THE HPV DILEMMA

DRUM - - Advice - SOURCES: WORLD HEALTH OR­GAN­I­SA­TION, CAN­CER AS­SO­CI­A­TION OF SOUTH AFRICA, IOL

AN IM­POR­TANT devel­op­ment in the fight against can­cer – or a li­cence for kids to go out and have sex? These, in a nut­shell, are two sides to one of the most con­tro­ver­sial vac­cines out there – a jab that has di­vided opin­ion pretty much down the mid­dle. One Cape Town fam­ily even be­lieves it has made their daugh­ter se­ri­ously ill.

But the Depart­ment of Health re­mains adamant: the hu­man pa­pil­lo­mavirus (HPV) vac­cine has been a great suc­cess.

Since the depart­ment in­tro­duced its im­mu­ni­sa­tion pro­gramme in 2014, close to two mil­lion pre­teen girls in pub­lic schools have been vac­ci­nated against the dis­ease.

HPV is one of the most com­mon causes of can­cer of the cervix, a dis­ease con­tracted by nearly 8 000 women in South Africa each year.

Pro­fes­sor Michael Herbst, health spe­cial­ist at the Can­cer As­so­ci­a­tion of South Africa (Cansa), be­lieves that the roll­out is vi­tal.

“We com­mend the na­tional de­part­ments of health and ba­sic ed­u­ca­tion and hope they con­tinue the pro­gramme,” he says.

Girls in Grade 4 are be­ing vac­ci­nated against HPV at no cost. Some par­ents have balked at the idea of their young daugh­ters be­ing vac­ci­nated against a sex­u­ally trans­mit­ted virus, but be­tween nine and 12 years old is the best time to ad­min­is­ter it, says Pro­fes­sor Hen­nie Botha, head of gy­nae­co­log­i­cal on­col­ogy at Stel­len­bosch Univer­sity.

“This is when the im­mune re­sponse to the vac­cine is strong­est,” he ex­plains.

Al­most all cer­vi­cal can­cers are caused by HPV, a com­mon virus that spreads through skin-to-skin sex­ual con­tact, says Herbst. It’s the most com­mon can­cer in fe­males aged 15 to 44 – but ex­perts be­lieve the HPV vac­ci­na­tion pro­gramme will re­sult in less di­ag­noses in this group.

CAN OLDER WOMEN GET THE JAB?

There’s no age limit for the vac­cine, Botha says, so older women – and men – can get it if they want to. “How­ever, ado­les­cents and young adults will ben­e­fit more than older women,” he adds.

This is be­cause the vac­cine should ide­ally be given be­fore a per­son be­comes sex­u­ally ac­tive, says Pro­fes­sor Yas­min Adam, chief spe­cial­ist in ob­stet­rics and gy­nae­col­ogy at Chris Hani Barag­wanath Aca­demic Hos­pi­tal and the Univer­sity of the Wit­wa­ter­srand.

There is lit­tle ev­i­dence that the vac­cine is ef­fec­tive once a woman has al­ready been ex­posed to HPV, she says. “In fact, most of the ev­i­dence shows it doesn’t work once the woman has al­ready had an HPV in­fec­tion.

“HPV in­fec­tion is quite preva­lent, with up to 50% of women con­tract­ing it. In most women the in­fec­tion clears up, but about 10% will de­velop le­sions on the cervix that are a pre­cur­sor to cer­vi­cal can­cer.”

Un­for­tu­nately, not all women can get the vac­cine for free from the state, Botha says. “The vac­cine is of­fered free of charge only to Grade 4 girls at school.”

But it can be ob­tained from phar­ma­cies from around R400 a dose, with two to three doses be­ing re­quired for it to be most ef­fec­tive, Botha adds.

There are two HPV vac­cines avail­able in SA: Cer­varix, which pro­tects against HPV types 16 and 18; and Gar­dasil, which pro­tects against HPV types 16, 18, 6 and 11 (see box).

WHAT ABOUT BOYS?

Men can also get var­i­ous can­cers as a re­sult of HPV in­fec­tion but it’s less com­mon com­pared to women, Botha says.

“Vac­ci­nat­ing boys pro­tects them as well as girls be­cause it stops them pass­ing the virus on. At the mo­ment only girls re­ceive the vac­cine for free in South Africa, but some coun­tries, such as Aus­tralia, have a gen­der-neu­tral pro­gramme in which both boys and girls are vac­ci­nated.”

Adam agrees boys will ben­e­fit from the vac­cine as it re­duces HPV-as­so­ci­ated con­di­tions such as gen­i­tal warts as well. “In those vac­cines that pre­vent HPV strains 6 and 11 there’s a re­duc­tion in warts in boys as well as girls who’ve re­ceived the vac­ci­na­tion.”

If par­ents want to get their teenage sons vac­ci­nated they should talk to their fam­ily doc­tor.

WHAT ABOUT SIDE EF­FECTS?

As with most in­jected vac­cines there may be what are called lo­cal side ef­fects, says Pro­fes­sor Gre­gory Hussey, direc­tor of the Vac­cines for Africa Ini­tia­tive (VACFA) at the Univer­sity of Cape Town.

“These in­clude some red­ness, swelling and pain at the site of in­jec­tion, which tend to go away af­ter a few days,” he adds. Some peo­ple may com­plain of headaches, muscle pain and tired­ness, which usu­ally get bet­ter af­ter a day or two. Hussey be­lieves the vac­cine is safe and doesn’t have sig­nif­i­cant ad­verse ef­fects. “More than 100 mil­lion peo­ple world­wide have re­ceived the HPV vac­cine. Its safety has been proven in ex­ten­sive clin­i­cal tri­als.”

But the par­ents of a young Cape Town girl who has de­vel­oped se­ri­ous health prob­lems since get­ting the HPV vac­cine don’t agree.

They say their 10-year-old daugh­ter started get­ting sick three months af­ter be­ing vac­ci­nated in April 2016, with symp­toms of dizzi­ness, weak­ness, se­vere body pain that left her un­able to walk on her own, and dif­fi­culty speak­ing.

There’s been lit­tle im­prove­ment in her con­di­tion and the girl’s mother said in a Face­book post that her daugh­ter is now “like a lit­tle child of about four or five. She has no con­trol over her emo­tions. She can’t think log­i­cally, loses her sense of re­al­ity and gets ter­ri­bly ag­gres­sive.”

Pro­fes­sor Pi­eter Fourie, the pae­di­a­tri­cian who’s treat­ing the girl, says it’s “re­ally a dif­fi­cult case,” and her di­ag­no­sis re­mains un­clear.

“Every­thing we’ve tested for has come back neg­a­tive,” he says, adding that he’s since re­ferred her to a psy­chi­a­trist for an as­sess­ment.

The “dis­com­fort­ing” thing about her con­di­tion, Fourie says, is that all her symp­toms started af­ter the vac­ci­na­tion. “So, from a log­i­cal-de­duc­tion point of view, there could be a causal re­la­tion­ship be­tween the vac­ci­na­tion and the on­set of symp­toms.

“The­o­ret­i­cally, the vac­cine should be safe, but we know from the re­sults published by the phar­ma­ceu­ti­cal com­pa­nies man­u­fac­tur­ing these vac­cines that a small per­cent­age of chil­dren do ex­hibit strange re­ac­tions – it’s in the pack­age insert,” Fourie says.

Ac­cord­ing to Mark van der Heever, the Western Cape health depart­ment’s deputy direc­tor of com­mu­ni­ca­tions, the mat­ter was in­ves­ti­gated and it was found that the girl’s symp­toms weren’t due to the vac­cine.

“The vac­cine con­tains noth­ing that can cause can­cer or other ill­nesses,” he says.

BY GABISILE NGCOBO

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