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Latin American Federation for Colposcopy and Pathology of the LGT Latin American Federation for Colposcopy and Pathology of the LGT State of the Art HPV Vaccination Elsa Díaz López Principal of GESFEM SC México Disclosures • I have recived honoraries from MSD like speaker • I have recived Honoraries from Sigfried Labs • No financial relationships or conflict of interest to disclose Statistics of cervical cancer Is the fourth most common cancer in women with an incidence estimated of 528,000 new cases (85% of them diagnosed in developing countries). Is the second largest cause of mortality due to cancer in women in the developing world.1 Like Latin America. Every year are diagnosed 63.068 women with cervical neoplasia, registering 29.222 deaths by this sickness 2. If current trends continue, the number of deaths in the Americas will grow by 45% in 2030. Mortality rates are 3 times higher in Latin America and the Caribbean than in North America, demonstrating huge inequalities in health. 1Ferlay et al., 2015 SITUACIÓN DE LOS PROGRAMAS PARA LA PREVENCIÓN Y EL CONTROL DEL CÁNCER CERVICOUTERINO OPS 2’00 Maribel Almonte, PhD, Lazcano et al.Nuevos paradigmas y desafíos en la prevención y control del cáncer de cuello uterino en América Latina. Salud pública de méxico / vol. 52, no. 6, noviembre-diciembre de 2010 What happen in Latino América? Most of the developing countries recognized the huge burden of disease and the need for positive actions in reducing the incidence of new cases of cervical cancer and its mortality. All countries have a National Program for prevention and control of cervical cancer. Primary and secondary prevention : -Difficulty in reaching the coverage -Timely diagnosis and tratments -Underreporting SITUACIÓN DE LOS PROGRAMAS PARA LA PREVENCIÓN Y EL CONTROL DEL CÁNCER CERVICOUTERINO OPS 2’00 Vaccination coveraje recent Although it is recommended that each issue be addressed in a fully informed decision-making process, some factors may outweigh and override others, depending on the specific circumstances. In addition, each country must decide what locally-gathered evidence they require in order to make a decision, and for what types of evidence they can rely on country or regional estimates (e.g., disease burden, cost-effectiveness) prepared by other groups, instead of conducting their own studies. As a result of this assessment of the issues, the decision might be to intr oduce the vaccine or not to introduce it at this time. Policy-makers may have to make further decisions about the scope of vaccination, target ages and schedule, and the specific vaccine product, since these have policy and financial implications. Countries that choose not to introduce a vaccine may decide to revisit the issue at a later date as Cervical Cancer in mor Latine evidence of the diseaseAmerica burden or impact and cost-effectiveness of the vaccine becomes available, or as conditions change, such as the supply and price of the vaccine, financial resources, and the ability of the immunization pr ogramme and health system to handle the vaccine. Most of these countries the cytology is used FIG. 1. Key issues to consider when deciding on the introduction of a vaccine as a technique for screening from 35 years THE DISEASE THE VACCINES ago, has not been achieved a significant reduction The demographic differences, policy, SHOULD THE VACCINE management of preventive programs, social BE INTRODUCED NOW? inequality, technological resources, financing, monitoring and follow-up of actions, vaccination strategies and management of STRENGTH OF THE IMMUNIZATION information to the population, make it a PROGRAMME AND HEALTH SYSTEM challenge modify the incidence and mortality of cervical cancer in this region. SITUACIÓN DE LOS PROGRAMAS PARA LA PREVENCIÓN Y EL CONTROL DEL CÁNCER CERVICOUTERINO OPS 2’00 Ferlay J, Shin HR, Bray F, Forman D, Mathers C and Parkin DM. GLOBOCAN 2008, Cancer Incidence and 2.1 | Deciding on the introduction of a vaccine 13 Mortality Worldwide: IARC Cancer Base No. 10 [Internet]. Lyon, France: International Agency for Research on Cancer; 2010. Available from: http:// globocan.iarc.fr Vaccines again HPV current status Safety Controversies profiles HPV vaccines prevent infection Efficacy with certain Future species of HPV associated with the development of cervical cancer or genital warts. Three HPV vaccines are available on the market Bivalent HPV vaccine produced by GlaxoSmithKline contains the VLP form antigen of HPV types 16 and 18. qHPV vaccine contains HPV types 6, 11, 16, and 18 L1 proteins for its antigen. 9-valent HPV (nHPV) vaccine produced by Merck contains HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58 R. Angioli et al. /Ten years of HPV vaccines: State of art and controversies Critical Reviews in Oncology/Hematology 102 (2016) 65–72 HPV Vaccination Programs HPV vaccination programs have been implemented in many countries between 2006 and 2009, two different human papillomavirus virus (HPV) vaccines were licensed.1 Both vaccines were shown to prevent up to 90–100% of infection of HPV and precancerous lesions in women not infected with HPV 16–18 at the time of vaccination. In 2014 a nonavalent vaccine was licensed to protect against the five most common oncogenic HPV types that account for the 90% of invasive cervical cancer in the world.2 1Herrero et al., 2015 2. Joura et al., 2014; Tjalma et al., 2013. HPV Role In The Etiology Of Other Neoplasias The persistent high-risk HPV infection is necessary but not sufficient in the pathogenesis of cervical cancer (Walboomers et al., 1999) and it is well known that HPV has a major role in the etiology of squamous cell carcinoma of the anus, vulva, vagina, penis, mouth and oropharynx.1 EDL EDL EDL 1. Bosch et al., 2002; Parkin and Bray, 2006). HPV associated to other sickness Clinical Therapeutics/Volume 36, Number 1, 2014 Fotografía Elsa Díaz López HPV vaccine results Quadrivalent vaccine showed a 100% efficacy in preventing vulvar and vaginal lesions associated with vaccine HPV types, furthermore in men it was able to reduce 90% penile, perianal and perineal diseases and 100% of penile intraepithelial lesions associated with HPV types. Palefsky et al., 2011 : US Assessment of HPV Types in Cancers: Implications for Current and 9-Valent HPV Vaccines • HPV DNA was detected in 90.6% of cervical • 91.1% of anal • 75.0% of vaginal • 70.1% of oropharyngeal • 68.8% of vulvar • 63.3% of penile • 32.0% of oral cavity • and 20.9% of laryngeal cancers • 98.8% of cervical cancer in situ (CCIS). Saraiya M US assessment of HPV types in cancers: implications for current and 9-valent HPV vaccines.JNCI J Natl Cancer Inst (2015) 107 (6): djv086. 7 HPV PREVENTIVE STRATEGIES - 224 - 7.2 HPV vaccination 7.2.1VaccinationHPV vaccine licensureCoverageand introduction Figure 119: Status of HPV vaccination programs worldwide Data accessed at 15 nov. 2015. For Afghanistan, Angola, Albania, Andorra, Armenia, Antigua & Barbuda, Azerbaijan, Burundi, Benin, Burkina Faso, Bangladesh, Bulgaria, Bahrain, Bahamas, Bosnia & Herzegovina, Belarus, Belize, Bolivia, Barbados, Brunei, Botswana, Central African Republic, ChileData, China, accessedCôte d’Ivoireat 15, nov.Cameroon, 2015 Congo, DR, Congo, Colombia, Comoros, Cape Verde, Costa Rica, Cuba, Czech Republic, Djibouti, Dominica, Dominican Republic, Algeria, Ecuador, Egypt, Eritrea, Western Sahara, Ethiopia, Micronesia, FS, Gabon, Georgia, Ghana, Guinea, Gambia, Guinea-Bissau, Equat orial Guinea, Grenada, Guatemala, Guyana, Honduras, Croatia, Haiti, Indonesia, India, Iran, Iraq, Israel, Jamaica, Jordan, Japan, Kazakhstan, Kenya, Kyrgyzstan, Cambodia, St Kitts & Nevis, Korea, Republic of, Kuwait, Laos, Lebanon, Liberia, Libya, St Lucia, Liechtenstein, Sri Lanka, Lesotho, Morocco, Monaco, Republic of Moldova, Madagascar, Maldives, Mali, Myanmar, Montenegro, Mongolia, Mozambique, Mauritania, Mauritius, Malawi, Namibia, Niger, Nigeria, Nicaragua, Niue, Nepal, Nauru, Oman, Pakistan, Philippines, Papua New Guinea, Korea, DPR, Paraguay, Palestine, Qatar, Saudi Arabia, Sudan, Senegal, Solomon Islands, Sierra Leone, El Salvador, Somalia, Serbia, South Sudan, Sao Tome & Principe, Suriname, Swaziland, Seychelles, Syria, Chad, Togo, Thailand, Tajikistan, Turkmenistan, Timor-Leste, Tonga, Trinidad & Tobago, Tunisia, Turkey, Tuvalu, Tanzania, Uganda, Ukraine, Uruguay, Uzbekistan, St Vincent & The Grenadines, Venezuela, Viet Nam, Vanuatu, Samoa, Less developed regions, More developed regions, Least developed countri es, Eastern Europe, Northern Europe, Europe PREHDICT, Southern Europe, Western Europe, Europe, Sub-Saharan Africa, Eastern Africa, Middle Africa, Northern Africa, Southern Africa, Western Africa, Africa, GAVI Countries, Caribbean, Central America, Latin America & Caribbean, Northern America, South America, Americas, Australia & New Zealand, Melanesia, Polynesia, Oceania, Central Asia, Eastern Asia, Southern Asia, South-Eastern Asia, Western Asia, Asia, World, Yemen, South Africa, Zambia, Zimbabwe the source is: Cervical Cancer Action, June2013 [accessed on July 15th 2013], available at Theinformation represented here has been collected through interviews with individuals and organizations involved with the countries represented and has not been verified with individual Ministries of Health. Any versights or inaccuracies are unintentional. Brazil the source is: WHO vaccine-preventable diseases: monitoring system. 2013 global summary. Available at: Last updated 20-Octl-2013 (data as of 16-Oct-2013); next overall update June 2014. Cyprus, Estonia, Finland, Hungary, Iceland, Lithuania, Poland, Slovakia the source is: European
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