VacciNation

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Genital HPV is one of the most common STDs, caused by the Human Papilloma virus. The virus is a double stranded DNA virus in the Papillomaviridae family with affinity for genital skin and mucus membranes. This virus usually attacks the basal cell layer of stratified squamous epithelium and stimulates cellular proliferation. Infections are usually transient, meaning that those infected are usually asymptomatic with very few clinical complications (3).

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HPV types are divided into two groups as well. One group is low-risk (non-oncogenic) associated with genetic warts and a mild pap test abnormality. Another group that is more serious is the high-risk oncogenic type associated with cervical dysplasia and cervical cancer. Since HPV can lead to cancer we can also classify it as an oncovirus. It might sound strange that a virus could cause cancer. Generally, a virus infects a cell via attachment to a cell, entering the cell and incorporating its DNA into the host cell’s DNA. Depending on the location of incorporation of the virus’s DNA into the host DNA there might be a frame shift, meaning the original reading frame of the nucleotides is shifted. This will then turn proto-oncogenes (normal gene that could turn into an oncogene from mutations) to a full-blown oncogene (unregulated gene that promotes unregulated cellular proliferation, which ultimately leads to cancer) (3).

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It is also estimated that 100% of sexually active men and women acquire genital HPV at some point. Although 90% of HPV infections tend to clear within two years, persistent infections can lead to precancerous cervical cellular changes which can develop into full blown cervical cancer. (3) The good news is that to prevent such an event from occurring one is advised to simply get vaccinated for HPV.

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Unfortunately, there are still parts of the world where cervical cancer, which stems from untreated HPV infection, is the number one cancer incidence among women in certain regions especially in eastern Africa and Melanesia. For less developed regions cervical cancer is the second most frequent cancer in women, under breast cancer (2).  Analysis of worldwide HPV vaccinations has also shown that HPV immunization programs that have been implemented have generally only reached middle and upper class individuals even though lower income individuals are at higher risk of infection. This is a major issue which many groups have been trying to address (1).

 

Previously the GAVI alliance (formerly the Global Alliance for Vaccines and Immunization) and Pan American Health Organization (PAHO) revolving fund launched a program in 2013 that would provide HPV Vaccinations to over 180,000 girls in several countries. Not only did this give immunizations to girls but it was also designed to implement and establish national HPV vaccination programs. GAVI has also negotiated $4.50 per dose for Gardasil and $4.60 for another HPV vaccine brand, Cervarix for use in developing countries.

 

Such efforts have been advantageous to increasing global immunization for HPV. Establishing immunization programs and training local medical personnel will allow for a self-serving process of providing vaccines without the aid of foreign nations. Collaborations and discounts for HPV doses will also allow for lower-income regions to afford and sustain vaccination programs (4).

 

References

1. Bruni, L., Diaz, M., Barrionuevo-Rosas, L., Herrero, R., Bray, F., Bosch, F. X., … Castellsagué, X. (2016). Global estimates of human papillomavirus vaccination coverage by region and income level: A pooled analysis. The Lancet Global Health, 4(7), 453–463. doi:10.1016/s2214-109x(16)30099-7

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2.Bruni, L., Barrionuevo-Rosas, L., Albero, G., Serrano, B., Mena, M., Gómez, D., & Muñoz, J. (2016, December). Human Papillomavirus and Related Diseases in the World. Retrieved from http://www.hpvcentre.net/statistics/reports/XWX.pdf

 

3. Burd, E. M. (2003). Human Papillomavirus and cervical cancer. Clinical Microbiology Reviews, 16(1), 1–17. doi:10.1128/cmr.16.1.1-17.2003

 

4. GAVI ALLIANCE. (2013, February 4). GAVI funds vaccines to protect girls against cervical cancer - Gavi, the vaccine alliance. [Website]. Retrieved March 1, 2017, from GAVI: The Vaccine Alliance, http://www.gavi.org/library/news/press-releases/2013/gavi-funds-vaccines-to-protect-girls-against-cervical-cancer/