Current Issue - 2007, Volume 2 Number 2

REVIEW ARTICLE

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CURRENT ISSUES FACING THE INTRODUCTION OF HUMAN PAPILLOMAVIRUS VACCINE IN MALAYSIA

CONCLUSION

Mortality from cervical cancer has undoubtedly been reduced by effective Pap smear screening programmes. Nevertheless, such programmes are costly and difficult to implement in resource-poor settings. The development of highly effective HPV vaccines is thus an important breakthrough as it offers great potential to reduce the incidence of cervical cancer, other HPV-related diseases, and the associated economic and psychological burden.

In order for HPV vaccination to be successfully implemented, social and political issues need to be addressed and agreed upon by stakeholder groups, including physicians, public health officers, parents, adolescents, and community leaders. Limited knowledge about HPV and HPV-associated disease may affect vaccine acceptability. Successful vaccine implementation thus would require educating the general public about HPV, to increase awareness, de-stigmatize HPV infection, and gain acceptance of vaccines.

References

  1. Parkin DM, Bray F, Ferlay J, et al. Estimating the world cancer burden: Globocan 2000. Int J Cancer. 2001;94(2):153-6. [PubMed]
  2. GCC Lim, Halimah Y (Eds). Second Report of the National Cancer Registry. Cancer Incidence in Malaysia 2003. National Cancer Registry. Kuala Lumpur 2004 [Full text]
  3. National Health and Morbidity Survey 1996. Institute of Public Health, Kuala Lumpur. Ministry of Health, Malaysia 1999.
  4. R, Budukh AM, Rajkumar R. Effective screening programmes for cervical cancer in low- and middle-income developing countries. Bull World Health Organ. 2001;79(10):954-62. [PubMed] [Full text]
  5. Nanda K, McCrory DC, Myers ER, et al. Accuracy of the Papanicolaou test in screening for ad follow-up of cervical cytological abnormalities: a systematic review. Ann Intern Med. 2000;132(10):810-9 [PubMed] [Full text]
  6. Ministry of Health Malaysia. Annual reports of Ministry of Health, 1998
  7. Cheah PL, Looi LM. Carcinoma of the uterine cervix: a review of its pathology and commentary on the problem in Malaysians. Malays J Pathol. 1999;21(1):1-15 [PubMed] [Full text]
  8. Wong LP, Wong YL, Low WY, Khoo EM, Shuib R. “To screen is to get the disease”: beliefs and behaviours affecting uptake of cervical cancer screening in a qualitative study of Malaysian women. Int J Behav Med. 2006;13(Suppl):162
  9. Nor Hayati O, Mukarramah CA, Wok Aimi AA, et al. Pap smears - is it an effective screening method for cervical neoplasia? - an experience with 2289 cases. Malaysian Journal of Medical Sciences. 1997;4(1):45-50 [Full text]
  10. Munoz N, Bosch FX, de Sanjose S, et al. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med. 2003;348(6):518-27 [PubMed] [Full text]
  11. Cheah PL. Human papillomavirus related diseases in Malaysians. Malays J Pathol. 1994;16(1):15-7 [PubMed] [Full text]
  12. Walboomers JM, Jacobs MV, Manos MM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999;189(1):12-9 [PubMed]
  13. Brown DR, Schroeder JM, Bryan JT, et al. Detection of multiple human papillomavirus types in Condylomata acuminata lesions from otherwise healthy and immunosuppressed patients. J Clin Microbiol. 1999;37(10):3316-22 [PubMed] [Full text]
  14. Kahn JA, Rosenthal SL, Succop PA, et al. Mediators of the association between age of first sexual intercourse and subsequent human papillomavirus infection. Pediatrics. 2000;109(1):E5 [PubMed] [Full text]
  15. Tarkowski TA, Koumans EH, Sawyer M, et al. Epidemiology of human papillomavirus infection and abnormal cytologic test results in an urban adolescent population. J Infect Dis. 2004;189(1):46-50 [PubMed] [Full text]
  16. Woodman CBJ, Collins SI, Young LS. The natural history of cervical HPV infection: unresolved issues. Nat Rev Cancer. 2007;7(1):11-22 [PubMed]
  17. Markowitz LE, Dunne EF, Saraiya M, et al. Quadrivalent human papillomavirus vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2007;56(RR-2):1-24 [PubMed] [Full text]
  18. Joura EA, Leodolter S, Hernandez-Avila M, et al. Efficacy of a quadrivalent prophylactic human papillomavirus (types 6, 11, 16, and 18) L1 virus-like particle vaccine against high-grade vulval and vaginal lesions: a combined analysis of three randomised clinical trials. Lancet. 2007;369(9574):1693-702 [PubMed]
  19. Harper DM, Franco EL, Wheeler CM, et al. Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomized control trial. Lancet. 2006 Apr 15;367(9518):1247-55 [PubMed]
  20. Villa LL, Costa RL, Petta CA, et al. High sustained efficacy of a prophylactic quadrivalent human papillomavirus types 6/11/16/18 L1 virus-like particle vaccine through 5 years of follow-up. Br J Cancer. 2006;95(11):1459-66 [PubMed]
  21. Kjellberg L, Hallmans G, Ahren AM, et al. Smoking, diet, pregnancy and oral contraceptive use as risk factors for cervical intra-epithelial neoplasia in relation to human papillomavirus infection. Br J Cancer. 2000;82(7):1332-8 [PubMed]
  22. Smith JS, Herrero R, Bosetti C, et al. Herpes simplex virus-2 as a human papillomavirus cofactor in the etiology of invasive cervical cancer. J Natl Cancer Inst. 2002;94(21):1592-3 [PubMed] [Full text]
  23. Sawaya GF, Smith-McCune K. HPV vaccination - more answers, more questions. N Engl J Med. 2007;356(19):1991-3 [PubMed]
  24. Taira AV, Neukermans CP, Sanders GD. Evaluating human papillomavirus vaccination programs. Emerg Infect Dis. 2004;10(11):1915-23 [PubMed] [Full text]
  25. Wilkin TJ, Palmer S, Brudney KF, et al. Anal intraepithelial neoplasia in heterosexual and homosexual HIV-positive men with access to antiretroviral therapy. J Infect Dis. 2004;190(9):1685-91 [PubMed]
  26. Reisinger KS, Block SL, Lazcano E, et al. A randomized controlled trial to evaluate the safety and immunogenicity of a quadrivalent human papillomavirus (types 6, 11, 16 and 18) L1 virus-like-particle vaccine in preadolescents and adolescents. Abstract presented at the European Society for Paediatric Infectious Disease, Basel Switzerland, May 3-5, 2006. [Abstract]
  27. Wright TC, Bosch FX, Franco EL, et al. HPV vaccines and screening in the prevention of cervical cancer; conclusions from a 2006 workshop of international experts. Vaccine. 2006;24(Suppl 3):S251-61 [PubMed]
  28. Baldwin SB, Wallace DR, Papenfuss MR, et al. Human papillomavirus infection in men attending a sexually transmitted disease clinic. J Infect Dis. 2003;187(7):1064-70 [PubMed] [Full text]
  29. Waller J, McCaffery K, Wardle J. Beliefs about the risk factors for cervical cancer in a British population sample. Prev Med. 2004;38(6):745-53 [PubMed]
  30. Dell DL, Chen H, Ahmad F, et al. Knowledge about human papillomavirus among adolescents. Obstet Gynecol. 2000;96(5 Pt 1):653-6. [PubMed]
  31. Lazcano-Ponce E, Rivera L, Arillo-Santillan E, et al. Acceptability of human papillomavirus (HPV) trial vaccine among- mothers of adolescents in Cuernavaca, Mexico. Arch Med Res. 2001;32(3):243-7 [PubMed]
  32. McCaffery K, Forrest S, Waller J, et al. Attitudes towards HPV testing: a qualitative study of belief among Indian, Pakistani, African-Caribbean and white British women in the UK. Br J Cancer. 2003;88(1):42-6 [PubMed]
  33. Zimet GD, Mays RM, Sturm LA, et al. Parental attitudes about sexually transmitted infection vaccination for their adolescent children. Arch PediatrAdolesc Med. 2005;159(2):132-7 [PubMed] [Full text]
  34. Center of Excellence in Cancer Communication Research Study: Information framing affects Americans’ intentions to vaccinate against HPV. Available here :   (Assessed on March 2007)
  35. Colgrove J. The ethics and politics of compulsory HPV vaccination. N Engl J Med. 2006 Dec 7;355(23):2389-91. [PubMed]
  36. Bradley J, Barone M, Mahe C, et al. Delivering cervical cancer prevention services in low-resource setting. Int J Gynecol Obstet. 2005;89(Suppl 2):S21-9 [PubMed]
  37. Gonik B, Jones T, Fasano N, et al. Vaccine-preventable diseases (VPD): improving the obstetrician/gynecologist’s knowledge and immunization practice patterns. Am J Obstet Gynecol. 2001;185(Suppl 6):S162 [PubMed]
  38. Sanders GD, Taira AV. Cost effectiveness of a potential vaccine for human papillomavirus. Emerg Infect Dis. 2003;9(1):37-48 [PubMed] [Full text]

Male circumcision reduced HIV infection by half in Africa men

Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007;369(9562):643-56 [PubMed]
The 2-year HIV incidence was 2.1% in the circumcision group and 4.2% in the control group (p=0.0065); the relative risk of HIV infection in circumcised men was 0.47, which corresponds to a reduction in the risk of acquiring an HIV infection of 53%.

RH, Kigozi G, Serwadda D, Makumbi F, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007;369(9562):657-66 [PubMed]

HIV incidence over 24 months was 0.66 cases per 100 person-years in the intervention group and 1.33 cases per 100 person-years in the control group (estimated efficacy of intervention 51%).