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The HPV Vaccine

To vaccinate or not to vaccinate...that is the question... (technically that’s a statement). The HPV Vaccine. Group 3 – Michael, Elani , Golshan , Sarah, Joseph, Nana. The Scenario.

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The HPV Vaccine

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  1. To vaccinate or not to vaccinate...that is the question... (technically that’s a statement) The HPV Vaccine Group 3 – Michael, Elani, Golshan, Sarah, Joseph, Nana

  2. The Scenario You are at your neighbour’s party one evening when he approaches you and asks for your opinion on something he read in the news. He has a 16 year old daughter who was told about ‘Gardasil®’ at school. He was reluctant to allow her to have it as he felt that it would only encourage sexual practice.After reading this article he is now concerned that his 19 year old son may be at risk and wonders if he should be getting everyone vaccinated.

  3. The ABC News - Call to extend HPV vaccine to boys (by Lindy Kerin) HPV virus → Cervical cancer in females → Oral cancer in younger males Currently subsidised for women. Should it be subsidised for men? Need to consider → Cost effectiveness → Sufficient evidence?

  4. Cancer, Warts and HPV in Men Genital warts prevalence is highest among men aged between 25-29 years and decrease with age The HPV virus is responsible for: • And about 85% of anal canal cancer is caused by HPV. • About 33-72% of oropharyngeal cancers and 10% of cancers of the larynx are associated with HPV infection. • A recent report has stated that about 50.5% of men are positive for at least one known oncogenic or nononcogenic HPV type. HPV 16 appears to be the most common type detected.

  5. Impact of HPV on Women Almost 300 million women carry HPV DNA, one third carry HPV 16/18 (oncogenic) types. Cervical cancer accounts for 6% of all female malignancies worldwide. Show the second youtube clip from Joseph’s page (bottom). Increased risk of cervical disease in Females with HPV-infected male partners (1)(2)(3)

  6. Impact of HPV on Men Any strain of HPV – 65.4% Oncogenic strains – 22.9% To prevent: • HPV related anogenital head and neck cancers in males, • Male bisexual HPV related diseases • The viral transmissions both to males and females. Evidence that as males’ get past their adolescent years and become older they are less likely to use the health care system in comparison to female adolescents Male vaccination can be important for achieving the maximum prevention for both males and females, because currently not great rates of females actually complete their full vaccination course. Prevalence in asymptomatic males in the US is over 20% (MS) The major oncogenic subtypes HPV 16 and 18 cause most anal cancers, 25–35% of oral cancers and 40% of penile cancers (MS) Non-oncogenic HPV 6 and 11 HPV cause genital warts

  7. What is the Vaccine? • Gardasil® by Merck and Co. Inc • The quadrivalent human papillomavirus (types 6, 11, 16, 18) recombinant vaccine available under NIP for females aged 12–26 years. • Approved by (FDA) in 2006 (for use in 9–26 year old females)(MS) • Consists of three doses, intended to be given three months apart.

  8. Evidence for Use • Females United to Unilaterally Reduce Endo/Ecto-Cervical Cancer (FUTURE) Phase III trial of Gardasil® (safety and efficacy). • Randomised, double-blind, placebo controlled, trial with 3 years follow up in 5455 healthy women aged 16–24. • 98% effective in preventing high grade lesions. • Some cross protection against other HPV types (52, 45, 31). • Long term safety and efficacy will require decades to establish. • The vaccine is intended as a prophylactic agent. Hence, its efficacy is most superior in younger women/men that have not been exposed to the virus strains.

  9. The Indication For the Vaccine • Subsidised for women <26 years. The vaccine is largely distributed to high schools. • Ineligible persons may pay $460 for the 3-dose course. • The vaccine received provision from the (US) Advisory Committee on Immunization Practices for men in October 2009 and full approval in May 2010 for males aged 9-26 for the prevention of genital warts, penile and anal cancer. (MS1, 2) • Similarly, there is recognition of the efficacy in males but no government subsidy in Australia for the vaccine.

  10. Factors Affecting Vaccine Acceptance Side effects/tolerance Financial costs Urban Myths Less Awareness of the Condition in Males

  11. Side Effects of the Vaccine Anecdotal reports of • GuillainBarré syndrome • Facial palsy These complications occurred in 5 people (of the 17 000) that were given the vaccine concomitantly with another vaccine, namely the meningococcal vaccine. Is there any information relating to how long you should wait before giving another vaccine?

  12. Financial Impact Currently, the vaccine is only subsidised for women. US based Survey conducted on 406 women with adolescent sons “How willing would you be to get the HPV vaccine for your son if it was free?” (Yes = 47%) “How willing would you be to get the HPV vaccine for your son if it cost $400 out of pocket?” (Yes = 11%)

  13. HPV Vaccination Acceptance Amongst Males Studies suggests that: • Male HPV vaccination is seen as acceptable to parents, adolescent and young adult males, and health care professionals (HCP). • To some parents it may be more acceptable vaccinating males than females. • HCPs showed interest to recommend HPV vaccine for their male patients • HPC generally preferred vaccinating females. • The females’ acceptance of HPV vaccination was higher than males. • A larger portion of males from the bisexual group expressed willingness to be vaccinated in comparison to the heterosexual group of males. Statistics to back this up? This sounds a little bit opinionative without stats.

  14. Summary Is this necessary?

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