (85%).

Thus, in countries whose populations have access to smear screening, it has led to a considerable reduction in the incidence of cervical cancer (from 40 to 60%). In contrast, the introduction of vaccination has not reduced the incidence or mortality of cervical cancer. Contrary to what is promised by laboratory-related physicians and by many global health authorities, vaccination campaigns have even been followed by an increase in the incidence of cancer.

France, with low levels of HPV vaccination, can serve as a control country. According to Public Health France, the incidence of cervical cancer in mainland France has steadily decreased from 15 in 1995 to 7.5 in 2007, 6.7 in 2012 and 6 in 2017. This decrease in incidence was accompanied by a decrease in mortality from 5 in 1980 to 1.8 in 2012 and 1.7 in 2017. France, with low use of Gardasil, has a much more satisfactory evolution for both incidence and mortality than that of the countries cited as example by the MPs who want to impose vaccination.

Comparison of recent standardized incidences with vaccination coverage rates.

Immunization advocates claim that a high vaccination coverage rate reduces the risk of invasive cancer of the cervix. Yet the comparison of incidence and mortality rates with vaccine coverage rates shows the opposite:

Australia, HPV vaccination coverage exceeds 85% , but in 2017 the incidence of cervical cancer is 7 and the mortality is 2

Great Britain, despite vaccination coverage exceeding 80%, the incidence in 2015 was 9.6 and mortality 3

Sweden the vaccination coverage rate is close to 75% but the incidence 2015 reaches 11.5.

USA, in 2017 the vaccination coverage rate is 60% for a cervical cancer incidence of 6.8 and a specific mortality at 2.3.

France , in 2017, HPV vaccination coverage is very low (around 15% ) for a cervical cancer incidence of 6 and a specific mortality of 1.7

In countries with high immunization coverage, the incidence of invasive cancers and mortality are therefore higher than in France, and compulsory immunisation proposed by some MPs would eliminate this French paradox that protects our children!

 

The harmful side-effects are difficult to deny

In their preamble, the MPs deny that Gardasil can lead (as any treatment) to complications while Japan, Austria and Denmark have stopped promoting this vaccination after serious complications, sometimes even fatal and that families suffering from these vaccines organized public demonstrations in several countries of the world (Japan, Colombia, Ireland), and that Danish doctors lodged a complaint against the European Medicines Agency (EMA), which refused to answer the questions they asked. after the notification of severe neurological events not listed in the EMA registers.

In France, several lawsuits are in progress.

« Among the most frequently mentioned by the victims defended by M pathologies e Coubris include multiple sclerosis, lupus, disseminated acute encephalomyelitis (inflammation of the central nervous system) and myofasciitis macrophages (a disease that results in pain muscle and chronic fatigue) ». A parliamentary commission of inquiry which could hear experts, citizens and independent associations of laboratories, having, from near or far, no link of interest with laboratories, would be a first step to enlighten Parliament.

IN CONCLUSION, the benefit-risk balance is not in favour of vaccination, let alone compulsory.

A compulsory health measure should not be based on faith in vaccination or hidden conflicts of interest, but on proven facts, verifiable by every citizen. However, the facts established by the official records of cancer registries show that HPV vaccination does not protect against invasive cancer of the cervix but seems rather to maintain its frequency at a high level, and sometimes even increase it.

Let us fight against this bill that threatens our children, by informing everyone, our MP, our senator, our elected officials, that no one may be unaware.

Only this work of proximity of each citizen this summer, will be able to avoid this new catastrophe of return which could be the anti-HPV vaccination, as it has been and still is the obligation of vaccination against hepatitis B.

Let’s apply the precautionary principle! Let us respect the right of every human being to informed choice/consent for medical interventions!

HPV associated with vaginal intraepithelial neoplasia in women exposed to DES in utero

Close follow-up is recommended for DES-exposed patients, especially those who have risk factors known to be associated with genital neoplasia

image of hpv virus
The role of human papillomavirus and herpes simplex virus in the etiology of intraepithelial neoplasia is discussed in this 1987 study.

Study Abstract

Human papillomavirus associated with vaginal intraepithelial neoplasia in women exposed to diethylstilbestrol in utero, Obstetrics and gynecology, NCBI PubMed PMID: 3037458,
1987 Jul.

Five out of 959 young women, exposed to diethylstilbestrol (DES) in utero, developed vaginal intraepithelial neoplasia while they were under follow-up in the Diethylstilbestrol-Adenosis Project at Baylor College of Medicine, Houston, Texas.

We suggest that the development of the vaginal intraepithelial neoplasia at a younger age than usual may be caused by a higher susceptibility of the DES-exposed patient to factors associated with the development of intraepithelial neoplasia. A common finding in all five women was the detection of the deoxyribonucleic acid (DNA) of human papillomavirus types 6 or 16 in their lesions, using high-stringency in situ hybridization.

The role of human papillomavirus and herpes simplex virus in the etiology of intraepithelial neoplasia is discussed.

Close follow-up is recommended for DES-exposed patients, especially those who have risk factors known to be associated with genital neoplasia.

More DES DiEthylStilbestrol Resources

Squamous cell carcinoma in situ of the vagina and cervix after intrauterine DES exposure

All cases of adenosis should be followed by colposcopy

young-woman
This 1978 study recommended that all cases of adenosis be followed by colposcopy.
I think I will just image by Mary.

1978 Study Abstract

Two patients exposed in utero to maternal diethylstilbestrol DES ingestion presented with adenosis. Each developed intraepithelial neoplasia in an area of active metaplastic change.

The question is raised whether a continuum exists beginning with DES exposure and proceeding through the occurrence of adenosis and active squamous metaplasia to dysplastic alteration and finally squamous neoplasia.

Since the cytologic smear is negative in 50% of cases during the dysplastic phase, it is recommened that all cases of adenosis be followed by colposcopy.

Sources and more information
  • Squamous cell carcinoma in situ of the vagina and cervix after intrauterine DES exposure, NCBI PMID: 683639, Obstet Gynecol. 1978 Jul;52(1 Suppl):30S-33S.
More DES DiEthylStilbestrol Resources

In-Utero DES Exposure associated with a Higher Rate of Herpes and HPV infections

Development of cervical and vaginal squamous cell neoplasia as a late consequence of in utero exposure to diethylstilbestrol

herpes-simplex-virus
In 1984, the DES-Adenosis (DESAD) Project found that DES-exposed daughters are associated with a higher rate of herpes simplex virus and human papillomavirus infections.

1988 Study Abstract

During the last 14 years, several articles have given contradictory reports on prevalence rates of squamous cell neoplasia of the cervix and vagina in diethylstilbestrol (DES)-exposed progeny.

In 1984, the DES-Adenosis (DESAD) Project found that the incidence of cervical and vaginal intraepithelial neoplasia in DES-exposed daughters was twice as high as in a comparison group of unexposed women.

This was also associated with a higher rate of herpes simplex virus and human papillomavirus infections. Possible hypotheses on the etiology of the increased incidence of squamous neoplasia are discussed.

Sources and more information
  • Development of cervical and vaginal squamous cell neoplasia as a late consequence of in utero exposure to diethylstilbestrol,
    NCBI PMID: 2829071, Obstet Gynecol Surv. 1988 Jan;43(1):15-21.
More DES DiEthylStilbestrol Resources

HPV vaccination: should boys be vaccinated too?

Estimating the benefits to men of offering HPV vaccination to boys

This post content is published by The BMJ, aiming to lead the debate on health, and to engage doctors, researchers and health professionals to improve outcomes for patients.

man-vaccinated
As richer countries consider vaccinating males, the focus for lower income countries should remain on cervical cancer prevention. Image of vaccination in man by Army Medicine.

Vaccination of girls against the human papillomavirus (HPV) has been implemented in most developed countries, driven by prevention of cervical cancer as a public health priority. Bivalent (Cervarix, GSK) and quadrivalent (Gardasil, Merck) vaccines protect against subsequent infection with oncogenic HPV16/18, and quadrivalent vaccine protects against HPV6/11, which cause anogenital warts. Although HPV vaccination effectively protects against external genital lesions and anal intraepithelial neoplasia in males, only a few jurisdictions have so far recommended universal vaccination of boys. These include Australia, Austria, two Canadian provinces, and the United States. In other countries, a cautious approach has been due, in part, to uncertainties around the population level impact and cost effectiveness of vaccination of boys.

In a linked article, Bogaards and colleagues estimated the benefits to men of offering HPV vaccination to boys. They used a dynamic simulation and a bayesian synthesis to integrate the evidence on HPV related cancers in men. The analysis takes account of indirect protection from female vaccination: heterosexual men will benefit from reduced HPV circulation in females, so if coverage in girls is high the incremental benefit of vaccinating boys is driven by prevention of the residual burden of anal cancer in men who have sex with men.

The findings reinforce those of prior analyses that found that adding boys to established vaccination programmes in girls becomes less cost effective as female coverage increases. The cost effectiveness of vaccination of boys also depends on other local issues, especially vaccine type and vaccine and administration costs. A threshold total cost per vaccinated boy for cost effectiveness can be identified at any level of coverage in girls: such analyses can provide policy makers with the maximum rational vaccine price appropriate to the local environment. If vaccine coverage in girls is lower, however, the most effective use of resources is likely to involve increasing coverage in girls, if feasible.

In some countries, vaccination of boys might not be cost effective, even at lower vaccine prices, due to higher administration costs. Recent developments towards reduced dose schedules could help. In 2013 the European Medical Agency recommended a two dose schedule for the bivalent vaccine in girls, in 2014 the United Kingdom switched to a two dose schedule, and the World Health Organization now recommends two doses for girls <15. Two dose schedules are the most cost effective option for girls provided protection lasts for ≥20 years and reduced dose schedules in boys are also likely to increase cost effectiveness if adequate efficacy is maintained.

Bogaards and colleagues highlight the importance of vaccination for prevention of anal cancer in men who have sex with men. In part due to uncertainties in natural history, the effectiveness of anal cancer screening is not established. Primary prevention with targeted vaccination of men who have sex with men is an attractive option and is potentially more cost effective than universal vaccination of boys. The US Advisory Committee on Immunization Practices already recommends vaccination of men who have sex with men up to the age of 26 years. Older men who have sex with men could also potentially benefit. The UK’s Joint Committee on Vaccination and Immunisation, as an interim position, recently stated that a programme to vaccinate men aged 16-40 who have sex with men with a quadrivalent vaccine should be considered, if cost effective. Lower coverage rates expected with targeted versus universal male vaccination are an important consideration, and the two approaches are not mutually exclusive.

Several other new developments should be factored in to future policy decisions. A recent study showed that the bivalent vaccine is effective in women aged ≥25 without a history of HPV disease. With a transition to primary HPV screening occurring in several countries, an interesting possibility to be evaluated involves “screen and vaccinate” strategies in older women—that is, offering HPV screening, followed by vaccination for HPV negative women with extended (or perhaps no) recall for this group. Secondly, a nonavalent vaccine (Gardasil9, Merck), which protects against an extra five HPV types, has recently been recommended for use in the US. In women, this will increase protection against cervical cancer in those who are fully vaccinated (from about 70% to about 90%) but as most HPV cancers in men are attributed to types included in current vaccines, tiered pricing structures for new generation vaccines based on differential incremental benefits (and thus differential cost effectiveness thresholds) in girls versus boys could be considered.

All these policy decisions must consider burden of disease, safety, effectiveness, acceptability, equity, and cost effectiveness. Although the focus in developed countries has now, appropriately, shifted to considering these issues for boys, men who have sex with men, and older women, broader efforts to prevent cervical cancer should remain the priority in low and middle income countries. Of the 610 000 cancers annually attributable to HPV worldwide, 87% are cancers of the cervix, and three quarters of these occur in countries with a low or medium human development index. Even if a substantial majority of young girls in such counties were vaccinated, hundreds of millions of older women would remain at risk—vaccination alone will not prevent an expected increase in cervical cancers in the next few decades, driven by population ageing. Here, the priority focus should be the development of integrated programmes for vaccinating young girls and screening older women. Based on experience in developed countries, this will also provide benefits for men through indirect vaccine protection.

Sources and more information: Who should be vaccinated against HPV? BMJ 2015;350:h2244, 12 May 2015.

Did vaccinated Women increase their Susceptibility to other HPV Types?

Women Who Received HPV Vaccine May Need More Shots…

HPV-vaccination image.
HPV Vaccination in Sao Paulo Brazil March 2014. Image via PAHO/WHO.
  • there are more than 80 HPV types …
  • … if a woman is already infected with HPV, the HPV vaccine cannot eliminate this infection …
  • … vaccinated women are not guaranteed to prevent cervical cancer and/or not to be infected with HPV: women in the study who received the Gardasil vaccine were less likely to be infected with the four strains of the virus included in the vaccine: about 11 percent of vaccinated women were (still) infected with HPV 6, 11, 16 or 18, compared with nearly 20 percent of unvaccinated women…
  • … however, the women who received the vaccine were more likely to be infected with other high-risk HPV strains not included in the vaccine. About 61 percent of the women who received the vaccine were infected with another type of high-risk HPV, compared with 40 percent of women who did not receive the vaccine…

Read Women Who Received HPV Vaccine May Need Another Shot,
livescience, April 22, 2015
and Comparison of HPV prevalence between HPV-vaccinated and non-vaccinated young adult women (20-26 years) ,
American Association for Cancer Research, Apr 19, 2015.