Human Papillomavirus or HPV

~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ *
~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ *

I Introduction

On June 2, 2006, the Maternal, Newborn and Child Health Promotion Network Bulletin reported on a "Scientific American" editorial that called for health care providers to make the case for the public for mass vaccinations against the Human Papillomavirus or HPV. The editorial speculated that North American families might resist vaccinating their children against a sexually transmitted disease. To be effective, the HPV vaccine is given to girls starting as young as nine years old.

Since June 2006, views and opinions on the HPV vaccine have remained in the news. The United States-based Kaiser Network for Women's Health supported the call for public vaccination at an HPV and Cervical Cancer Summit held in Washington, DC in November 2006 (Kaiser Network, 2006). A survey of health professionals in Canada concurs that health professionals need to advocate at the provincial levels to support public vaccination programs (Duval, 2006).

A vaccine has been approved by Health Canada, and some provinces are making the vaccine available.

~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ *
~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ *

II What is HPV?

HPV is a virus with various active strains that can infect different parts of the body. Some strains of the HPV are sexually transmitted. The virus can result in genital warts, a common sexually transmitted infection, for both men and women. Health Canada estimates that half of all sexually active people will get HPV at some point in their lives (PHAC, 2007). For women, HPV can also lead to cervical cancer (Cancer Care Ontario, 2007). Cervical cancer is the second most common cancer among women worldwide and results in death for more than half of those affected (Scientific American, 2006). There is no cure for HPV.

~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ *
~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ *

III HPV and Cervical Cancer

Cervical cancer has very few visible symptoms. A pap test is the only common diagnostic tool to detect cervical cancer and, if caught early, it has a high rate of survival. For females who are sexually active, the Pap smear must be a routine part of regular physical examinations. The Public Health Agency of Canada says, "...regular screening can prevent almost all cases of invasive cervical cancer..." (PHAC, 2007). The Agency also estimates there are about 1,000 new cases of cervical cancer a year—and less than half of these women survive.

~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ *
~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ *

IV The HPV Vaccine in Canada

Four of the most common types of the HPV are believed to be preventable with vaccination. A vaccine that provides protection against these four strains of HPV was approved in Canada in July for females between 9 and 26 years old. The vaccine, commercially marketed as Gardasil, is given by injection in three doses (at 0, 2, 6-month intervals), and is available by prescription at most pharmacies in Canada at cost of about $500.

The HPV vaccine does not guarantee that women will not develop cervical cancer. Females engaged in sexual activity need to continue with regular pap tests and to protect themselves against other sexually transmitted infections (STIs) by using condoms during sexual intercourse.

The National Advisory Committee on Immunization (NACI) has recommended that the HPV vaccine be approved for use in Canada for girls and women 9 to 26 years of age (Globe & Mail, Jan. 30, 2007). Some jurisdictions in Canada have begun making the vaccination available, and some provincial governments seem to be moving towards fully funding the vaccinations as part of children's immunization programs. For example, in November 2006, the Chief Health Officer for Prince Edward Island, Dr. Lamont Sweet, called for public funding of vaccinations against HPV for all of the province's Grade 6 girls (CBC News, Nov. 23, 2006). Until the vaccine becomes part of the publicly funded immunization program, it can be obtained through a physician's prescription.

~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ *
~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ *

V Issues and Controversies

The existence of a vaccine against a deadly cancer is good news, but it is not without controversy. Although cervical cancer is the second most common cancer among women worldwide, in North America, cervical cancer ranks as the eleventh top cause of death for women. Opponents of the HPV vaccine believe scarce medical and pharmaceutical dollars would have been better invested in seeking vaccines or cures for any of the other top 10 causes of death for women, including breast cancer, for example.

Another concern is that the full impact of the vaccine is unknown. Merck's vaccine, Gardasil, was studied for less than 4 years, making some question the long-term adverse effects and effectiveness of the vaccine and, therefore, objecting to what could be seen as mass testing on girls. In the United States, questions are particularly being raised around the mass marketing campaign launched by the Merck. Television and print ads encourage young women to "Tell Someone" to get vaccinated. Some see these ads as fear-mongering to boost sales of the Merck-produced vaccine.  

There is also a fear that, given the mass advertising about the vaccine, girls and women may develop a false view that once vaccinated, they will be protected from cervical cancer. This may result in less frequent physical examinations and pap tests, and in not using condoms during sexual intercourse.

How do parents feel about immunizing their young daughters against a potential STD? In Canada, it seems parents are welcoming the vaccine as health promotion. A study by the Canadian Centre for Vaccinology in Halifax found that 75% or more of parents and their teen daughters would welcome the vaccine. Parents who were more reluctant said if their family doctors could convince them of the need - and safety - of the vaccine, they would participate (Globe and Mail, Dec 4/06, p. A7).

And what about health care practitioners? In a survey of health professionals, 54% said they strongly agreed that parents will accept HPV vaccinations for children 14 years old and younger, and 39% strongly agreed that adolescent and young adults view an HPV vaccine favourably (Duval, 2006).

Even with the HPV vaccine, informed health organizations advise that pap tests are an essential part of regular health examinations for females who are sexually active. Below are a few research articles and the sources for information used for this article. They are helpful for the general public as well as for health care professionals.  A section on other references cited appears at the end of this article.

~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ *
~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ *

VI References

CBC News. PEI considers paying for HPV vaccine. Nov. 23, 2006.

Cancer Care Ontario. HPV and Cancer of the Cervix: Frequently Asked Questions. Retrieved from www.cancercare.on.ca/index_screeningCervicalHPV.htm Feb. 6, 2007.

Duval, Bernard (2006), Conference presentation for the CAIRE HPV psychosocial research group, Winnipeg, MB.

The Globe and Mail. Parents, teens support vaccine against virus spread through sex. Sheryl Ubelacker. Dec. 4, 2006, p. A7

The Globe and Mail. HPV vaccinations urged for Canadian girls and women. Canadian Press. Jan. 30, 2007.

Kaiser Network. Retrieved from www.kaisernetwork.org Jan. 26, 2007.

Public Health Agency of Canada (2007). Human Papillomavirus (HPV) Prevention and HPV Vaccine: Questions and Answers. Retrieved from PHAC Jan. 24, 2007:
www.phac-aspc.gc.ca/std-mts/hpv-vph/hpv-vph-vaccine_e.html

Public Health Agency of Canada (2007). Cervical Cancer in Canada 1990.
One of a series of "Cancer Updates' by the PHAC. Retrieved from PHAC Jan 24, 2007:
www.phac-aspc.gc.ca/publicat/updates/cervix-98_e.html

Scientific American. February 2006 Editorial: To Banish a Cancer, p. 8.