Deploying HPV Vaccine: Lessons from Australia

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Deploying HPV vaccine: lessons from Australia Ian Frazer, Research Director, The Translational Research Institute Brisbane, Australia Cervical cancer is 100% due to HPV infection, and kills 250,000 women per year, mostly in the developing world ALL CANCERS CERVICAL CANCER Controlling HPV infection is a challenge Preventing the infection seems more sensible HPV vaccine development: A 15 year $1 billion process Zur Hausen Jian Zhou Cancer associated Virus Like HPV vaccines Human particles1 (~2005) Papillomaviruses (~1990) (~1980) 1:J. Zhou, X. Y. Sun, D. J. Stenzel, and I. H. Frazer. Virology 185 (1):251-257, 1991. -needing many people and a hard end point to prove efficacy Vaccine Study1 Vaccine2 No of subjects End-points efficacy1 Vaccine Control % ( confidence limits) Koutsky 6/11/16/18 6087 6080 CIN 2/3 AIS 98 (86-100) Ault 6/11/16/18 10291 10292 CIN 2/3 AIS 99 (93-100) 2241 2258 CIN 2/3 AIS 100 (94-100) 6/11/16/18 Garland 2261 2279 GW VIN VAIN 100 (94-100) 7811 7785 VIN2/3 VAIN 100 (72-100) 6/11/16/18 Joura 2/3 CIN2,3 93 (89-98) Parvonen* 16/18 9319 9325 1: prevention of premalignancy in HPV Adapted from J. A. Kahn and R. D. Burk. Papillomavirus vaccines in naïve subjects, for prevention of disease perspective. Lancet 369 (9580): caused by vaccine HPV types 2135-2137, 2007. *: Phase III bivalent vaccine data from 25th IPV Malmo 2009 Nine steps to prevention of HPV associated cancer • Define the problem – HPV and cancer Zur Hausen • Develop the science –recombinant VLPS Jian Zhou • Find commercial partners Merck/GSK • Scale up the manufacture Merck/GSK • Complete safety and efficacy trials Many groups • Educate the profession, govt, the public Ongoing • Confirm field efficacy • Improve the product – 9 valent vaccines, 2 dose regimens • Encourage deployment globally • Develop effective immunotherapy Population-based coverage estimates for HPV vaccine in Australia by age in mid 2007, as at March 2011 Measuring human papillomavirus (HPV) vaccination coverage and the role of the National HPV Vaccination Program Register, Australia, Dorota M. Gertig A, Julia M. L. Brotherton A B and Marion Saville A Sexual Health 8(5705) 171– 178 http://dx.doi.org/10.1071/SH10001 Three dose HPV vaccination coverage in Australian women aged 18–26 years in 2007 estimated by three methods Julia M.L. Brotherton , Bette Liu , Basil Donovan , John M. Kaldor , Marion Saville Vaccine, Volume 32, Issue 5, 2014, 592 – 597 http://dx.doi.org/10.1016/j.vaccine.2013.11.075 Uptake of HPV vaccines across Australia (3 doses, 15 y.o’s) Since the introduction of vaccination in Australia, HPV related disease has virtually disappeared in vaccinated young women Ali, H. Et al BMJ 2013;346:f2032 doi: 10.1136/bmj.f2032 ..and in unvaccinated young men! Ali, H. Et al BMJ 2013;346:f2032 doi: 10.1136/bmj.f2032 Differences in HPV genoprevalence between prevaccine and postvaccine populations. Tabrizi S N et al. J Infect Dis. 2012;infdis.jis590 Reduction in HPV related cervical disease by age at immunisation Impact of a population-based HPV vaccination program on cervical abnormalities: a data linkage study. Dorota M Gertig, , Julia ML Brotherton, Alison C Budd, Kelly Drennan Genevieve Chappell and A Marion Saville BMC Medicine 2013, 11:227 doi:10.1186/1741-7015-11-227 .

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