The Human Papillomavirus Vaccine in Canada

By Morris, Shaun K.; Nguyen, Claire K. | Canadian Journal of Public Health, March/April 2008 | Go to article overview

The Human Papillomavirus Vaccine in Canada


Morris, Shaun K., Nguyen, Claire K., Canadian Journal of Public Health


ABSTRACT

Clinical studies have shown the human papillomavirus (HPV) vaccines to be very effective at preventing persistent infection by vaccine serotypes. The development of these new vaccines heralds a new era in cancer prevention. Gardasil, Merck's quadravalent HPV vaccine, has recently been licensed in Canada for women aged 9 to 26 years of age. It necessitates that health professionals become familiar with the vaccine, the evidence supporting its effectiveness and issues related to vaccine strategy, cost effectiveness, and remaining research questions. The vaccine is recommended in Canada for females aged 9 to 13 years and should also be offered to females aged 14 to 26 years. Ongoing research will determine the duration of protection conferred by the vaccine, and the potential need for booster doses. In conjunction with continued screening programs, the HPV vaccine offers the potential to dramatically reduce the burden of cervical cancer in Canada, and to do so in a cost-effective manner.

Key words: Human papillomavirus; cervical neoplasms; vaccines; public health; Canada

RÉSUMÉ

Des études cliniques ont montré que les vaccins contre le virus du papillome humain (VPH) sont très efficaces pour prévenir les infections persistantes par les sérotypes vaccinaux. La mise au point de ces vaccins annonce une ère nouvelle pour la prévention du cancer. Gardasil, le vaccin quadrivalent anti-VPH de Merck, a récemment été homologué au Canada pour les filles et les femmes de 9 à 26 ans. Il faut cependant que les professionnels de la santé se familiarisent avec le vaccin, les preuves de son efficacité, la stratégie de vaccination, le rapport coût-efficacité et les questions de recherche non résolues. Au Canada, le vaccin est recommandé pour les filles de 9 à 13 ans et devrait aussi être offert aux filles et aux femmes de 14 à 26 ans. Des recherches en cours permettront de déterminer la durée de la protection conférée par le vaccin et les doses de rappel nécessaires, le cas échéant. Utilisé conjointement avec les programmes de détection en cours, le vaccin anti-VPH présente la possibilité de réduire considérablement le fardeau du cancer du col utérin au Canada, et de le faire de façon économiquement rentable.

Mots clés : virus du papillome humain; néoplasmes cervicaux; vaccins; santé publique; Canada

High-risk types of human papillomavirus (HPV) are the causal agents of more than 99% of cervical cancer cases.1,2 Of the more than 100 types of HPV, there are approximately 13 to 18 serotypes that are linked to cervical cancer.2 two types, HPV 16 and HPV 18, are associated with over 70% of cases of cervical cancer.3 HPV is also associated with other types of malignancies including anal4,5 and penile cancer,5 as well as genital warts in both males and females.6 two serotypes, HPV 6 and 11 cause approximately 90% of anogenital warts.

A high percentage of women are infected with HPV soon after sexual debut.7 the public health agency of canada estimates that high-risk types of HPV have a prevalence of 11-25% in the general female population, and over 50% in some high-risk populations including First nations, recent immigrants, and women of lower socio-economic standing.8

The incidence of cervical cancer has been dramatically reduced in the developed world due to routine screening for abnormal cells with the papanicolaou (pap) smear. While specific guidelines vary from country to country, they generally call for smears in sexually active women over the age of 18 every one to three years.9 however, in canada, 16% of all women over the age of 18 had never had a smear, and 35% of women aged 18 to 24 had never had a smear.9 certain groups, including First nations women, the homeless, and sexually active teenagers, are at particular risk for not receiving pap smears as recommended. It is estimated that in canada, there are 1,350 new cervical cancer cases and approximately 400 deaths each year. …

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