HPV vaccine, the guardian of cervical cancer, “before and after”

  According to the 2013 China Tumor Registry Annual Report, the incidence of cervical cancer in China is increasing year by year and is trending younger. There are about 150,000 new cases of cervical cancer in China every year, accounting for about 1/3 of the total number of patients worldwide, and nearly 80,000 women die as a result. A study shows that if the future HPV vaccination program in China is targeted at girls aged 9-15 years, the 7-year delay in immunization with HPV vaccine from 2006 to 2012 may cause 59 million girls in China to miss the opportunity to be vaccinated. If these girls do not receive other interventions such as screening in the future, there will be 380,000 new cases of cervical cancer and 210,000 cervical cancer deaths among them.  ”Cervical cancer is currently the only malignancy with a clear cause. With measures such as HPV vaccination, regular screening and early diagnosis and treatment, it may be possible to gradually eliminate this cancer.” Lang Jinghe, academician of the Chinese Academy of Engineering and director of the Department of Obstetrics and Gynecology at Peking Union Medical College Hospital, emphasized at the 12th National Cervical Cancer Collaborative Group Working Conference on April 25, 2014.  It is widely recognized internationally that the HPV vaccine has a preventive effect on women aged 9-45 years, and if women can get the HPV vaccine before their first sexual intercourse, it will reduce the incidence of cervical cancer and precancerous lesions by 90 percent. In different clinical trials, the vaccine has been shown to protect against tumors and precancerous lesions of the cervix and vaginal vulva caused by HPV-related types by more than 95%. Because viral sequences are often integrated in HPV infection-associated precancerous lesions and malignant tumor cells, late proteins are often broken and lost, making it difficult to detect late proteins, the prophylactic vaccine has no therapeutic effect on established infection-associated lesions, i.e., it has no effect on women already infected with HPV.  In 2006, the world’s first HPV vaccine, Gardasil, was developed by Merck Sharp & Dohme and launched in the United States with priority approval. This quadrivalent vaccine controls HPV types 16, 18, 6 and 11. Although the vaccine does not cover all virus subtypes, 70% of cervical cancers are associated with HPV16 and HPV18, while HPV6 and HPV11 may cause warts such as condyloma acuminatum. The WHO has issued approval for the HPV vaccine to enter developing countries with corresponding quality pre-certification, and it is self-funded in Hong Kong, China and Taiwan, China. There are reports of many women from the mainland coming to Hong Kong for injections. Some private clinics in Hong Kong have indicated that they only need to provide valid identification documents, including ID cards, travel visas, passports, etc. to register for the vaccine. The prevailing price is about $1,200 a piece, and full HPV immunization requires three doses of the vaccine over a six-month period.  Like all vaccines, the HPV vaccine can cause certain adverse reactions, including pain, swelling, redness, fever, dizziness, and nausea. Some people would worry that less than a decade from development to market is too short a time frame. However, as of March 2014, 170 million HPV vaccines have been used worldwide and there have been no particularly serious adverse reactions. In 2013, more than 30 women in Japan experienced pain after receiving GSK’s vaccine, which did not improve after treatment. After that, the Japanese Ministry of Health, Labour and Welfare decided to temporarily suspend the “active recommendation” of two HPV vaccines. It is important to note that Japan has not discontinued the use of HPV vaccine.  It is worth noting that after HPV types 16 and 18 are suppressed, further research is needed to determine whether other HPV cancer-causing types will replace the original HPV types 16 and 18 and become popular HPV cancer-causing types worldwide again. Currently, Merck is conducting research on a 2nd generation preventive vaccine that can cover more HPV types.  The question of whether there will be reinfection after having been vaccinated against HPV, WHO officials said that information is only available for about 10 years after HPV vaccination, during which the vaccine has a definite protective effect, but a longer observation period is needed to determine the duration of the vaccine’s protection.