The HPV Strain | Pocketmags.com

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The HPV Strain

In Australia, over nine million doses of Gardasil have been administered to boys and girls for over a decade.

HPV, or human papillomavirus, is a sexually transmitted infection which can be transmitted via skin-to-skin contact.

It can also be transmitted through anal, oral, or vaginal sex. Strains of the infection can cause anal cancer, penile cancer, cervical cancer and oropharyngeal cancer (cancer of the back of the throat, including the base of the tongue and tonsils). HPV can also cause genital warts in men and women. HPV is the most common sexually transmitted infection worldwide, with three in four people aged between 15 and 24 carrying the virus. The virus contains 100 strains, of which the vast majority present no noticeable symptoms and cause no long-term health issues. Strains 6, 11, 16, and 18 are responsible for 70 per cent of the previously mentioned cancers and genital warts.

Overall, HPV is responsible for 5.2 per cent of cancer worldwide – 90 per cent of anal cancers, 70 per cent of cervical cancers, 65 per cent of vaginal cancers, 60 per cent of oropharyngeal cancers, 50 per cent of vulvar cancers and 35 per cent of penile cancers. Although HPV is perhaps most notorious for its links to cervical cancer in young women; men who have sex with men (MSM) are also at risk of anal, oropharyngeal, and penile cancers resulting from the virus. MSM do not benefit from the ‘herd immunity’ conferred through vaccinating adolescent girls. MSM – in particular

HIV-infected MSM – have a higher incidence of sexually transmitted infections, including HPV, compared to the general population.

HPV associated cancers are more prevalent in MSM compared to the general population – for example, rates of anal cancer are 15 times higher in MSM compared to heterosexual men. According to the American Center for Disease Control, men overall are also statistically at a higher risk of contracting genital warts than women.

A widely available HPV vaccine protects against these dangerous strains of the virus. The vaccine, currently offered by the HSE for MSM and young women, is called Gardasil. Gardasil has been proven to protect completely against strains 6, 11, 16, and 18 of the human papillomavirus. For the past four months, it has been offered in public STI clinics across Ireland. In order to complete the vaccine course you must undertake three doses of Gardasil over a six-month period. In Dublin, one clinic providing the HPV vaccine to MSM is the Gay Men’s Health Service (GMHS) on Baggot Street.

According to Siobhán O’Dea, manager of the GMHS, there has been a significant uptake of the vaccine among MSM within the relatively short timeframe of this particular programme, since it began in early April at the GMHS and across the country. The GMHS offers a dedicated HPV vaccine service to all patients aged up to age 26, free of charge. Visitors to the clinic may request the vaccine as a standalone service, or receive their Gardasil dosage alongside a full STI test. Eligible service users may request the course of vaccines while attending for an STI screen. O’Dea notes that all attendees are also encouraged to get vaccinated against Hepatitis A and B, as both these courses of preventative vaccines are key steps to minding your sexual health.

ADVERSE REACTIONS

Prior to its extension to young men, the HPV vaccine has been best known for its use in immunising young girls. In 2010, the vaccine became widely available in girls’ schools across the country. While rates of acceptance among the target group quickly reached the desired rate, uptake has plummeted sharply over the course of the past two years. In 2015, uptake among girls nationally was at 87 per cent – one of the highest rates of HPV vaccination in the world. This has since fallen to 50 per cent in 2016. The primary reason for this dramatic decline, according to current Minister for Health Simon Harris, is due to a consistent and long-term media campaign led by an Irish group R.E.G.R.E.T. (Reactions and Effects of Gardasil Resulting in Extreme Trauma), which began in 2015.

R.E.G.R.E.T. describes itself as a support group led by mothers of young girls who had suffered adverse reactions to Gardasil following vaccination in schools. Since its inception, R.E.G.R.E.T. has highlighted these reactions across numerous media appearances, and in a dedicated TV3 documentary;

The Cervical Cancer Vaccine - Is It Safe?. Members of R.E.G.R.E.T. claim their daughters have been incapacitated following vaccination, with symptoms of chronic fatigue, seizures, chronic pain, and breathing problems.

The TV3 documentary in particular focused on these individual cases and interviewed the girls who claimed to have suffered adverse reactions to the HPV vaccine. According to the group, these young women have often been forced to drop out of school and seek homeschooling or abandon their education altogether. Dr. Kevin Connolly of the National Immunisation Advisory Committee was also featured in the TV3 documentary. He pointed out that there has been no proven link between Gardasil and the symptoms outlined by the girls and their parents.

Approached for comment on this article, R.E.G.R.E.T. responded with a brief statement explaining that their primary focus was obtaining proper treatment for their daughters’ medical symptoms and an investigation of the causes behind them. They were unable to provide any information on the effects of the vaccine in MSM.

In addition to claims that the vaccine causes harmful side-effects, R.E.G.R.E.T. and similar groups argue that it is too soon to prove that Gardasil prevents HPV-related cancer as, in Ireland at least, it has been available for less than ten years. In Australia, over nine million doses of Gardasil have been administered to boys and girls for over a decade. This has resulted in a 77 per cent reduction in strains of cancer-causing HPV, a 50 per cent reduction in cervical abnormalities in young women under 18 years of age, and a 90 per cent reduction in genital warts in heterosexual men and women.

NOT MEDICAL EXPERTS

For the most part, R.E.G.R.E.T. have appeared in their position as parents rather than medical experts, often debating a wide variety of doctors, members of the HSE and HPRA, and other health professionals who advocate HPV vaccination. It is difficult to find Irish doctors or health professionals who have spoken out against the vaccine. One doctor who has openly opposed the administration of Gardasil and other vaccines, Dr. Neville Wilson, was featured in a recent episode of RTÉ’s Prime Time, which investigated the backlash against the HPV vaccine.

In his blog Dr. Wilson has an extensive piece on HPV and Gardasil, which downplays the efficacy of the vaccine. In addition to his research on the effects of Gardasil, Dr. Wilson has written to the Irish Medical Times linking the MMR vaccine to autism and brain damage in the past. Dr. Wilson cites multiple examples of vaccine research from Physicians for Life, a US-based group which promotes abstinence over vaccination for prevention of HPV.

In the US, a Kentucky-based doctor who took part in some clinical trials of both Gardasil and another HPV vaccine, Cervarix, has advised caution in the extension of the vaccine to young girls. Dr. Diane Harper, who has published extensive research into the efficacy and risks of Gardasil, has been embraced by many as a voice against the vaccine. However, a number of anti-Gardasil sites, including Collective Evolution and Healthwyze [sic] Report have misrepresented quotes from Dr. Harper, alleging that she denies the vaccine is effective. Dr. Harper has since clarified in an interview with Ben Goldacre for The Guardian that she does believe in the efficacy of Gardasil, and that she does also support and believe in the safety of HPV vaccination in general. Her primary concern is that those who receive the HPV vaccination will consider themselves invincible to HPV and related cancers and rely on their immunisation rather than regular pap smears (in MSM an anal pap test can be performed to check for anal cancer), which she believes are still essential to the cervical cancer prevention.

Dr. Harper has also been quoted in 2012, saying that the vaccine has caused 70 deaths of young girls, as recorded by the Vaccine Adverse Event Reporting System (VAERS). VAERS reports are voluntary and are not investigated to show any type of causality between the vaccination event and the claimed morbidity or mortality. In a disclaimer found on the homepage of the VAERS website, the programme notes: “that the data cannot be used to ascertain the difference between coincidence and true causality.”

Not all cases reported to the VAERS even have sufficient data to begin to investigate the cause of death or other adverse side effect. Of the cases that are supported by patient data, Dr. Barbara Slade has analysed the side effects of those who received Gardasil before experiencing illness. Based on this investigation, most of those who suffered serious adverse side effects had medical reasons for their symptoms. These include pre-existing conditions, a family history of illness which would cause the symptoms experienced, or mitigating factors such as birth control, which can cause the blood clots reported to the VAERS. Many symptoms occurred after the six-week window of biological plausibility following vaccination. Dr. Slade was unable to find a causal link between the vaccine and the reported serious adverse effects.

As of May this year, uptake of the vaccine had begun to slowly climb once again in Ireland. In August the HSE announced the formation of the HPV Vaccination Alliance, a coalition of 30 groups working to promote uptake and clarify public perception of the vaccine. This group includes the Irish Cancer Society, the National Women’s Council of Ireland, and the Children’s Rights Alliance.

It is ultimately up to young men and women, along with their parents, to make an informed choice about the vaccine based on all research available. They then have the option to receive it in school, if offered, or to choose to undertake the free immunisation programme at the Gay Men’s Health Service or any other public STI clinic.

For information on how to receive the HPV vaccine through the Gay Men’s Health Service, visit www.gmhs.ie or call (01) 669 9553. For more information on the HPV vaccine, visit www.hpv.ie

75 per cent to 80 per cent of all anal cancers are caused by HPV infection, but how safe is the vaccine against it?

Practically all sexually active people will contract some strain of HPV infection at some stage in their lives. The vast majority of these infections are harmless and will clear of their own accord spontaneously.

OPINION: Dr. Andrew Rynne The HPV vaccine conundrum

There is a very good reason why girls under the age of 12 have been targeted for vaccination against HPV in Ireland and it is because, at this age, they are unlikely to have been exposed to infection. The vaccination does not work well against HPV if it is an already established infection. Indeed some studies suggest that the spontaneous clearing of infection may even be retarded by vaccination. This concern was well documented by the FDA’s Vaccination Advisory Committee back in 2006.

Given that many men being urged to have the HPV vaccine will already be sexually active and therefore likely to already carry the infection, vaccination under these circumstances may actually be contra-productive and only make matters worse. Without further study, we simply do not know. Presenting vaccination against HPV as vaccinating cancer in men is delusory.

So, how safe is this vaccine? Here we have two diametrically and often bitterly opposed points of view. On the one hand are the authorities like the HSE whose job it is to promote all vaccines including the one against HPV. On the other side are the parents of young girls who became chronically and seriously ill within days of receiving Gardasil. In Ireland alone there are some 400 girls whose lives have been permanently blighted by a chronic fatigue-like syndrome associated with Gardasil injection.

The manufacturer’s own Patient Instruction Leaflet would seem to support the concerned parents. It says: “As with other vaccines, side effects that have been reported during general use include: confusion (Guillain-Barré Syndrome, Acute disseminated encephalomyelitis); dizziness, vomiting, joint pain, aching muscles, unusual tiredness or weakness, chills, generally feeling unwell, bleeding or bruising more easily than normal, and skin infection at the injection site.”

Unfortunately this leaflet does not mention the fact that some of these side effects may be a lifelong sentence. The word ‘chronic’ is never used. This, in my view, is a serious omission and most disingenuous.

Before going for this HPV vaccine I would urge you to do your own research and make up your own mind. Since they did not include the 400 girls who developed chronic fatigue like illnesses following this vaccine, I do not accept the HSE’s statement that side effects from HPV vaccine are rare. Nor do

I accept their assertion that all chronic illnesses immediately following vaccination are coincidental. Some maybe are, but not all. Coincidences do not happen 400 times.

With any quandary like this, one needs to consider what we call the risk/ benefit ratio. The question is: do the potential benefits of HPV vaccine given to sexually active men outweigh the risk involved? My answer to that is that they do not. That may not be your conclusion however. It is your call. Thread very carefully here. Do not let yourself be bounced into something you might regret for the rest of your life.

Andrew Rynne is a general medical practitioner working in Clane

Co. Kildare. He is the owner on an Online Medical Consultation service at: www.medicaladviceforyou.com

Immunisation programmes o er the greatest potential to prevent HPV-associated disease.

Human papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) worldwide; it is highly prevalent in the sexually active population and is rapidly acquired after sexual debut. Over 90 serotypes of HPV have been identified; low-risk (LR)-HPV types (predominantly 6 and 11) can cause genital warts, while high-risk (HR)-HPV types (predominantly 16 and 18) can cause cancer of the cervix, anus and oropharynx.

The incidences of HPV-associated anal and oropharyngeal cancers have increased dramatically in the past decade. Certain ‘at-risk’ groups including men who have sex with men (MSM), and particularly those with HIV infection, are disproportionately affected. The incidence of anal cancer has been documented at one-to-two cases per 100,000 in the general population, up to 35 cases per 100,000 in HIV-negative MSM and up to 70 cases per 100,000 in HIV-infected MSM. HPV associated disease can be prevented with a safe and effective vaccine.

OPINION: Dr Corinna Sadlier HPV Vaccine and MSM

Three vaccines have been developed to protect against HPV infection. The quadrivalent HPV vaccine protects against HPV 6, 11, 16 and 18 (Gardasil), and the bivalent vaccine protects against HPV 16 and 18 (Cervarix). The nonavalent HPV vaccine (Gardasil) was approved by the US Food and Drug Administration (FDA) in December 2014 and provides protection against five additional oncogenic HPV types (31, 33, 45, 52, and 58).

All HPV vaccines have demonstrated safety and efficacy against the development of cervical intraepithelial neoplasia (CIN) 2 or 3, the precursor to cervical cancer among HPV-naïve women. The quadrivalent HPV vaccine has, in addition, demonstrated efficacy against genital warts in males and females and anal intraepithelial neoplasia (AIN) (the precursor to anal cancer) in males.

Despite the potential clinical benefit of the HPV vaccine in males, mathematical models suggest that universal vaccination would exceed acceptable cost-effectiveness thresholds particularly in a setting where female vaccine coverage is high. Despite this, and recognising the protective benefits of the HPV vaccine in males, countries such as the US, Canada and Australia now offer HPV vaccine to both males and females through their national immunisation programmes.

Real world data from Australia has demonstrated that high levels of female vaccination decrease genital warts in both females and unvaccinated heterosexual males through ‘herd immunity’. However, no protection was observed in MSM.

Models looking at specific ‘at-risk’ male populations such as MSM and those infected with HIV have established cost effectiveness over a range of assumptions, given the increased risk of HPV infection and associated disease in these groups.

Immunisation programmes providing HPV vaccination to both males and females offer the greatest potential to prevent HPV-associated disease. While we await implementation of such programmes, targeted vaccination has potential to confer a direct protective benefit to MSM and to impact the high burden of HPV associated disease observed in this group.

Dr Corinna Sadlier is a Consultant in Infectious Diseases at Cork University Hospital

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