The need of Human Papilloma Virus (HPV) vaccine: A review

Chandru B

Clinical Pharmacist, Kauvery Hospital, Cantonment, Trichy

Abstract

Worldwide, sexually transmitted diseases (STD) and cervical cancer play cause morbidity among adults. However gaps exist in public awareness on the role of Human Papilloma Virus in the development of these diseases. This review is to create awareness and knowledge about HPV and its prevention by HPV vaccine.

Background

Human Papilloma Virus is a non-enveloped double standard, DNA virus that causes serious epithelial lesions and genital warts. There are more than 200 subtypes of HPV, among them forty types are known to cause genital infections. They are classified as low risk types (6, 11, 42, 43, and 4) that are responsible for benign genital warts. Others are high risk types (16, 18, 31, 33, 34, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, and 70.) and cause almost all the cases of cervical cancer and other oropharyngeal, anal, penis and vulva cancers. Persistent HPV infection is one of the important sexual transmitted diseases (STDs) associated with more than 5% of all cancers in the world and cervical cancer which holds the second place in all cancers that affect Indian women. [1] The development of vaccines against these types of virus has created considerable optimism world-wide, and has major implications for both primary and secondary prevention strategies.

Epidemiology

  • In Tamil Nadu the cervical cancer number has increased from 6,872 in 2014 to 8,534 in 2023
  • From screening programme of cervical cancer, In Trichy by screening 4,838 middle age women. Cervical cancer was diagnosed in 159(4.6%) and precancerous lesions in 528(15.4%) women.[2]

Causes and mode of transmission

The infection is transmitted through sexual intercourse and it is widely spread among women from 25 to 30 years of age. Some studies reported a second peak in the prevalence of infection among women over 55 years of age

Well-known risk factors for anogenital HPV infection are multiple sexual partners, a new sexual partner, the partner’s previous sexual history and young age

HPV could even cause oral and skin infections, transmitted by oral–genital intercourse, and contact or wounds with contaminated materials. These cancers often takes years, even decades, to develop after a person gets HPV.

Actually, the natural history of HPV infections is not clearly understood. It appears that the majority of infections are transient and asymptomatic, but HPV could lead to benign proliferations (warts, epithelial cysts, hyperkeratosis, anogenital, oro-laryngeal and -pharyngeal papilloma’s, etc.) or to invasive malignancy. [3]

Screening for HPV

Only regular cervical cytological examination by all sexually active women can prevent the occurrence of carcinoma cervix. The HPV test mostly screens for cervical cancer in women aged 30 and older. HPV tests are not recommended to screen men, adolescents, or women under the age of 30 years [4]. Common screening tests are:

  1. A Pap smear – Also called a Pap test, it should be done every 3 years for women who are sexually active.
  2. HPV-DNA detection – test is recommended for women every 5 years.[5]

Prevention and vaccination

Though it is a virulent virus we can prevent it by vaccines. The main aim of the vaccines is to stop the prevalence. So, infected people can’t get the benefit from the vaccine. Some of eligibility criteria for vaccination are:

  1. All preteens (including boys and girls) at age 11 or 12 years (or can start at age 9 years).The goal is to vaccination children before they become sexually active and risk exposure.
  • Doses for 9 to 15: The 2-dose schedule, the second shot should be given 6–12 months after the first shot.
  • Booster dose: The minimum interval is 5 months between the first and second dose. If the second dose is administered after a shorter interval, a third dose or Booster dose should be administered a minimum of 5 months after the first dose and a minimum of 12 weeks after the second dose.
  1. Everyone through age 26 years, if not vaccinated already.
  • Doses for 15 and above: Should follow 3-dose schedule; the second shot should be given 2 months after the first shot and the third shot should be given 6 months after the first shot.
  • Booster Dose: The minimum intervals are 4 weeks between the first and second dose, 12 weeks between the second and third doses, and 5 months between the first and third doses. If a vaccine dose is administered after a shorter interval, it should be re-administered after another minimum interval has elapsed since the most recent dose.
  • If the vaccination schedule is interrupted, vaccine doses do not need to be repeated (no maximum interval).
  1. The current recommendations advise getting vaccinated up until age 45. The appropriate dosing schedule will be determined by a health care professional [6]

Side Effects of HPV Vaccine

Mostly non serious side effects and very rare,

  1. Syncope (fainting)
  2. Dizziness
  3. Nausea
  4. Headache
  5. Fever
  6. Injection site reactions (pain, swelling, and redness)

Available Vaccines in India

The prophylactic vaccines activate the humoral immunity and production of virus-neutralizing antibodies, inhibit viruses from entering into host cells, and induce effective protection against HPV infection. [7] To date (2024), three prophylactic licensed vaccines for the prevention of high-risk HPV infection are available in most countries. The vaccinations are Gardasil, Cervarix, and Gardasil-9 which protect you from the second most common cancer in Indian women

  1. Gardasil (Effective against HPV Strains – 6, 11, 16 and 18)
  2. Cervarix (Effective against HPV Strains – 16 and 18)
  3. Gardasil 9 (Effective against HPV Strains – 6, 11, 16. 18, 31, 33, 45, 52 and 58)[8]

Conclusion

It is smart to prevent disease, and we can prevent HPV infection by vaccination. Vaccines are long-term healthcare initiatives with a high return on investment. The prevention of a deadly disease by a vaccine is huge success for Public Health. So, let use HPV vaccine and thus prevent the highly contagious cancer causing virus. [9]

Reference

  • Yousefi Zahra , Aria Hamid , Ghaedrahmati Farhoodeh , Bakhtiari Tahereh , Azizi Mahdieh , Bastan Reza , Hosseini Reza , Eskandari Nahid An Update on Human Papilloma Virus Vaccines: History, Types, Protection, and Efficacy. Frontiers in Immunology. 2022;12: 1664-3224.
  • Viswanathan V, Ganeshkumar P, Selvam JM, Selvavinayagam TS. Referral mechanism and beneficiary adherence in cervical cancer screening program in Tiruchirappalli district, Tamil Nadu state, India, 2012-2015. Indian J Cancer. 2022;59(1):39-4
  • Wierzbicka M, San Giorgi MRM, Dikkers FG. Transmission and clearance of human papillomavirus infection in the oral cavity and its role in oropharyngeal carcinoma – A review. Rev Med Virol. 2023;33(1):e2337.
  • Srivastava AN, Misra JS, Srivastava S, Das BC, Gupta S. Cervical cancer screening in rural India: Status & current concepts. Indian J Med Res. 2018;148(6):687-696
  • Muñoz N, Bosch FX, Castellsagué X, et al. Against which human papillomavirus types shall we vaccinate and screen? The international perspective. Int J Cancer. 2004;111(2):278-285.
  • Bhatla N, Lal N, Bao YP, Ng T, Qiao YL. A meta-analysis of human papillomavirus type-distribution in women from South Asia: implications for vaccination. Vaccine. 2008;26(23):2811-2817.
  • https://www.who.int/teams/immunization-vaccines-and-biologicals/diseases/human-papillomavirus-vaccines-(HPV)
  • https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-vaccine-fact-sheet
  • Wang CJ, Palefsky JM. Human Papillomavirus (HPV) Infections and the Importance of HPV Vaccination. Curr Epidemiol Rep. 2015;2(2):101-109.

Chandru B
Clinical Pharmacist

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