In July 2016, the HPV vaccine was finally approved to be marketed in China, and at that time I wrote an article about HPV vaccine overnight, which was widely read, and later the Health China cartoon team adapted it into a cartoon for free, but I never sent it out. Today, I borrowed this comic as a presentation slide for the “HPV Vaccine Authoritative Expert Interpretation Meeting” for media friends, and it worked well, so I am sharing it now. I. What is HPV? HPV is the abbreviation of “human papillomavirus”, and there are more than 100 members in the HPV family, among which the ones with ambiguous relationship with malignant tumors are called high-risk HPV (led by HPV types 16 and 18). German scientist Chur Hausen, for the first time the causal relationship between HPV and cervical cancer was made known to the world, thus winning the 2008 Nobel Prize in Medicine or Physiology! Secondly, snapping infected with HPV, with the jugular or mouth is okay? But since you ask, I will uphold the scientific attitude to answer. Don’t underestimate HPV16 and HPV18, they are not only associated with over 70% of cervical cancers, but also 80% of anal cancers, 60% of vaginal cancers, and 40% of vulvar cancers. The backyard road is blocked, the upper road is safe? Give it up, tweens! Researchers have found that cancers of the oropharynx and some breast cancers may also be associated with high-risk HPV infection. The famous Hollywood playboy Michael Douglas once revealed that his throat cancer was caused by HPV infection on behalf of a woman’s “bite”! Is HPV infection a sure way to get cancer? HPV is very common, similar to the flu. Women who have sex have a 40% to 80% chance of being infected with HPV in their lifetime. In other words, if you dare to get tested, it will be positive! Don’t be afraid, more than 80% of HPV infections will clear up naturally within 8 months only a few persistent high-risk HPV infections for more than 2 years are likely to cause cancer. The cancer-causing process of high-risk HPV is long, HPV infection → persistent infection → precancerous lesions → cancer usually takes about 10 years during which time it may heal itself, or the process can be ended by treatment. (Only a tenacious HPV and careless owners can make this happen) IV. Why is it marketed in Europe and America? HPV vaccine is the world’s first tumor vaccine, the first human attempt to eradicate a cancer through a vaccine! Europe and the United States approved the HPV vaccine 8 years ago on the premise of “no harm and no gain”, making it available to the people earlier. If we had to wait, we would have had definite data to support its launch at least by 2020. You can see how important it is not to be dogmatic! V. Is there a risk of HPV vaccination causing viral infection? People with this question should be aware that many vaccines are artificially treated with a weakly virulent virus. It is equivalent to disarming the weapons and equipment of the virus and then pushing it into the battlefield. One, it can draw the attention of the immune system to easily strangle it. Secondly, the immune system will be concerned about the virus for a long time. But the HPV vaccine is a preventive vaccine that uses antibodies to a special protein on cancer cells to trigger immunity. So the vaccine itself is not a virus, it is a protein and naturally does not function as a virus, much less cause a viral infection. VI. How many types of HPV vaccines are currently available? There are many kinds of HPV vaccines being researched around the world, but the most popular ones currently have only three members: bivalent, quadrivalent and nine-valent vaccines, with the “price” representing the type of virus that the vaccine can prevent. The bivalent vaccine can prevent cervical cancer caused by HPV 16 and HPV 18 lesions. This is a blessing in disguise, as over 70% of cervical cancers are caused by these two viruses! It is this student who was lucky enough to be approved to enter the Chinese market a few days ago. The quadrivalent vaccine can prevent HPV types 6, 11, 16 and 18. the quadrivalent vaccine is just the icing on the cake because HPV6 and HPV11 are not high-risk HPV viruses for cervical cancer, they can cause condyloma acuminata and vulvar cancer, which is much less common than cervical cancer. The nine-valent vaccine targets nine subtypes of HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58 and is claimed to prevent 90% of cervical cancers! Unfortunately, the nine-valent vaccine has not yet been approved to enter the Chinese market. VII. What is the best age to receive HPV vaccine? It is generally believed that the best age to start HPV vaccination is 11 to 12 years old. The American recommendation is 9 to 26 years of age. Globally, it is generally considered that it can be between the ages of 9 and 45. The bivalent vaccine that was approved for marketing in China recently is recommended for women aged 9 to 25 years old In fact, it can be said that if needed and if you have the money, you can be vaccinated at any age. How late is not late! Can I still get vaccinated after having sex? Previously, it was thought that the vaccine could be administered only if you had not had OOx. Currently, it is believed that the vaccine can be administered even if you have had sex. Why did the HPV vaccine always have to mention whether or not I had sex in the past? Because the chances of women being infected with HPV increase dramatically when they have sex. It would be “less cost effective” for the country to give the vaccine to these women for free. But please note in particular that it is only not cost effective, and not without medical value. If you are paying for the vaccination yourself, you can disregard the economic benefits. In other words, you can get vaccinated even if you have sex. Of course, if one does not intend to have sex for the rest of one’s life, the need for HPV vaccination is minimal. X. How many doses of the vaccine are usually required to be effective? Much like the hepatitis B vaccine, the HPV vaccine is usually given in 3 injections over a period of 6 months. The doses are given in months 0, 1, and 6, respectively. In order to reduce health costs, studies in Western countries have concluded that two injections can also be effective in preventing cervical cancer. The bivalent vaccine marketed in China is still a 3-dose immunization program. XI. Are there any side effects of HPV vaccine? As the saying goes, no one is perfect and any vaccine or medicine has possible side effects. There are very few cases of side effects from HPV vaccine and the symptoms are mild, such as red rash, swelling and pain at the injection site. More serious side effects include: fever, nausea, dizziness, muscle weakness and paralysis; but as with all vaccines, there are definitely pros > cons. 12. Is the HPV vaccine effective for women in mainland China? If we go by the rules, a vaccine proven to be effective in Europe and the United States needs to be retested on the Chinese to determine its effectiveness. From the experience of Korea and Japan, these vaccines are effective for women in Asia. From the experience of Taiwan and Hong Kong, the vaccines were also effective for Chinese women outside of mainland China. Researchers have found that the anatomical structure and physiological function of the reproductive organs of mainland women are not too different from those of women worldwide, and the status of HPV infection is basically similar, so the HPV vaccine should also be effective. XIII. Can I get the HPV vaccine during pregnancy and while breastfeeding? Because there is not enough human data to support the vaccine, it is not recommended for pregnant and breastfeeding women for the time being. In fact, HPV is not as harmful as imagined. It is not too late to wait a year and a half for the HPV vaccine after the birth and weaning of the fetus. XIV. What if I get pregnant after HPV vaccination? No adverse effects of the vaccine on the fetus have been found. Therefore, if you become pregnant unexpectedly within 6 months of vaccination, you can continue your pregnancy under close observation. XV. What if I was going to receive the vaccine but have my period? The current information shows that vaccination during menstruation does not have any effect. There is no need to miss the appointment even if your period visits. Can men and boys receive HPV vaccine? “Men are the root of all evil” and have an important role in the transmission of HPV. Therefore, theoretically, HPV vaccination for boys can reduce the spread of HPV. Again, considering the input-benefit ratio, most countries and official WHO documents, have not yet recommended vaccination for males. But Australia is rich and boys are vaccinated for free. There is no clear evidence that HPV vaccination for men has much effect on the prevention of cervical cancer in women. Instead, it can prevent genital warts (a sexually transmitted disease caused by HPV), which does not kill people, but can give promiscuous guys something to worry about. XVII. Do I need to be tested for HPV before I get the HPV vaccine? Considering that HPV can be repeatedly infected, it is usually considered unnecessary to test for HPV infection in the body before vaccination. However, if you have been infected with HPV or if this has caused cervical lesions, it is a different story and it is better to treat the infection and get vaccinated after it has turned negative. Can I get the vaccine if I have HPV infection or cervical lesions that have been cured? Korean studies have shown that HPV vaccination after HPV infection or resulting cervical lesions have been cured can reduce the recurrence rate of the disease. Especially since there are several types of HPV viruses that the current vaccine can prevent that you have not been infected with, vaccination is still beneficial. Do I still need to be screened after vaccination? How many years can I manage after vaccination? The answer is yes! Whether you receive the 2-valent vaccine, 4-valent vaccine or 9-valent vaccine, you still need to be screened regularly after receiving the vaccine. The reason is simple: existing vaccines, including the 9-valent vaccine, do not protect against all high-risk HPV types, and there may be a small wave of high-risk HPV types that are not currently identified, and certainly no targeted vaccines. It is not entirely clear how many years of immune protection can be maintained after HPV vaccination. The reason for this is that the HPV vaccine has been in use for less than a decade and its effectiveness remains to be seen. Some time ago it was thought that it would last for 5 years without problems. At present, it is thought that there is no problem to maintain it for 10 years. 20. How much does the HPV vaccination cost? Although the HPV bivalent vaccine has obtained the marketing license from the State Food and Drug Administration, it is estimated that it will only be officially listed in the beginning of next year (2017) and can only be injected in mainland China. According to the reference price of HPV vaccination in Hong Kong, it currently costs about HK$3,000 (equivalent to about 2,600¥) to complete 3 injections, which is not too expensive. And three years ago, the price was about three times of what it is now. It can be expected that the price will drop further. When will there be a domestically produced HPV vaccine, free vaccination will be promoted. “Self-reliance” and “independent innovation” are not slogans. The revolution has not yet succeeded, comrades still need to work hard!