vaccine

Vaccine law should cover HPV cancers

Source: www.sacbee.com
Author: Brandon Brown

Vaccines are the most effective way to prevent infectious diseases. Gov. Jerry Brown rightly signed a law that requires, starting July 1, 2016, that all children enrolled in public or private schools or day care be vaccinated against whooping cough, measles, polio and other diseases, regardless of parents’ religious or personal beliefs. But frustratingly, the California mandate does not include the vaccine to protect against cervical, anal and oral cancers, and genital warts.

HPV vaccines have been around for 10 years. Three types exist, with the newest providing the highest protection against chronic infection and precancerous conditions among boys and girls. Despite the recommendations of major health groups, national data show only 57 percent of adolescent females and 35 percent of males received at least one dose of the three-dose HPV vaccine series in 2013. HPV vaccine has the lowest completion rate of any vaccine in the United States.

There may be several explanations for this. One is the short time that providers have available to stress the need for early vaccination during a normal medical visit, much less to address parents’ concerns about implicitly sanctioning sexual activity. But the vaccine is linked to age rather than sexual activity, and postponing it until after boys and girls start having sex decreases its effectiveness.

Another reason for low vaccination rates is that it requires tremendous work, including training health care providers on how to promote HPV vaccine as a cancer-prevention tool similar to hepatitis B vaccine, which has a similar route of transmission. With hepatitis B, sex is not part of the discussion, and HPV should be treated the same way.

We must applaud Rhode Island for recently joining Washington, D.C., and Virginia for incorporating all vaccines recommended by pediatricians and the Centers for Disease Control and Prevention, including HPV, into their school immunization regulations.

More than 14 million HPV infections occur annually in the United States. With such a sobering statistic, no sound justification can be made for HPV vaccines to be treated differently than other recommended vaccines. It’s time for solutions instead of excuses.

Author: Brandon Brown is an assistant professor at the University of California, Riverside, School of Medicine.

September, 2015|Oral Cancer News|

An HPV-E6/E7 immunotherapy plus PD-1 checkpoint inhibition results in tumor regression and reduction in PD-L1 expression

Source: www.nature.com
Author: A E Rice, Y E Latchman, J P Balint, J H Lee, E S Gabitzsch and F R Jones
 

We have investigated if immunotherapy against human papilloma virus (HPV) using a viral gene delivery platform to immunize against HPV 16 genes E6 and E7 (Ad5 [E1-, E2b-]-E6/E7) combined with programmed death-ligand 1 (PD-1) blockade could increase therapeutic effect as compared to the vaccine alone. Ad5 [E1-, E2b-]-E6/E7 as a single agent induced HPV-E6/E7 cell-mediated immunity. Immunotherapy using Ad5 [E1-, E2b-]-E6/E7 resulted in clearance of small tumors and an overall survival benefit in mice with larger established tumors. When immunotherapy was combined with immune checkpoint blockade, an increased level of anti-tumor activity against large tumors was observed. Analysis of the tumor microenvironment in Ad5 [E1-, E2b-]-E6/E7 treated mice revealed elevated CD8+ tumor infiltrating lymphocytes (TILs); however, we observed induction of suppressive mechanisms such as programmed death-ligand 1 (PD-L1) expression on tumor cells and an increase in PD-1+ TILs. When Ad5 [E1-, E2b-]-E6/E7 immunotherapy was combined with anti-PD-1 antibody, we observed CD8+ TILs at the same level but a reduction in tumor PD-L1 expression on tumor cells and reduced PD-1+ TILs providing a mechanism by which combination therapy favors a tumor clearance state and a rationale for pairing antigen-specific vaccines with checkpoint inhibitors in future clinical trials.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

September, 2015|Oral Cancer News|

HPV vaccine now free for ‘at-risk’ boys and men under 26

Source: www.vancitybuzz.com
Author: Jill Slattery

vaccine

The government of B.C. announced this week the HPV vaccine for human papilloma virus will now be available free of charge to boys and men under age 26 who classify as ‘at-risk’.

Beginning in September, the free HPV vaccine program currently only available to young women will become available to men who have sex with males or who are “street-involved”.

“Providing the vaccine for all girls protects heterosexual boys as well, but leaves at-risk boys and young men unprotected. This change will address that gap,” said the province in a media release.

“The human papilloma virus is the most common sexually transmitted infection,” said Health Minister Terry Lake. “It can lead to serious health problems and could develop into an HPV-related cancer. Our vaccination program will help protect all young British Columbians from cancers and other diseases caused by HPV infection.”

HPV can be contracted by having sex with another person infected by the virus. According to the Centers for Disease Control and Prevention (CDC), HPV is “spread easily during anal or vaginal sex, and it can also be spread through oral sex or other close skin-to-skin touching during sex. HPV can be spread even when an infected person has no visible signs or symptoms.”

While HPV may cause little to no symptoms in some, it can lead to genital warts and certain kinds of cancer. In men, oropharyngeal cancers (cancers at the back of the throat) are the most common.

“In general, HPV is thought to be responsible for more than 90% of anal and cervical cancers, about 70% of vaginal and vulvar cancers, and more than 60% of penile cancers,” reports the CDC.

“It is clear that some men are more at risk for HPV related cancers than are others,” said Dr. Perry Kendall, B.C.’s provincial health officer. “As most of these infections are vaccine-preventable, extending B.C.’s HPV immunization program to this at-risk demographic is a cost-effective way to provide protection to the people who need it most.”

Men who have sex with other men carry a disproportionately high chance of contracting HPV.

The provincial HPV vaccine program uses the Gardasil vaccine, protecting from HPV types 16 and 18 that cause 70% of cervical cancers, 80% of anal cancers and other cancers of the mouth, throat, penis, vagina and vulva. It also protects against infection from HPV types 6 and 11 that cause about 90% of cases of genital warts.

Hey, Ontario — boys deserve protection from HPV, too

Source: news.nationalpost.com
Author: Robyn Urback

For years now, groups including the Canadian Medical Association, the Canadian Cancer Society and the National Advisory Committee on Immunization have been petitioning the Ontario government to cover the cost of the HPV vaccine for boys. Since 2007, the province has paid to immunize girls against the common sexually transmitted infection — which is known to cause cervical, vaginal and other cancers in women, and mouth and throat cancers in men — but boys still have to shell out around $400 or more for three doses (though recent studies show that two doses may be sufficient) of the demonstrably effective, safe vaccine.

HPV Vaccinations Back In Spotlight After Perry Joins Presidential Race

Alberta and Prince Edward Island already cover the cost of the immunizations for both boys and girls, and so too will Nova Scotia as of this coming fall. And there’s good reason for that: doctors say that the rates of oral cancers among men have risen dramatically over the past several years, with HPV present in about two-thirds of cases. The good news is that the survival rate of these HPV-positive cancers is about 80 per cent; the bad news is that there can be lifelong effects, including problems with swallowing, hearing, tasting and in extreme cases, dependence on a feeding tube.

But here’s more good news: we know the HPV vaccine works. In the U.S., for example, it has been shown to reduce the rates of infection among 14- to 19-year-old girls by more than 56 per cent since it was introduced in 2007, and there are indications it might be similarly successful among boys. So with such obvious benefits, why would Ontario choose to leave half of its young population exposed?

Money. Obviously. According to a statement released by the Ministry of Health a couple of weeks ago, the province has put off expanding its vaccination program to boys in order to evaluate “economic and societal factors.”

There’s no question that these vaccines don’t come cheap, but they certainly don’t cost as much as treating a patient with oropharyngeal cancer, and indeed there may long-term savings — anywhere from $8 million to $28 million per year, as a recent study has shown. Furthermore, the immunization program in Ontario now depends on the notion of “herd” immunity, whereby the spread of the infection is contained if a large enough proportion of the population is inoculated. That means, essentially, that 15-year-old boys in Ontario today are left to either trust that the girls around them have been vaccinated, or to fork over the money in order to protect themselves. (This also leaves boys who might contract the virus from other boys completely exposed to the infection).

It is true that the prevalence of throat cancers among men in Ontario is still relatively low, but according to a 2011 study published in the Journal of Clinical Oncology, if trends continue the way the are, the rates of HPV-positive oropharyngeal cancer in the U.S. will surpass that of cervical cancer by the year 2020. It’s also likely that the cost of the vaccine will come down over the next few years (indeed, it used to be prohibitively expensive at more than $500 for a full course), especially as old patents expire and new versions of the vaccine become available. But here’s the most compelling reason why Ontario should expand its HPV vaccination: boys deserve to be protected from a cancer-causing infection, too. Alberta, Nova Scotia and PEI get that; it’s a shame Ontario still needs to think it over.

Single Dose of HPV-16/18 Vaccine Looks to Be Sufficient

Source: www.medscape.com
Author: Jenni Laidman
 

A single dose of a vaccine against human papillomavirus (HPV) may prevent cervical cancer as effectively as the standard three-dose regimen, researchers concluded after analyzing the combined results of two large vaccine trials. The HPV vaccine in these studies was Cervarix (GlaxoSmithKline), which is effective against HPV strains 16/18.

If randomized controlled trials ultimately support the result of this post hoc analysis, it could broaden protection against cervical cancer in areas of the world where vaccination programs are hardest to administer and where cervical cancer is disproportionately burdensome, the study authors say.

“Even if you ignore the expense, the feasibility of implementing and getting back to individuals for a second and third dose is quite challenging, especially in places where there is no infrastructure,” coauthor Cosette Wheeler, PhD, Regents Professor, Pathology and Obstetrics and Gynecology, University of New Mexico Health Sciences Center in Albuquerque, told Medscape Medical News.

The studies are published online June 10 in the Lancet Oncology.

The possibility of a single-dose HPV vaccine is “a huge public health win,” coauthor Aimée R. Kreimer, PhD, Investigator, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland, told Medscape Medical News. “Even if one dose protects only against HPV types included in the vaccine formulation, if we vaccinated most girls, we would have the chance to reduce cervical cancer by around 75%.”

That’s the exciting part, Dr Wheeler added. “If we’re able to achieve success with one dose, or frankly even with two doses, that makes the possibility for worldwide prevention much greater.”

HPV type 16 is the leading cause of cervical cancer, responsible for about 50% of all cases, and HPV 18 is the second-largest cause, at 20%.The authors note that this research was carried out with Cervarix, and it is unclear whether the results would also apply to the other HPV vaccine that is available, Gardasil (Merck & Co.), which is active against several more HPV strains and is the product that is commonly used in the United States. Whether results of this trial have any bearing on Gardasil will depend on what’s driving the strong immune response to Cervarix, the authors suggest. Cervarix carries a proprietary adjuvant, which may be responsible for the immune response.

Surprise Over Efficacy Findings

The idea of the current post hoc analysis arose from results in the large randomized controlled Costa Rica Vaccine Trial, in which about 20% of participants received fewer than three doses of HPV-16/18 vaccine. “We were surprised to observe that efficacy was the same regardless of the number of doses received,” Dr Kreimer told Medscape Medical News.

That led to the post hoc analysis of the immunization results from the Costa Rica Vaccine Trial combined with results from the only other large phase 3, double-blind, randomized trial of HPV-16/18, for a total of more than 14,000 participants, ages 15 to 25 years, including about 7000 control subjects. The second trial, called PATRICIA (Papilloma Trial Against Cancer in Young Adults), took place in 14 countries. The analysis found that 4 years after vaccination, women who received the required three vaccine doses and women who received fewer than three doses — usually due to pregnancy or a colposcopy referral — were equally protected against HPV-16/18. Further, the analysis showed a potential benefit of cross-protection against closely related HPV strains 31/35/45 among women whose two doses were 6 months apart — a benefit previously seen only with three doses.

Four-year vaccine efficacy against HPV-16/18 in the combined analysis was 77% for the 13,296 (6634 case, 6662 control) women in the three-dose group, 76% for the 549 (273 case, 276 control) women in the two-dose group, and 85.7% for the 238 (138 case, 100 control) women in the single-dose group. Efficacy against the closely related HPV-31/33/35 was 59.7% for three doses, 37.7% for two doses, and 36.6% for one dose. When data for the two doses were analyzed according to dosing regimen, the cross-protective efficacy was 10.1% for those who received their second dose 1 month after the first and 68.1% for those who received the second dose at 6 months.

Antibody concentrations for two doses given 6 months apart were very close to concentrations for three doses, the research showed. One-dose vaccination titers at 6 to 48 months were lower than those for two or three doses, “but the titers were stable and several times higher than those identified for natural immunity,” the researchers write. “We can now infer that these lower, vaccine-induced antibody titers provide as strong HPV prevention as the titers from two or three doses, at least in the short term.”

Just how long these vaccines will provide protection still needs to be determined. “We know with three doses we can see the protection going out toward 10 years, and we hope that maybe the protection is lifelong,” commented Dr Wheeler. “That does not mean that we know we will never need a booster. And that doesn’t mean if we give less than three doses that we know about the longevity or durability of that protection. So that’s another piece of the puzzle.”

Although these results cannot be applied to Gardasil, Dr Wheeler notes that studies looking at Gardisil antibody titers after two doses look promising.

In an accompanying comment, Julia M.L. Brotherton, Medical Director, National HPV Vaccination Program Register, VCS Registries, East Melbourne, Victoria, Australia, commented: “These data suggest that one dose of bivalent HPV vaccine might be adequate to protect against HPV-16 and HPV-18 persistent infections and, therefore, probably disease. HPV-16 and HPV-18 cause more than 70% of cervical cancers and the vast majority of HPV-related cancers at other anatomic sites. If this finding is confirmed, it opens up a great opportunity to extend the reach of protection using HPV vaccines to more people than we would have previously thought possible.”

Four authors of the study are GSK employees and own shares and stock options in the company. Other researchers had financial or advisory relationships GSK, Roche Molecular Systems, Merck, and Sanofi Pasteur MSD. Dr Brotherton notes that she has been an investigator for investigator-initiated HPV epidemiology research grants partially funded by bioCSL/Merck, but this did not involve financial compensation.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

Three things you might not know about HPV

Source: www.huffingtonpost.ca
Author: Sunnybrook Health Sciences Centre

April 26 to May 2 is National Immunization Awareness week in Canada. One immunization known for raising a lot of questions is the Human Papillomavirus (HPV) vaccination, provided free of charge in Ontario to girls in grades 8-12, and following provincial schedules across the country.

n-HPV-VACCINE-large

While there is lots of information online, at school and at the doctor’s office about HPV, there is still a lot of confusion about what it may mean for your loved ones. Dr. Nancy Durand, gynecologist at Sunnybrook, explains three little-known facts about HPV.

1) HPV causes cancer in men, too
When Michael Douglas candidly revealed his oral cancer was caused by HPV, many people expressed surprise.

Even though HPV has traditionally been thought of as a disease that affects women and mainly causes cervical cancer, men are actually at higher risk of being diagnosed with certain types of HPV-positive cancers than women.

“It’s not well understood why men are at higher risk for HPV-positive oral cancer, but it does point out that vaccination in men is even more important than we may have previously thought,” says Dr. Durand. Physicians are learning more and more that HPV can also cause other cancers in both women and men, such as anal cancers and head & neck cancers (cancers of the base of the tongue, tonsils and soft palate).

2) Not all HPV infections lead to cancer
You’ve probably read some of the (slightly scary) statistics about HPV: Three in four Canadians will get HPV in their lifetime. It can lead to a variety of cancers and cause genital warts, and there is no cure. But should this keep you up at night, worrying about the potentially deadly consequences of HPV?

Hardly, says Dr. Durand. “Most people who are infected with this virus will clear it — probably 80 per cent of people. It’s the other 20 per cent of people with a persistent infection who may be at risk of cancer, and it’s still only a very small percentage of those people who may go on to develop cancer,” she says.

Many people never even realize they’ve had an HPV infection, as there are usually no symptoms, and the infection often goes away on its own.

3) You’re never too old to get the HPV vaccine
What if you didn’t get the HPV vaccine back in middle school, and now you think it’s too late to get it?

“Regardless of your age and your onset of sexual activity, we can vaccinate both men and women, and we can see a reduction in disease,” says Dr. Durand.

It’s actually not too late — the vaccine can still be effective, even in adults who’ve already been sexually active. “Many people think vaccination can only be done before the onset of sexual activity. But regardless of your age and your onset of sexual activity, we can vaccinate both men and women, and we can see a reduction in disease,” says Dr. Durand.

Anyone, male or female, over the age of nine can be vaccinated. So, if you’ve put off getting the vaccine because you thought you were too old, it’s not too late!

Note: Co-authored by Sybil Millar, Communication Advisor at Sunnybrook Health Sciences Centre

April, 2015|Oral Cancer News|

Nova Scotia to include boys in HPV vaccination schedule

Source: www.theglobeandmail.com
Author: Kelly Grant, Health Reporter

hpv_vaccine
Boys in Nova Scotia will begin receiving free vaccinations against the human papillomavirus next fall, a move that makes the Maritime province only the third in Canada to extend public funding of the cancer-thwarting shot to all children, regardless of gender.

In the budget unveiled on Thursday, Nova Scotia’s Liberal government announced it would make the HPV vaccine available to Grade 7 boys as part of the regular school-based immunization program. The expansion is expected to cost $492,000 a year.

Every province in Canada already covers the HPV vaccine for girls in an effort to prevent genital warts and cervical cancer, both of which can be caused by some strains of the virus, which is transmitted through sex and skin-to-skin contact.

But in recent years, oncologists and major health organizations – including the Canadian Cancer Society and the National Advisory Committee on Immunization – have begun calling for HPV vaccinations for boys, too. Until this week, only Prince Edward Island and Alberta had heeded that call with a publicly funded program.

HPV can lead to cancers of the penis, anus, oral cavity and throat in men, as well as genital and anal warts.

“We have a vaccine. It can prevent cancers in men and women, so we want Canadians to be vaccinated against it, because we can actually prevent cancers from starting in the first place,” said Robert Nuttall, the assistant director of cancer control policy at the Canadian Cancer Society.

Nova Scotia’s decision to fund the vaccine for boys was especially important to one recently retired member of the provincial legislature. Gordie Gosse, who until last week represented the riding of Sydney-Whitney Pier in Cape Breton, was diagnosed nearly a year ago with Stage 4 throat cancer caused by HPV. The 59-year-old former speaker of the legislature had more than 12 hours of surgery to remove the tumour and reconstruct parts of his face, followed by chemotherapy and radiation.

“If I’d had the vaccine, I wouldn’t have had the cancer,” he said in an interview on Friday.

Mr. Gosse, a member of the opposition NDP, made it his final mission as an elected official to extend public funding of the HPV vaccine to boys, which, according to a spokesman for the province’s department of health, the Liberal government was already studying as part of its annual vaccine review.

When his private members’ bill on the male vaccine program passed second reading on April 1, Mr. Gosse figured the measure would be in the budget. He announced his retirement the next day. “I was quite ecstatic,” Mr. Gosse said.

The HPV vaccine is most effective when administered before a child or teen starts having sex.

However, provincial governments are wrestling with whether it is cost-effective to vaccinate boys as well as girls.

“Right now it’s [about] money,” said Eduardo Franco, chair of the department of oncology at McGill University in Montreal.

Dr. Franco pointed to an evaluation done in Quebec two years ago that found vaccinating boys would not be cost-effective, in part because men who sleep with women would benefit from the protection the vaccine provided to their female partners. But that leaves gay men vulnerable, Dr. Franco said.

“The solution is truly universal HPV vaccination,” he said. “No questions asked. We [should] just take it for granted that it’s part of the adolescent vaccine calender.”

Alberta’s Grade 5 HPV immunization program costs $11-million a year – $4-million for boys, $4-million for girls, plus an extra $3-million a year for a limited-time “catch-up” program for Grade 9 boys that ends in 2017.

But the overall HPV immunization program is expected to save an estimated $13.4-million a year down the road by preventing some cases of HPV-caused cancer, according to Alberta Health.

Ontario is reviewing its HPV immunization program, said David Jensen, a spokesman for the Ministry of Health and Long-Term Care.

“Various factors are being considered such as scientific evidence (e.g., burden of disease and vaccine effectiveness), economic and societal factors, as well as cost effectiveness and impact on the health system,” he said by e-mail.

April, 2015|Oral Cancer News|

Head and neck cancer on rise in young men

Source: www.healthcanal.com
Author: staff

“The head and neck cancers we have found in younger men with no known risk factors such as smoking are very frequently associated with the same HPV virus that causes cervical cancer in women.” said Kerstin Stenson, MD, a head and neck cancer surgeon at Rush and a professor of otolaryngology at Rush University. The cancer develops from an HPV infection, likely acquired several years earlier from oral sex.

“Men are more susceptible to these cancers because they don’t seem to have the same immune response as women and do not shed the virus like women do,” Stenson said.

‘Epidemic proportions’
According to the Centers for Disease Control and Prevention, cancers of the oropharynx (back of the throat, including the base of the tongue and tonsils) are usually caused by tobacco and alcohol, but recent studies show that about 72 percent of oropharyngeal cancers are caused by HPV.

“There has been significant change in the last decade. Overall, head and neck cancers account for approximately 3 to 5 percent of all cancers, but what’s changed in the past decade is the HPV-associated oropharyngeal cancer. It has reached epidemic proportions,” said Stenson.

The American Cancer Society estimates that 45,780 Americans will be diagnosed with cancer of the oral cavity and oropharynx in 2015. If this trend continues, the number of cases of HPV-positive oropharyngeal cancer will surpass the number of cervical cancer cases.

Early detection is key
The current vaccine has been shown to decrease the incidence of HPV-associated cervical infections and cancer. While the same result is anticipated for HPV-associated head and neck cancer, the impact of vaccines on incidence of persistent oral HPV infection and/or HPV associated oropharyngeal cancer has not yet been investigated. We will need about 10-30 more years to see the anticipated effect of the vaccine on HPV-related cancers that could affect people who are now teenagers. Still, head and neck surgeons, medical oncologists and other researchers strongly advocate vaccination of both girls and boys to help prevent all HPV-associated cancers.

“For all individuals, the key is in early detection, as with any cancer,” Stenson said.

In addition to being vaccinated, Stenson stresses the importance of regular visits to the dentist. “Dentists play a key role in detecting oral cancer. You might not see a primary care physician even once a year, but most people see their dentist twice a year. Having regular dental visits can help catch cancers early to help ensure the best outcome.”

The American Dental Association states that 60 percent of the U.S. population sees a dentist every year.

Oral cancer warning signs
The Oral Cancer Foundation presumes that cancer screenings of the existing patient population would yield tens of thousands of opportunities to catch oral cancer in its early stages.

“There is much that can be done for those who are diagnosed with head and neck cancer. Since early detection and treatment is critical, it’s important to see your dentist regularly and to promptly see a medical professional if there are any warnings signs,” Stenson advised. Strategies to improve public awareness and knowledge of signs, symptoms, and risk factors are critical topics for study and may decrease the disease burden of head and neck cancers.

Possible warning signs of oral cancer may include difficulty swallowing, pain when chewing, a white patch anywhere on the inside of your mouth, a lump or sore in the mouth or on the lip that does not heal.

If you notice any of these symptoms, ask your dentist or doctor about it.

Treatment includes surgery for early or low-volume late stage lesions and radiation or chemoradiation for more advanced cancers.

March, 2015|Oral Cancer News|

Clinician support critical to HPV vaccination

Source: www.medpagetoday.com
Author: Charles Bankhead, Staff Writer, MedPage Today

Immunization against human papillomavirus (HPV) infection continues to lag behind rates for other vaccine-preventable diseases, primarily because of lost opportunities in the clinic, according to participants in a national conference.

Primary care providers have yet to get onboard with HPV immunization with their critical recommendation to patients or parents. Enthusiasm for HPV vaccination also has taken a hit because of its portrayal as a means to prevent a sexually transmitted disease (STD) instead of a vaccine to prevent cancer, speakers said during an HPV vaccination “summit” at Moffitt Cancer Center in Tampa, Fla.

“The most important problem is that many healthcare providers are not making a strong recommendation for the vaccine in the same way that they recommend other recommended vaccines,” said Melinda Wharton, MD, of the Centers for Disease Control and Prevention (CDC) in Atlanta. “That’s fundamentally what we think the biggest problem is.”

“We’re hurting ourselves by approaching it differently and talking about it differently than we’re talking about the other vaccines,” said Ailis Clyne, MD, of the Rhode Island Department of Health, which has mounted one of the more successful HPV immunization campaigns in the U.S.

Not only have the primary “pitch men” not been getting the message out about HPV, too often the sales pitch has focused on the wrong disease, said Otis Brawley, MD, chief medical officer for the American Cancer Society (ACS).

“We need to start talking about [the vaccine] as a cancer vaccine, instead of a vaccine for sexually transmitted disease,” said Brawley.

The focus on HPV vaccination as protection against an STD helped create and perpetuate a stigma associated with the vaccine. Moreover, focusing on the STD angle obscures the bottom-line benefit of preventing cervical and other cancers, Brawley and other speakers at the conference emphasized.

The conference brought together dozens of representatives of cancer and public health organizations to compare notes on how to improve HPV vaccination rates. In addition to the CDC and ACS, conference participants included the National Cancer Institute, National Partners for Comprehensive Cancer Control, and representatives of the nation’s comprehensive cancer centers.

Since 2006, the CDC Advisory Committee on Immunization Practices (ACIP) has recommended HPV immunization as a part of routine care for all girls ages 11 to 12, extending the recommendation to 11- and 12-year-old boys in 2011. According to the latest estimates from the CDC, 57% of adolescent girls and 34% of boys have received at least one of the recommended three doses of HPV vaccine. If every girl born in 2000 had received at least one dose of vaccine, coverage would have exceeded 91% by now.

Presentations and discussion at the HPV conference highlighted a number of obstacles to HPV vaccine uptake. Currently, a majority of states (29) have no formal policies regarding HPV immunization. Conference participants appeared divided about the effectiveness of vaccine mandates, as some speakers said mandated HPV immunization (along with other childhood immunizations) is the only way to ensure uptake, whereas others said experience to date suggests mandates have had limited success in improving the vaccination rate for HPV.

Clyne provided a few insights into potential pathways to improved vaccine uptake. The state health department had the autonomy to mandate HPV vaccination without seeking approval of the state legislature. Additionally, Rhode Island directly purchases all state-mandated vaccines and distributes them to healthcare providers free of charge.

Clyne’s bosses at the Rhode Island Department of Health refused MedPage Today’s request to interview her about the state’s HPV immunization program.

Discussants repeatedly returned to the issue of providing support and encouragement to clinicians, whose recommendations have proven critical to a wide range of healthcare actions.

“One of the things we can do at the community level is to help physicians make that strong recommendation,” said Anna Giuliano, PhD, of Moffitt Cancer Center. “When they have families in their offices with age-eligible boys and girls, they should take that opportunity to make the recommendation for HPV vaccination.”

Public education also will play a major role in improving vaccine uptake, Giuliano added. Parents need clear, accurate, and concise information to make an informed decision about HPV vaccination.

Education for the public and healthcare professionals should emphasize the wide range of cancers that can be prevented by HPV immunization, said Jennifer Smith, PhD, of the University of North Carolina School of Public Health at Chapel Hill. Although cervical cancer has received the most attention, HPV also causes anal, penile, and vulvar cancer, as well as oral cancer.

“Increasing the uptake of the vaccine will be followed by reductions in all of the HPV-associated cancers,” said Smith.

The conference ended with agreement to prepare a written summary of the conference proceedings, develop an agenda for action, and revisit the issues, obstacles, and progress related to HPV immunization at a future date. Additionally, several working groups have taken shape to address specific issues in greater detail.

“The top priorities are really about that provider recommendation, making sure that it is strong and it is consistent,” Susan Vadaparampil, MD, of Moffitt Cancer Center, told MedPage Today. “Another important priority is to emphasize that we need to vaccinate not only our adolescent girls but also our adolescent boys. Finally, the message about the benefits of this vaccine are around cancer prevention.”

February, 2015|Oral Cancer News|

HPV Vaccine Linked to Less-Risky Behavior

Source: torontosun.com
Author: Roxanne Nelson, Reuters
 

Contrary to concerns that getting vaccinated against human papilloma virus (HPV) will lead young people to have more or riskier sex, a new study in England finds less risky behaviour among young women who got the HPV vaccine.

“To my knowledge no studies have shown that HPV vaccination increases risky sexual behavior among young women and some of these studies have shown this (less risky behaviour) is also the case outside of the UK,” said Dr. Laura Sadler of the University of Manchester, who led the study.

It’s possible that getting vaccinated led to better education about sexual health, Sadler and her colleagues write in the Journal of Family Planning and Reproductive Health Care.

Sadler and other experts say it’s also possible that young women who are already less likely to take risks are the ones who are more likely to get vaccinated.

HPV is one of the most common sexually transmitted infections and causes the majority of cervical cancers. The virus has also been linked to anal and throat cancers. Two vaccines, Cervarix and Gardasil, are now available that protect against strains of HPV that cause most cervical cancers.

Even though public health officials recommend that girls and young women be vaccinated against HPV, some parents have hesitated, fearing that it could encourage sexual activity or unsafe sex.

For their study, Sadler’s team reviewed the medical records of 363 women born in 1990 or later who attended an English clinic. Almost two-thirds of the young women in the group had received at least one dose of the vaccine. Full vaccination requires three vaccine shots.

The researchers compared the womens’ histories of behaviours that are risky in themselves or tend to be linked to risky sexual behaviour, such as not using condoms, having sex for the first time when they were 15 or younger, having six or more sexual partners and drinking alcohol two or more times a week.

They found five variables related to sexual behaviour that were significantly different between women who had been vaccinated and those who hadn’t.

Women who were not vaccinated were more likely to have had three sex partners in the last six months, to have attended the clinic with symptoms of a sexually transmitted disease, to have had anal intercourse with their last sexual contact and to have tested positive for Chlamydia (a common sexually transmitted infection) at their clinic visit.

Being vaccinated, in contrast, was associated with less-risky behaviours, such as using condoms.

“In this study, the lower prevalence of some risk outcomes among vaccinated women relative to unvaccinated women may be related to underlying differences in preventive care seeking and preventive health behaviors,” said Robert A. Bednarczyk, an assistant professor at the Rollins School of Public Health at Emory University, and who was not involved in the study.

“The women in our study were mainly from the catch-up vaccine program – older teens – and as in the other studies, it shows that among this group, vaccination was taken up by those demonstrating other types of preventive or less risky behaviors,” Sadler told Reuters Health by email.

While the findings are encouraging, and consistent with other research demonstrating that HPV vaccination does not lead to riskier behaviors, the study does not demonstrate that vaccination causes less risky behaviors, said Dr. Jessica Kahn, a professor of pediatrics at Cincinnati Children’s Hospital Medical Center.

“One explanation for the findings is that girls who are vaccinated receive education about sexual health and prevention which decreases riskier behaviors,” Kahn said in an email.

Another explanation is that girls who practice healthier and less risky behaviors are more likely to receive the vaccine, she noted. “Preventive health behaviors tend to cluster, so it makes sense that girls who practice safer behaviors are more likely to be vaccinated.”

 

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
February, 2015|Oral Cancer News|