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Our memories of Mahabaleswar

Our memories of Mahabaleswar

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Our memories of Mahabaleswar

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  1. Our memories of Mahabaleswar

  2. CDC - Immunization Update 2006 Satellite Internet Broadcast December, 2006 Cervical Cancer Vaccine - HPV Summarized from the CDC Broadcast by Dr. R.V.S.N.Sarma. M.D., M.Sc.,

  3. Cervical Cancer • Cervical cancer is the 2nd leading cancer amongst women worldwide • 500,000 new cases and 300,000 deaths due to Ca Cx • >99% related to human papilloma virus (HPV) infec. • HPV infect epithelial cells including the genital tract • HPV type 16 related to half of these cases • HPV –18, -45, -31, -33, -52, -58 and -35 together with HPV-16 responsible for 90% of all cervical cancers worldwide

  4. Human Papillomavirus • More than 100 types • More than 60 cutaneous types • Can lead to skin warts • 40 mucosal types • High risk types (particularly 16 and 18) • cervical cell abnormalities • certain anogenital cancers • Low risk types (particularly 6 and 11) • cervical cell abnormalities- usually resolve spontaneously and do not lead to cancer • genital warts • respiratory papillomatosis

  5. Up to Decades Within 1 Year 1-5 Years Persistent Infection CIN 2/3 Cervical Cancer CIN 1 Natural History of HPV Infection InitialHPV Infection Cleared HPV Infection

  6. Cancer Attributable to HPV - 2006 Cancer Cases 12,000 3,700 4,480 1,000 10,000 Attributable Fraction 100% 90% 40% 40% 12% Cancer Cervical Anal Vulvar/vaginal Penile Oral/pharynx

  7. HPV-associated Conditions Estimated % 70% 30%-50% 10% HPV 16, 18 Cervical cancer - High/low grade cervical abnormalities Anal, Vulvar, Vaginal, Penile Head and neck cancers HPV 6, 11 Low grade cervical abnormalities Genital warts RRP 10% 90% 90%

  8. Global distribution of HPV types in cervical cancer

  9. Human Papilloma Virus Vaccine • Contains the L1 protein from four types of HPV (16, 18, 6, 11) • Produced using recombinant DNA technology • L1 proteins self assemble into non-infectious units called virus-like particles (VLPs) • VLPs are highly immunogenic

  10. Yeast Cell Culture Insect Cell Culture HPVVaccines • L1 VLPs made in insect cells – GSK 16 and 18 - Cervarix • i.m. 3 shots 0, 1 and 6 month • VLPs made in yeast cells – • Merck 16,18,11 and 6 -Gardasil • i.m. 3 shots 0, 2 and 6 month

  11. HPV vaccine news headlines • “Vaccine prevents most cervical cancers.” - New York Times, October 7, 2005. • Vaccine proves 100 percent effective in preventing cervical cancer – Seattle Times, October 6, 2005. • “Promising new vaccines could wipe out cervical cancer. But they must be administered to preteens, and some groups oppose that.” – Philadelphia Inquirer, July 4, 2005. • “OK Roll up your sleeve; new vaccines are arriving but the economics are still a challenge” –Business Week, July 25, 2005.

  12. Efficacy of HPV Vaccine Among 16-26 year-old Females* *Package insert: Gardasil® . Integrated dataset; results in the per-protocol populations CIN – cervical intraepithelial neoplasia; AIS – adenocarcinoma in situ

  13. Human Papillomavirus Vaccine Efficacy • High efficacy among females without evidence of infection with vaccine HPV types • No evidence that the vaccine had efficacy against existing disease or infection • Prior infection with one HPV type did not diminish efficacy of the vaccine against other vaccine HPV types

  14. HPV Vaccine Schedule • Approved for females 9-26 year of age • 3 doses at 0, 2, and 6 months • Minimum intervals: • 4 weeks between doses 1 and 2 • 12 weeks between doses 2 and 3

  15. HPV Vaccine – Provisional ACIP Recommendations • Routine vaccination of ♂ at 12 years of age • The vaccination series can be started as young as 9 years of age at the clinician's discretion • Vaccination is recommended for females 13-26 years of age who have not been previously vaccinated • Ideally vaccine should be administered before onset of sexual activity • Females who are sexually active should be vaccinated

  16. HPV Vaccine – Special Situations* • Females 26 years of age or younger with, equivocal or abnormal Pap test, positive HPV DNA, and genital warts may be vaccinated • Vaccine will have no effect on existing disease or infection *Provisional ACIP recommendation, June 2006

  17. HPV Vaccine – Special Situations* • Females 26 years of age or younger who are lactating/breastfeeding or are immuno-compromised may be vaccinated • NOT recommended for pregnant women *Provisional ACIP recommendation, June 2006

  18. Screening for Cervical Cancer • Why get screened? • Screening was developed to detect abnormal cervical cells in the early stages when it is easy to remove them • Who should be screened? • Women from 25-65 years • Once every 3 years

  19. HPV Vaccine and Cervical Cancer Screening • Cervical cancer screening recommendations have NOT changed for females who receive HPV vaccine • 30% of cervical cancers caused by HPV types are not prevented by the quadrivalent HPV vaccine • Vaccinated females could subsequently be infected with non-vaccine HPV types • Sexually active females could have been infected prior to vaccination • Providers should educate women about the importance of cervical cancer screening

  20. Adding up the facts • HPV is present in the majority of sexually active adults • Presence of HPV does not indicate promiscuity • HPV is short lived and asymptomatic in most adults • If high risk HPV (16 and 18) persists – can cause Ca CX • Cervical cancer kill 200,000 women worldwide annually • 70% of Ca Cx is due to HPV 16 and 18 types • HPV vaccine given at age 11, eliminates 70% of Ca Cx • HPV vaccine does not replace screening for Ca Cx • HPV vaccine in men prevents Ca Penis and genital warts • Rapid adoption of HPV vaccine is right and essential

  21. US National Immunization Program • Hotline (800) CDC-INFO • Email nipinfo@cdc.gov • Website www.cdc.gov/nip • Broadcast Updates and Resources Web Page www.cdc.gov/nip/ed/UpdatesandResources.htm