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A decade of Latin -American experience with HPV prevention

Explore the trends in cervical cancer incidence and death rates, the introduction of HPV vaccines, and the vaccination coverage in Latin American and Caribbean countries. Learn about the safety of the HPV vaccine and the challenges faced in promoting vaccination.

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A decade of Latin -American experience with HPV prevention

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  1. A decade of Latin-American experiencewith HPV prevention Dr. Pablo Elmassian

  2. Trends in ICC incidence: LATAM and Caribbean countries New cases per year Deaths per year

  3. Trends in ICC deaths: LATAM and Caribbean countries 2010-2100

  4. HPV Vaccines WHO Position Paper • HPV vaccines should be introduced as a part of a coordinated strategy to prevent cervical and other HPV-related diseases: Education, Information, Screening programmes

  5. INTEGRAL PROGRAM Primaryprevention VACCINE Secondary Prevention SCREENING SURVEILLANCE

  6. Countries with HPV vaccine in the national immunization programme 2017 (74 countries or 38.1%) Introduced* to date 86 countries (40%) Not Available, Not Introduced/No Plans (120 countries or 61.9%) 114 countries (60%) * Includes partial introduction Not applicable Data source: WHO/IVB Database, as of 09 August 2017 Map production Immunization Vaccines and Biologicals (IVB), World Health Organization

  7. 12 LAC have National Vaccination Programmes

  8. LAC: Vaccination Policies I • All LAC prioritize vaccination among adolescents girls cohorts aged 9-14 years with one-year and several years birth cohorts • Three countries have included adolescent boys as a secondary target group • Delivery strategy is focused in health centers, school-based strategy or a combination of both

  9. Vaccination Policies II • Most countries are using tetravalent vaccine • Most countries switched to a two-dose schedule • All countries have implemented VAERS

  10. Vaccination Coverage • Coverage for the first dose started high and decreased with subsequent cohorts • A decline in coverage between the first and second dose in most countries • Coverage with 3 doses: 75% Panama (2010-2014) and 73,5% Peru (2011-2014)

  11. HPV Immunization Strategy in Argentina Men and Women, from 11 to 26 years with HIV and transplanted

  12. Vaccination strategies

  13. HPV Vaccination Coverage: Argentina 2011-2016

  14. VAERS HPV: Argentina 2011-2016 • Number of dosis administered: 3.883.178 • VAE: 331 • Serious: 11 • 8 seizures secondary to vasovagal syncope • 1 generalized rash • 2 bronchospasm • 100% full recovery

  15. Colombia: “Carmen de Bolivar Episode” • 2012: 1st 97,5%, 2nd 96,7%, 3rd 87,1% • 2013: 91,4% of 2.4 millions • After the “Carmen de Bolivar episode”the coverage decreased to a mere 20.4% by the end of 2014. • 2012: 1st 97,5%, 2nd 96,7%, 3rd 87,1% • 2013: 91,4% of 2.4 millions

  16. Safety of HPV Vaccine: GACVS (WHO) • Since licensure in 2006 > 270 million doses • No association between HPV vaccine and GBS •  risk of anaphylaxis: 1,7 cases per million doses •  syncope: a common anxiety or stress-related reaction to the injection • No evidence for a causal association between HPV vaccine and: CRPS-POTS- premature ovarian insufficiency- primary ovarian failure, and venous thromboembolism, autoimmune issues

  17. Vaccination and Laboratory Centers in BA City

  18. “PATIENTS ASSISTED IN A PRIVATE INSTITUTION AFTER BEING VACCINATED OR HAVING A LABORATORY STUDY” • Objectives:Describe the characteristics of assisted patients and relate de requirement for medical assistance with vaccination or having a laboratory study • Population: 1142 assisted patients over a total of 1.190.428 at Stamboulian Medical Centers from 3/2010 to 12/2012 • Age of assisted patients: Mean: 21,8 years Median: 16 years

  19. Results I • 1142 assisted patients: • 56,65% vaccinated • 43,34% laboratory practice • Most women: 71,5% • Main reasons for medical assistance: 84% lipothymia, 8% dizziness, 3,3% syncope,

  20. Results II • More applied vaccines in assisted patients post vaccination • DTPa 212 • HPV 289 • Meningococcal cuadrivalent 136 • Conclusions: • Adolescent and female patients required assistance more frequently • There was a statistically significant difference in favor of the patients who attended the laboratory on those who attended for vaccines.

  21. A call to Action: Overcoming Barriers • Limited knowledge of HPV, HPV related diseases, and features of the HPV vaccine • Misguided safety concerns by parents and targeted population for HPV vaccine • Cultural barriers

  22. A call to Action: Overcoming Barriers The key to reach high HPV vaccination coverage is to promote the integrated alliance of 3 areas: • Health • Education • Communication

  23. Thankyou pelmassian@fidec-online.com

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