HPV Vaccination, Cerviocal Cancer : Do we need it
for Prevention of cervical cancer &
other HPV related diseasesm,
Presentation Outlines
Cervical cancer disease burden
Prevention with HPV vaccination
Vaccination of sexually active women
Opportunity of Postpartum HPV vaccination
Importance of genital warts prevention
Real world effectiveness data
Safety of HPV vaccine
Human papillomavirus (HPV) causes cervical cancer being the fourth most common cancer in women. 99% of all cervical cancer cases are related to genital infection with HPV. HPV Vaccines are now available and are the springboard for a change by primary prevention of this threatening situation.
PANEL DISCUSSION
MODERATOR: DR. RUPAM ARORA / Dr. Sharda Jain
PANELISTS:
DR. ARUNA SAXENA
DR. DEEPTI NABH
DR. ILA GUPTA
DR. JYOTI AGARWAL
DR. RAJ BOKADIA
DR. RENU CHAWLA
Is cervical cancer common
HPV Vaccination, Cerviocal Cancer : Do we need it
for Prevention of cervical cancer &
other HPV related diseasesm,
Presentation Outlines
Cervical cancer disease burden
Prevention with HPV vaccination
Vaccination of sexually active women
Opportunity of Postpartum HPV vaccination
Importance of genital warts prevention
Real world effectiveness data
Safety of HPV vaccine
Human papillomavirus (HPV) causes cervical cancer being the fourth most common cancer in women. 99% of all cervical cancer cases are related to genital infection with HPV. HPV Vaccines are now available and are the springboard for a change by primary prevention of this threatening situation.
PANEL DISCUSSION
MODERATOR: DR. RUPAM ARORA / Dr. Sharda Jain
PANELISTS:
DR. ARUNA SAXENA
DR. DEEPTI NABH
DR. ILA GUPTA
DR. JYOTI AGARWAL
DR. RAJ BOKADIA
DR. RENU CHAWLA
Is cervical cancer common
UPDATE HPV Vaccination IN Cervical Cancer Prevention Dr Sharda Jain Lifecare Centre
Cervical Cancer In India: A Preventable Tragedy That Requires Urgent Attention
It is estimated that in India, about 160 million women aged 30-59 years are at risk of developing cervical cancer, with fatality rate of 50 per cent
The United States Congress designated January as Cervical Health Awareness Month.
CANSA places the focus on Cervical Cancer during the month of September. Cervical Cancer is the 2nd most common cancer among South African women.
Sources: http://www.cansa.org.za/womens-health/
Two – Dose regime of 4HPV : Indian Perspective Dr. Jyoti Agarwal Dr. Sharda J...Lifecare Centre
Aim
To compare the immunogenicity and frequency of persistent infection and cervical precancerous lesions caused by vaccine-targeted HPV after vaccination with:
Two doses of quadrivalent vaccine on days 1 and 180 or later
With three doses on days 1, 60, and 180 or later, in a cluster-randomised trial
Cancer Biomarkers Research, HPV and Cancer, HPV VaccineJames Lyons-Weiler
An overview of advances in cancer biomarker research strategies, the pathogenesis of HPV virus and a focus on the HPV vaccine with an analysis of evidence of type replacement.
UPDATE HPV Vaccination IN Cervical Cancer Prevention Dr Sharda Jain Lifecare Centre
Cervical Cancer In India: A Preventable Tragedy That Requires Urgent Attention
It is estimated that in India, about 160 million women aged 30-59 years are at risk of developing cervical cancer, with fatality rate of 50 per cent
The United States Congress designated January as Cervical Health Awareness Month.
CANSA places the focus on Cervical Cancer during the month of September. Cervical Cancer is the 2nd most common cancer among South African women.
Sources: http://www.cansa.org.za/womens-health/
Two – Dose regime of 4HPV : Indian Perspective Dr. Jyoti Agarwal Dr. Sharda J...Lifecare Centre
Aim
To compare the immunogenicity and frequency of persistent infection and cervical precancerous lesions caused by vaccine-targeted HPV after vaccination with:
Two doses of quadrivalent vaccine on days 1 and 180 or later
With three doses on days 1, 60, and 180 or later, in a cluster-randomised trial
Cancer Biomarkers Research, HPV and Cancer, HPV VaccineJames Lyons-Weiler
An overview of advances in cancer biomarker research strategies, the pathogenesis of HPV virus and a focus on the HPV vaccine with an analysis of evidence of type replacement.
What Are the Key Statistics About Cervical Cancer?
The American Cancer Society's estimates for cervical cancer in the United States for 2017 are:
About 12,820 new cases of invasive cervical cancer will be diagnosed.
About 4,210 women will die from cervical cancer.
Cervical pre-cancers are diagnosed far more often than invasive cervical cancer.
Cervical cancer was once one of the most common causes of cancer death for American women. But over the last 40 years, the cervical cancer death rate has gone down by more than 50%. The main reason for this change was the increased use of the Pap test. This screening procedure can find changes in the cervix before cancer develops. It can also find cervical cancer early − in its most curable stage.
Cervical cancer tends to occur in midlife. Most cases are found in women younger than 50. It rarely develops in women younger than 20. Many older women do not realize that the risk of developing cervical cancer is still present as they age. More than 15% of cases of cervical cancer are found in women over 65. However these cancers rarely occur in women who have been getting regular tests to screen for cervical cancer before they were 65. See the section, " Can cervical cancer be prevented?" and Cervical Cancer Prevention and Early Detection for more information about tests used to screen for cervical cancer.
In the United States, Hispanic women are most likely to get cervical cancer, followed by African-Americans, Asians and Pacific Islanders, and whites. American Indians and Alaskan natives have the lowest risk of cervical cancer in this country.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
2. Setting the scene
HPV and Cervical cancer
What are the vaccines and what do we know about their use
• Facts
• Assumptions
National immunisation programmes – challenges, effectiveness,
cost, impact on screening
3. <3.9 <7.9 <14.0 <23.8 <55.6
Cancer of the cervix (mortality/100,000)
Mortality falling developed world
Mortality rising in developing world
4. Relative incidence of cervical cancer Ireland
versus England
0
2
4
6
8
10
12
14
16
18
ESRper100,000women
Ireland
England
NCRI, NHSCSP (Includes Wales up to 1994)
5. Human Papilloma Virus
The link with cervical cancer
Epidemiology of
cervical cancer–
sexually transmitted
agent.
Human
Papillomavirus
(HPV) is the major
infectious agent
involved .
99.7% of cervical
cancers contain high
risk HPV DNA
6. Human Papilloma virus
The virology lesson
Double
stranded, tightly
coiled, circular
virus
More than 100
types
Genetic structure
• Early Late and Upper
regulatory areas E
(1,2,6,7), L (1,2)
Infects basal cell
layers of genital
epithelium
7. HPV and cervical neoplasia –
Molecular pathway
Integration of HPV
DNA into host
nucleus
Gatekeeper gene E2
Controls Activity of
E6 and E7.
Integration damages
E2
Interferes with
“Quality control
inspectors” or tumour
supressor genes.
•E 6 “takes out” p53
•E 7 “takes out” pRB
Result - More
abnormal cells which
live longer
8. Natural History of HPV infection
•Transmission by
sex
•Lifetime risk 80% -
most within 18
months
Exposure
•Transient
•Most resolve within
18 months
Infection
•Less than 20%
persist
•No antibodies
detectable
Persistence
•Virus integrates
into host DNA
Malignant
Transformation •Loss of tumour
supressor gene E2
•Uncontrolled cells
division
CIN
9. HPV and neoplasia the problem
A large
proportion of
sexually active
women will be
infected with
HPV
A minority will
have persistent
infection with
high grade CIN
Fewer still will
evolve into
invasive cancer
There must be other factors which interfere with immunity ? Cigarette smoking
10. Which Human Papillomaviruses to target?
Low Risk 6, 11, 40, 42, 43, 44, 54, 61
Anogenital warts
High risk 16, 18 45, 31, 33, 52, 58, 35,
59, 56, 39, 51, 73, 68, 66
Anogenital neoplasia
6,11,
16,18,
90%
warts
70%
cervical
cancer
11. HPV Vaccination
• Virus Like Particle
• L1 Surface protein as
empty shell (no DNA)
• 5 years years follow up
• Immunogenic and safe
12. Current VLP Vaccines
No comparitive studies
300 Euros for three doses
Quadrivalent
Sanofi Pasteur
Gardesil
Subtypes
16/18/6/11
Bivalent
GSK Bivalent Vaccine
Ceverix
HPV 16/18
Not yet Licenced
13. Future 2 Study: Quadrivalent
Vaccine
•93% of study
population were non
virgins
•Efficacy best in group
of women who were
HPV negative at time
zero (PPE)
•Efficacy reduced in
Modified Intention to
treat group (MIT)
(NEJM, May 2007)
14. Questions efficacy in non HPV
Naive women
Target Percentage
Reduction
High Grade CIN/AIS
associated with
HPV16/18
39%
High grade CIN/AIS
associated with any
CIN
12%
Condylomata 68.5
15. HPV Vaccine – Provisional ACIP
Recommendations
• Routine vaccination of females 11 or 12 years of age
• The vaccination series can be started as young as 9 years
of age at the clinician's discretion
• Vaccination is recommended for females 13-26 years of age
who have not been previously vaccinated (Note not
Mandated)
• Ideally vaccine should be administered before onset of
sexual activity
CDC, June 2006
16. UK
• NHS
• 27th October 2007
• JVCI – Advice
• Vaccination programme
• Girls aged 12-13
• Catch up to 18 years
delivered over two years
17. Questions - Epidemiology
• What proportion of cervical cancer and other HPV
related diseases are caused by subtypes covered by
vaccines? – (70%)
• What fraction of cervical cancer overall will be
prevented by a vaccine against HPV 16 and 18? -
(Depends on uptake and durability)
• Will immunity induced by vaccines alter the
distribution of other non vaccine HPV types? –
(Unknown)
(Lowndes, 2006)
18. Questions – Cost and impact on screening
programme
• How will a vaccination programme affect current
programmes for cervical cancer screening and when
should screening change?
• What is the cost effectiveness of various strategies for
vaccination programmes?
(Lowndes, 2006)
19. Effect on screening
While 70% of cancers
are associated with
HPV 16/18 a vaccine
with 98%
effectiveness may
reduce cancers by
only 51%
Replacement with
other high risk
vaccines an issue
• Cervical Screening will
have to continue for
vaccinated women
• Potential for Targeted
screening based on
virological tests in
future
20. HPV Vaccine and Cervical Cancer
Screening
• Cervical cancer screening recommendations have NOT
changed for females who receive HPV vaccine
• 30% of cervical cancers caused by HPV types not
prevented by the quadrivalent HPV vaccine
• Vaccinated females could subsequently be infected with
non-vaccine HPV types
• Sexually active females could have been infected prior to
vaccination
CDC, June 2006
21. Cost effectiveness – comparison with other
vaccinations
• Cost 300 euro per person – most expensive vaccine yet
but… cheaper for countries than individuals
Vaccination Life expectancy increase
(days)
HPV 2.8
Measles 2.7
Mumps 3.0
Rubella 0.3
Pertussis 3.3
22. Effectiveness
Combining vaccination of 12 year old girls with screening
would reduce cancer by 90% but would cost $45,000 per
QALY gained
Inclusion of boys would produce marginal increase in
efficacy but would increase the cost per QALY gained by
a factor of 10 to $450,000
25. Acceptability of the vaccine
• Lack of awareness
Shock, Fear,
• Before education
• Acceptors 55%
• Decline 22%
• Undecided 23%
• Following education
• Accept 74%
• Decline 18%
• Undecided 8%
Journal of lower genital tract disease 2004;8(3):188-94
26. Conclusions
• Vaccination before sexual debut maximises the long term
impact of vaccination
• Catch up programmes can speed up impact and reduce
the number of cumulative cases.
• Little evidence in favour of vaccinating women who
already have had HPV