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In a bid to reduce cases of cervical cancer, the government is likely to roll out an immunisation campaign against Human Papillomavirus (HPV) in the second quarter of the year. Girls between the ages of 9 and 14 years across India will be vaccinated for free in three phases under the government’s programme over the next three years. After the “catch-up” is completed, the HPV vaccine will be included in the government’s routine immunisation programme for 9-year-old girls.
The quadrivalent vaccines, including the Serum Institute of India’s Cervavac, prevent the entry of four of the most commons types of HPV 16, 18, 6 and 11 thereby preventing infections, genital warts, and eventually cancer. The indigenously developed, cheaper Cervavac will be used in the government campaign.
At least 14 HPV types have been identified to have the potential to cause cancer. Among these, HPV types 16 and 18 are considered to be the most oncogenic, causing about 70 per cent of all cervical cancer cases globally.
Universal immunisation of girls also reduces the transmission of the infection to boys and protects them from other cancers.
The vaccine has to be administered in adolescent girls before they are sexually active. This is because the vaccine can only prevent the entry of the virus. “HPV is a very common infection and 90% of sexually active women already have it. Other than that, the response to the vaccine is also better in the adolescence. This is the reason a booster is needed for girls over the age of 15 years who get the shot,” said Dr Sarika Gupa, consultant of gynaecologic-oncology at Rajiv Gandhi Cancer Institute-New Delhi.
Although not covered by the planned government campaign, the vaccine can also be administered to adolescent boys and is recommended for men who have sex with men.
Yes. If you are not eligible to receive the vaccine under the government’s campaign or you would like to get it before the campaign is rolled out, SII’s Cervavac is commercially available for R2,000 per dose. You primary physician can administer the shot for you.
Yes. While the vaccine is not as effective among older women, it can still be administered up to the age of 45 years. Even if a person has already been exposed to an HPV infection, they are likely to be protected against other HPV types that the vaccines have.
Experts, however, suggest regular screening to be a better tool for older women. “Women who have not received the vaccine must undergo a pap smear test and an HPV DNA test every five years. If the HPV DNA test shows that they have not yet been exposed to HPV, then their chances of cervical cancer remains low,” said Dr Gupta.
HPV DNA test is expensive, costing around 3,500 to 4,000. Dr Gupta says: “In the absence of HPV DNA test, a pap smear should be done every three years.
More than 95% of all cervical cancer cases are linked to persistent infection with certain high-risk strains of HPV. What this essentially means is vaccination can be effectively used to prevent the infection and thereby cervical cancer cases. This is especially necessary in a country like India that accounts for nearly a fifth of the cervical cancer cases globally. India reports around 1.25 lakh cases and about 75,000 deaths each year.
While the effect of a vaccination drive will be most pronounced for cervical cancer, with HPV infection linked to cancers of anus, vagina and oropharynx, there is likely to be a drop in the incidence of these as well.
“The vaccine is 97% effective in preventing cervical cancer. This is the reason more than 100 countries have now implemented HPV vaccination programmes and they have seen a decline in the incidence as well,” said Dr Gupta.
