HPV vaccine - the global perspective - National Immunisation Conference Robb Butler - HSE
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
National Immunisation Conference
Dublin, 25 May 2018
HPV vaccine – the global
perspective
Robb Butler
Vaccine-preventable Diseases and Immunization
WHO Regional Office for Europe
Presentation outline • Burden of HPV‐related diseases • WHO position on HPV vaccines • HPV vaccines safety • Introduction of HPV vaccine globally and in WHO European Region • Early impact of HPV vaccines
Source: International Agency for Research on Cancer, Globocan 2012
Estimated cervical cancer incidence and mortality
worldwide, 2012
Estimated age‐standardized
rates per 100,000
Source: Globocan, 2012
Estimated cervical cancer incidence and mortality,
WHO European Region, 2012
Source: Globocan, 2012
Human papillomavirus type distribution in
invasive cervical cancer
2/4-valent 16 60.6
vaccines
direct 18 10.2
protection
45 5.9
2/4-valent
9-valent 33 3.8
vaccines
vaccines
cross-
direct
protection
protection 31 3.7
52 2.8
58 2.3
0 20 40 60 80
%
Serrano at al., 2015
WHO Position paper on HPV vaccine
(WER May, 2017)
(www.who.int/immunization/documents/positionpapers/en/)
HPV vaccines should be included in national
immunization programmes
HPV vaccines should be introduced as part of a
comprehensive strategy to prevent cervical cancer
and other diseases caused by HPV
Primary target group: girls aged 9–14 years, prior to
becoming sexually active
Secondary target group: females aged ≥15 years or
males (if feasible, affordable, cost‐effective)
Multiple age cohorts (9‐18 years old) – faster and
greater population impact
To date GACVS has reviewed the following safety issues
related to the HPV vaccine:
• Adverse events coinciding with pregnancy
• Aluminium adjuvant used in the 4vHPV vaccine
• Syncope and anaphylaxis
• Venous thromboembolism and stroke ;
• Autoimmune conditions (MS and Guillain‐Barre) and cerebral
vasculitis
• Complex regional pain (CRPS) and / or other conditions of chronic
pain syndrome.
y
• Postural orthostatic tachycardia y
syndrome ( )
(POTS)
WHO Global Advisory Committee on Vaccine
Safety Statement, June 2017
• Over 270 million doses of HPV vaccine distributed since
2006
• Safety studies include million persons
• Wide range of outcomes was compared in vaccinated an
unvaccinated subjects
http://www.who.int/vaccine_safety/committee/topics/hpv/June_2017/en/
WHO Global Advisory Committee on Vaccine
Safety Statement, June 2017 (Cont’d)
• Risk of anaphylaxis was characterized as 1.7 cases per
million doses
• Syncope was established as a common stress-related
reaction to injection
• No other adverse reactions have been identified and GACVS
considers HPV vaccines to be extremely safe
• However, attention continued to focus on spurious case
reports and unsubstantiated allegations which have negative
impact on coverage will result in real harmCountries with HPV vaccine in the national immunization
0
programme, May 2018
1,200 2,400 4,800
Kil
Introduced* to date (79 countries or 40.7%)
* Includes partial introduction Not Available, (115 countries or 59.3%)
Not Introduced/No Plans
Data source: WHO/IVB Database, Map production
Immunization Vaccines and Biologicals (IVB), The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of
World Health Organization any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be
full agreement. ©WHO 2018. All rights reserved.Introduction of HPV vaccine in WHO European Region, 2017
Source: WHO/UNICEF JRF
Russian Federation implement HPV
vaccination in some regionsElements of successful introductions
• Transparent and inclusive decision making process
• Political commitment
• Effective communication tailored to the needs of target audiences
• Education and training of medical workers
• Setting up coverage targets and monitoring coverage rates
• Building resilience of immunization programmes, including capacity
to timely and effectively respond to vaccine safety concerns,
rumours, and anti-HPV lobbies / campaignsThe vaccines are very effective: in the real world
Proportion of Australian born women diagnosed as having genital warts at first visit
Against Genital
Warts
See also
• Bauer et al Am J Pub Health 2012
• Leval et al JID 2012
• Smith et al JID 2014
• Baandrup et al STD 2013
• Chow et al STI 2014
• Howell-Jones et al JID 2013
FemalesTrends in rates of histologically-confirmed high-grade cervical
abnormalities by age, Victoria, Australia, 2000-2014HPV prevalence pre and post vaccination,
Percentage of women positive for any HPV
Scotland
Kavanagh K, Pollock KG, Cuschieri K, Palmer T, Cameron RL, Bhatia R, Moore C, Cubie H,
Cruickshank M, Robertson C. Lancet Infect Dis. 2017 Sep 28. pii: S1473‐3099(17)30468‐1Percentage of 20-year old women diagnosed with
CIN 2/CIN3+ by birth cohort year
(1.0) (4.2) (35.6) (65.2) (69.3) (70.1) (86.5) (Vaccine uptake
3‐doses)
Slide: M. Cruickshank, Conference on HPV
vaccine, MDA, 2018Comprehensive approach to
cervical cancer prevention and control
INTEGRATION
INTEGRATIONYou can also read
