Cervical Cancer Vaccine

Most cervical cancers are associated with HPV or Human Papilloma Virus, a sexually transmitted infection.

Different strains of HPV are spread through sexual intercourse and most are associated with cervical cancer, which is the leading cancer in women in India.

It is estimated that 75 % of sexually active women are likely to be infected with HPV. Most often the infection resolves spontaneously or with treatment and only a minority (< 1 %) of the HPV progress to cancer. Pap smear test is used to find cellular abnormalities in the cervical tissue which aids in early diagnosis.

Some cofactors are necessary for progression of the HPV infection to cancer. These include

  • Long term use of hormonal contraceptives
  • Multiple pregnancies
  • Early initiation of sexual activity
  • Multiple sex partners
  • Tobacco smoking
  • Co-infection with HIV and other STDs
  • Immunosuppression
  • Low socio-economic status
  • Poor hygiene
  • Diet low in anti-oxidants

Why Vaccination?

Genital HPV can be prevented by:

  • Sexual abstinence
  • Lifetime sexual monogamy of both partners
  • Periodic screening
  • Vaccination

At present there are two types of vaccines which are marketed in India:

  • Gardasil: protects against HPV variant 16, 18, 11 and 6
  • Cervarix protects against HPV variant 16 and 18

Dosage and schedule

The vaccine is given as 0.5 ml intramuscularly, either in the deltoid or antero-lateral thigh. WHO recommends age for initiation of vaccination is 9-13 years. Catch up vaccination is permitted upto the age of 26 years.

Gardasil is given at day 0 (9-12 years), 2 months and 6 months

Cervarix is given at day 0 (9-12 years), 1 month and 6 months

A minimum interval of 4-6 weeks is given between the 1st and 2nd dose and 12 weeks between 2nd and 3rd dose and 24 weeks between 1st and 3rd dose. This vaccine can be given simultaneously with Hepatitis B and Tdap.

If the HPV vaccine schedule is interrupted, the vaccine series need not to be restarted. If the series is interrupted after the first dose, the second dose should be administered as soon as possible, with an interval of at least 12 weeks between the second and third doses. If only the third dose is delayed, it should be administered as soon as possible

The vaccine will not be effective for protection against cervical cancer, if given after a person gets infected with HPV.

Side Effects and Contraindications of Vaccines

  • Pain at the injection site
  • Swelling and redness at the injection site
  • Fever
  • Nausea
  • Muscle or joint pain

Contraindications

In India the vaccine is not given

  • Below 9 years
  • Above 26 years
  • Males
  • Moderate or severe acute illnesses
  • Those with hypersensitivity to any vaccine component
  • Pregnancy

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