IMPORTANCE OF VACCINATIONS FOR GIRLS AGED 9 TO 14 YEARS. IS HPV VACCINE SAFE ?
The Human Papilloma virus is a family of double standard small DNA viruses. It belongs to the Papillomaviridae family. This virus is known to infect the overlying epithelium of the human body. There are many types that are identified. HPV virus infects the epithelium of the mucosa and they can cause skin warts. It is the most common viral infection of the reproductive tract as well as the most common sexually transmitted infection. Most sexually active women and men do get infected with this virus at some point in their lives. The HPV infection is asymptomatic and hence it is very difficult to know if someone is infected with or not. This virus also has a tendency to clear up many years after infecting the host as well. But in occasional cases the virus stays back and causes cancer in coming years of the life. The cancers which are most commonly caused due to HPV virus are cervical cancer, anal cancer, penile cancer, cancer of the vagina and vulva ( i.e male and female genital respectively)
In order to combat against HPV infection and the cancers caused by them, modern science has led to the invention of HPV vaccination against the most common strains that are notoriously associated with these cancers. There have been numerous trials and efficacy and safety studies and then , only after the FDA approval these vaccines have been recommended by World Health Organization and CDC to be given to all girls. The recommended age range is 9 to 26 years of age. The recommended age for vaccination in India is 11 or 12 years. The basic aim is to give the vaccine before sexual exposure happens.
Cancer of the cervix is the fourth most common cancer in women all around the world and it is estimated that there are 600,000 new cases and 340,000 deaths due to this cancer in 2020. Unfortunately majority of the new cases and deaths in the world happen in the low and middle income countries of the world. The HPV virus type 16 and 18 are responsible for
approximately 50% of the high grade pre-cancers of the cervix. The major route of transmission of the HPV virus is through sexual contact and most people are infected shortly after the onset of the sexual activity. 90% of these infections do clear eventually but occasionally they do not and that is when it leads to the formation of cancer. Also it is noteworthy that the women who have human immuno deficiency virus (HIV) the possibility of developing cancer of the cervix six times more than a person who does not have HIV. Therefore the importance of vaccination and screening is a very effective strategy. It has to be stressed that cancer of the cervix is a very treatable condition if it is diagnosed early. Hence we must not leave this window of opportunity by vaccinating our young girls with this vaccine. In India there are two types of HPV vaccines available and both of them are globally licensed. Cervarix is a bivalent vaccine and Gardasil is a quadri-valent vaccine, meaning that cervarix gives protection against two types of virus and Gardasil gives protection against four types of virus. Both of these vaccines are made using the technique of recombinant DNA technology. The HPV vaccines work just like the other immunizations work against viral infections. They basically promote the production of antibodies in the body which in turn helps to encounter the HPV virus in the future by the body, and thereby the virus is prevented from infecting the cells. The HPV vaccines are based on the entity called virus like particle (VLP). So they basically help in promoting the antibody production of the body and this makes the vaccines very effective. It is to be noted that the vaccine however does not prevent other sexually transmitted diseases nor does it cure if there is an existing HPV infection or HPV associated disease. The national technical advisory group for immunization (NTAGI) has recommended the introduction of HPV vaccine into the universal immunization programme of India.
The Indian Academy of pediatrics (IAP) committee also recommends that HPV vaccine must be offered to all the females who can afford it. The cost of the vaccine ranges from 2800 to 3299 INR depending on the company of the vaccine.
The World Health Assembly has formed a global strategy to fasten the elimination of cervical cancer as public health problem. The elimination is defined as attaining the threshold of less than 4 cases per 100,000 women .In order to attain this, it has set up 90-7090 target explained as follows –
• 90% of the girls must get vaccinated by 15 years of age.
• 70 % of women must get screened by testing at age of 35 years and again at age of 45 years.
• 90% of the screen detected women must be treated for the cervical diseases (this includes the precancerous as well as the invasive cancers of the cervix).