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on Jul 17, 2012 Says :
good presentation on HPV virus and cervical cancers.
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Slide 1 :
HPV vaccination to prevent cervical cancer Swasti Sharma
Slide 2 :
Cervical cancer Enormous disease burden in developing world Most common genital cancer Human papilloma virus (HPV) infection is the cause of cervical cancer in almost 100% cases. HPV types 16 and 18 are responsible for more than 70% of HPV-related cervical cancers
Slide 3 :
Other HPV associated diseases; genital warts, recurrent respiratory papillomatosis, vaginal, vulval, anal and penile cancers. Prevention of HPV associated diseases can therefore prevent cervical cancers. Primary prevention can be achieved by vaccination and secondary prevention by screening.
Slide 4 :
Effective screening program (pap smear) has significantly reduced the disease in developed countries. (60-70% reduction in cancer of the cervix within 3 years of implementation as a secondary preventive measure) Introduction of prophylactic vaccine against cancer of the cervix- the first of its kind in the world of oncology. Universal prophylactic vaccination of young adolescent girls will be a more workable and effective option.
Slide 5 :
Human papillomavirus (HPV) non-enveloped double stranded DNA virus that infects the skin and mucosae of the upper respiratory and anogenital tracts. More than 100 HPV types have been detected, with >80 types sequenced and classified. Approximately 30–40 types of HP are anogenital, of which 15–20 types are oncogenic
Slide 6 :
HPV infection & Ca Cervix HPV infects its host by penetrating through mucosal tears in the basal membrane Benign HPV infection; HPV genome is not integrated to host DNA; it lies inside host cell freely (episome). Integration of HPV into the DNA of the infected host cell is associated with high-risk oncogenic HPV types and it is an important step in tumor progression. HPV DNA integration into the host cell’s chromosome occurs through a break in the viral genome around the E1/E2 region
Slide 7 :
Uncontrolled expression of E6 and E7 E6 & E7 protein ? inactivates tumor suppressor protein p53 & pRb
Slide 8 :
more than 90% of the infections are spontaneously cleared by the immune system within approximately 1 year without treatment Persistent HPV infection is the detection of the same HPV type in follow-up visits 6–12 months apart in women
Slide 9 :
Schematic diagram of natural history of HPV infection 60% of CIN 1 lesions (or low-grade dysplasia), regress without treatment 10% 1% 16,18
Slide 10 :
HPV vaccines Made to elicit virus-neutralizing antibody responses that prevent initial infection Offers 100 percent protection against the development of cervical pre-cancers caused by the HPV type in the vaccines. Vaccines are based on hollow virus-like particles (VLPs) assembled from recombinant HPV coat protein (L1).
Slide 11 :
HPV vaccines It will induce serum anti-L1 neutralizing antibodies thereby resulting in protection against HPV infection. Two vaccines have been licensed globally Quadrivalent vaccine ( Merck) Gardasil HPV types 6, 11, 16 and 18related genital warts, vaginal intraepithelial neoplasia (VaIN) and vulval intraepithelial neoplasia (VIN) Bivalent vaccine (GSK) Cervarix HPV types 16 and 18
Slide 12 :
Vaccination Target Group Bivalent?10-45 yrs Quadrivalent?9-26 yrs The vaccine should target females at the most convenient and optimal age (12-16yrs)for vaccination before their first sexual exposure. Routine vaccination is recommended for females aged 10-12 yrs.
Slide 13 :
Dosage Schedule For a quadrivalent vaccine three doses at 0,2and 6 mth,IM. (minimum intervals between doses are 4 weeks between 1st and 2nd dose 12 weeks between 2nd and 3rd dose) Quadrivalent vaccine? mean follow up period of 3 years. For a Bivalent vaccine three doses at 0,1 and 16 months ,IM Bivalent vaccine?15 month follow up. Antibody titers produced with quadrivalent HPV vaccine remained high even after 5 years ?need for booster still undecided
Slide 14 :
Counseling before Vaccination Full explanation of the role, action and usefulness of the vaccine should be provided to the woman or her parent/guardian. The explanation should include: The role of HPV in cervical carcinogenesis, trial results and expectations, immunological responses,saftey and efficacy.
Slide 15 :
HPV testing before vaccination Not recommended before vaccination. Vaccination in Sexually active women Benefits may be limited to the protection against infection of HPV genotypes with which they have not been infected.
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Special situations Women with previous cervical intraepithelial neoplasia ? Benefits limited to the protection against infection of HPV genotypes(and related CIN) with which they have not been infected. Cervical screening and corresponding management must continue.
Slide 17 :
Vaccination in Pregnancy and lactation Not recommended No teratogenic effect has been reported. No evidence to suggest that vaccine adversely affects pregnancy , fetal outcome or lactation. Women who become pregnant before completion of the vaccine are advised to postpone the remaining dose until after the pregnancy.
Slide 18 :
HPV vaccines Role of HPV vaccine in males less cost-effective than for young women ?since penile and anal cancers are much less common Vaccinating men as well as women decreases the virus pool within the population. Recommended for prevention of genital wart in 9-26 yr males
Slide 19 :
HPV vaccines Side effects Pain and swelling at the injection site (arm), Headache Nausea and fever Myalgia Syncope (observed for15 minutes after receiving HPV vaccination)
Slide 20 :
Contraindications to HPV vaccination Pregnancy History of hypersensitivity to any vaccine component. Vaccination of people with moderate to severe acute illness should be deferred until after the illness improves.
Slide 21 :
Genital Human Papill...
Methodology for Usin...
Vaccination against ...
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