A clever way to prevent cervical cancer - get vaccinated against HPV

        Romantic Valentine's Day is approaching, although intimate behavior may warm up the relationship, unsafe sexual behavior may lead to illness. According to statistics, the probability of women being infected with Human Papillomavirus (HPV) in their lifetime is as high as 80%, and there is a trend towards younger age groups. As long as there has been sexual activity, there is a risk of infection, even with a single sexual partner, there is still a nearly 60% chance of infection. In addition, studies have shown that persistent HPV infection is the main cause of cervical cancer, with the highest proportion of infections being HPV types 16 and 18. In this issue of 'Health Column', we will analyze the biggest threat and prevention methods that cause cervical cancer.

                HPV virus and cervical cancer

        Cervical cancer is one of the common cancers among women and one of the top ten cancer incidence and mortality rates among women in Taiwan. It can be considered a hidden killer of women's health. However, it is actually a cancer that can be reduced in incidence through prevention.

        More than 90% of cervical cancers are related to human papillomavirus (HPV), a common virus that can infect both men and women. It is mainly transmitted through contact with skin, mucous membranes, or bodily fluids during sexual intercourse. In addition, if the external genitalia come into contact with objects carrying HPV, it may also cause infection.

        Understanding Human Papillomavirus (HPV)

        HPV is a DNA virus with over 100 known types. According to the risk of cancer, it can be divided into high-risk and low-risk types. High risk HPV is also associated with the occurrence of male and female genital cancer. Among them, types 16 and 18 are the most common high-risk HPV, causing over 70% of cervical cancer. In comparison, the risk of cancer caused by low-risk HPV infection is relatively low, but it may cause genital warts (commonly known as cauliflower).

        Who can receive the HPV vaccine?

        The HPV vaccine is most effective for individuals who are not yet sexually active or have not been infected with HPV, but those who have had sexual experience can still receive it. The World Health Organization recommends that women aged 9-14 be the main target of vaccination, and the vaccination rate should be increased. If the vaccination rate reaches 80% or more, it can also reduce the risk of male HPV infection. Therefore, Taiwan follows the recommendations of the World Health Organization to provide vaccination services, rather than relying on public subsidies. Before vaccination, individuals can refer to the instructions on the brochure or check the website of the Food and Drug Administration.

        Who is not recommended to receive the HPV vaccine?

        Individuals who experience allergic symptoms after receiving the HPV vaccine.

        2. Pregnant individuals (so far, there have been no adverse pregnancy events caused by HPV vaccines to the mother or fetus).

        3. Planned pregnancy (avoid pregnancy during the six-month period of vaccination).

        4. Individuals with a history of special diseases (such as coagulation disorders, immune dysfunction, or currently taking immunosuppressants).

        On the day of vaccination, if you have fever, infection symptoms, or are taking medication, you should inform the doctor first for evaluation.

        The mechanism of action of HPV vaccine

        The HPV vaccine is made by recombining the protein shell particles to mimic the external structure of HPV, resulting in virus like particles. In other words, it is a hollow shell structure composed of protein shell particles, which does not contain any HPV virus genes inside. After vaccination, it can induce an immune response and produce anti HPV antibodies, but it will not cause disease, so it will not be infected with HPV virus due to vaccination.

        What are the currently approved HPV vaccine brands?

        The Taiwan Food and Drug Administration has approved the marketing of three HPV vaccines, namely the vaccine "BoBei Cervarix" from the Dutch pharmaceutical company GlaxoSmithKline, and the vaccines "JiaXi (quadrivalent) Gardasil" and "JiaXi (nonavalent) Gardasil" from the American pharmaceutical company Merck.

        What are the differences between bivalent, quadrivalent, and nonavalent HPV vaccines?

        The difference between these three HPV vaccines lies in the prevention of different HPV types. Among them, "BoBei (bivalent) Cervarix" prevents HPV types 16 and 18, "JiaXi (quadrivalent) Gardasil" prevents HPV types 6, 11, 16, and 18, and "JiaXi (nonavalent) Gardasil" prevents HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58. Both bivalent, quadrivalent, and nonavalent vaccines can prevent cervical cancer caused by human papillomavirus (HPV) types 16 and 18, which are highly carcinogenic.

        How many doses of HPV vaccine should be administered? How long is the interval between them?

        According to the vaccine sample approved by the Food and Drug Administration, the recipients may receive 2 or 3 doses of the vaccine due to differences in gender, age, and vaccine items, and the interval between doses may also vary.

        Vaccination with bivalent Baobei HPV vaccine

        Women aged 9-14 years old: Administer 2 doses and receive vaccination between 0, 5, and 13 months.

        Women over 15 years old (inclusive): Administer 3 doses and receive vaccinations at 0, 1, and 6 months.

        Vaccination with quadrivalent Jiaxi HPV vaccine

        Women aged 9-13 years old: administer 2 doses and receive vaccination at 0, 6, or 12 months.

        14-45 year old women: Administer 3 doses and receive vaccinations at 0, 2, and 6 months.

        Men aged 9-26: Administer 3 doses and receive vaccinations at 0, 2, and 6 months.

        Vaccination with the 9-valent Jiaxi HPV vaccine

        Men and women aged 9-14 years old: administer 2 doses and receive vaccination at 0, 6-12 months.

        Male and female aged 15 to 45: Administer 3 doses and receive vaccinations at 0, 2, and 6 months.

        How long is the protective effect after complete vaccination?

        At present, the longest period of tracking subjects is only 12 years, and it is not yet possible to confirm how long their protective effect can last. However, according to the latest data, the protective effect of "Baobei Cervarix" is at least 11 years, the protective effect of "Jiaxi (quadrivalent) Gardasil" is at least 12 years, and the protective effect of "Jiaxi (nonavalent) Gardasil" is at least 8 years. In addition, WHO stated in 2022 that there is currently no evidence to suggest the necessity of administering additional doses.

        epilogue

        Cervical cancer is one of the biggest challenges to women's health, and the persistent infection of human papillomavirus (HPV) is closely related to cervical cancer. Reminder to consult with family medicine, obstetrics and gynecology, and urology departments. Having a physician evaluate and receive HPV vaccination, as well as regular screening, not only can we work together to prevent and treat HPV infection, but we can also protect ourselves and our partners from diseases. This is the most romantic gift for a warm Valentine's Day.

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