Family Med-eZine TeamFriday, 18 Apr 2014, 04:14 pm

Cervical cancer is a major cause of disease-related deaths among women in India. Research has conclusively shown that one of the most common causes for cervical cancer is infection with specific types of the Human Papilloma Virus (HPV). HPV infection can cause abnormalities in cervical cells that turns cancerous over a period of time. Extensive research has led scientists to conclude that while the HPV infection itself may not be fatal, it is important to control it because of its increased propensity to give rise to cancerous mutations in cells. It is thus the first step in the fight against cervical cancer. 

There are currently 2 types of vaccines against HPV available for use in India.

Cervarix –provides protection against cervical cancer only (acts against HPV 16, 18)

Gardasil – provides protection against both cervical cancer and genital warts (acts against HPV 6, 11, 16, 18)

The vaccines as per the US FDA (Food and Drug Administration), should be initiated at the ages of 9 to 12 (given as a series of 3 shots) and can be extended till age 26. It is safe to administer these vaccines along with other vaccines as well. Also, research is currently underway to prove the effectiveness of a single dose of vaccine rather than the usual 3 doses, to achieve almost similar effectiveness in the long run.

Who may benefit from it?

Females who have had no prior sexual exposure are the ones most likely to benefit from these vaccines. However, women who are already sexually active may also get some benefit from these vaccines. For example, a sexually active woman may not have been exposed to one or more of the HPV strains targeted by the vaccines and hence may benefit from these vaccines.

The vaccines have shown to be safe and effective against the main cancer causing HPV forms. However, these vaccines do not protect women from all the types of HPV viruses that could cause cervical cancer. Also, they do not protect against any HPV infection that is already present in the woman. Hence, regular screenings (PAP smears) to detect changes in cervix are warranted even if the vaccine has been taken. 

Troubled teenHowever, with many countries reporting numerous cases of adverse effects, which they claim are vaccine-induced, there are some doubts about the vaccine in several quarters. In India, a major controversy the vaccine faced was the death of 7 young tribal girls in 2009-10, when it was used in an observational study across Andhra Pradesh and Gujarat. The study was conducted by the State Governments in association with the ICMR and the US-based NGO, PATH. Following the death of the young girls, the government suspended the continuation of the clinical trials, primarily because these experimental trials had a number of shortcomings and flaws in the way they were conducted. Subsequent investigations were not able to conclusively ascribe the alleged deaths to the HPV vaccine. However, in September 2013, a panel appointed by India's Parliament accused the US-based non-profit firm PATH of violating clinical trial standards while testing cervical cancer vaccines on 162 women and 108 children in the two Indian states and recommended strong action against the group.

The US FDA recommends these vaccines to be relatively safe, with some mild side-effects being generally noted. These include common injection-site problems like redness, itching, burning sensations and mild-to-moderate pain and other side-effects like fever, dizziness and nausea. Complete information on the potential side effects of Gardasil and Cervarix as detailed in the Patient Information Leaflets is available here and here.

Challenges faced by healthcare professionals while recommending the HPV vaccines in India include:

  • Moral Grounds - Some people argue that these vaccines may encourage unprotected sex among young girls, giving them a false sense of security and may promote promiscuity. They may also stay away from getting regular gynaecological screenings. It is important young girls be adequately guided before taking this vaccine, under the supervision of their guardians, so that promiscuous behaviour may be controlled. Also the need of the hour is adequate sex education, not moral policing.
  • Prohibitive cost - The high price of the vaccines discourages routine use. Gardasil costs Rs 2,800 per dose, while Cervarix is priced at Rs 3,299. 

If you are a teen considering taking the vaccine or a mother contemplating getting your young daughter vaccinated, please talk to your family doctor. He/She will be able to best explain to you all the pros and cons of the HPV vaccine. In the end, the decision to get vaccinated must be taken only when you have completely understood and discussed the risks, benefits and limitations of these vaccines with your doctor.