This document discusses HPV vaccines and cervical cancer prevention. It provides details on HPV types, transmission, and associated cancers. It outlines recommendations for HPV vaccination including target groups, dosing schedules, and delivery strategies. The goals of HPV vaccination are to reduce the global burden of HPV-related cancers through immunization programs.
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
Report Back from SGO 2023: What’s New in Cervical Cancer?bkling
Curious about what’s new in cervical cancer research? Join Dr. Evelyn Cantillo, gynecologic oncologist at Weill Cornell Medicine, as she shares the latest updates from the Society of Gynecologic Oncology (SGO) 2023 Annual Meeting on Women’s Cancer. Dr. Cantillo will also highlight what the research presented at the conference means for you and answer your questions about the new developments.
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
Report Back from SGO 2023: What’s New in Cervical Cancer?bkling
Curious about what’s new in cervical cancer research? Join Dr. Evelyn Cantillo, gynecologic oncologist at Weill Cornell Medicine, as she shares the latest updates from the Society of Gynecologic Oncology (SGO) 2023 Annual Meeting on Women’s Cancer. Dr. Cantillo will also highlight what the research presented at the conference means for you and answer your questions about the new developments.
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
HPV Infection , HPV Vaccination , Cervical cancer , Cancer in India , Dr. SHA...Lifecare Centre
HPV inefection , HPV disease prevention, Cervical cancer prevention , Cervical cancer treatment, Female cancer , Female cancer prevention , Uterine cancer , Cancer in india
All the guidelines recommend co testing as the modality of choice for cervical cancer screening.
However, Cobas test was approved by FDA as primary screening modality in 2014.
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
HPV Infection , HPV Vaccination , Cervical cancer , Cancer in India , Dr. SHA...Lifecare Centre
HPV inefection , HPV disease prevention, Cervical cancer prevention , Cervical cancer treatment, Female cancer , Female cancer prevention , Uterine cancer , Cancer in india
All the guidelines recommend co testing as the modality of choice for cervical cancer screening.
However, Cobas test was approved by FDA as primary screening modality in 2014.
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
These slides contain detailed description of HIV in children including : Introduction, Definition, HIV structure, Incidence, Impact of HIV on infant and child survival, Mode of transmission - Vertical transmission and horizontal transmission, Pathophysiology, Clinical features, Laboratory investigations, Management, Prevention, Nursing management, Nursing diagnosis.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
1. D R . S U K H W I N D E R S I N G H
HPV VACCINES: AN
UPDATE
2. OUTLINE
• Global burden of HPV related cancers
• Human papilloma virus
• HPV life cycle in cervix
• Types of HPV
• Association between Human Papillomavirus and Malignant Diseases
• Clinical manifestations
• HPV disease prevention
• History of HPV vaccine
• Vaccine profile
• Mechanism of action HPV vaccines
• Natural history of HPV infection & carcinoma cervix
• Whome to vaccinate
• Possible HPV vaccination target groups and special populations
• Vaccination recommendations for HPV
• Adverse effect of HPV vaccine
• HPV vaccine delivery strategy
• Progress in HPV vaccine implementation
• Hpv vaccination in India
• Other way to prevent cervical cancer
• Therapeutic HPV vaccines
3. GLOBAL BURDEN OF HPV RELATED
CANCERS
Cervical cancer
• 2,784 million women aged 15 years and older worldwide are at risk
of developing cervical cancer
• 4th most common cancer among women in the World
• 2nd most common cancer among women aged 15-44 years
Worldwide
4. CERVICAL CANCER
New annual
cervical cases
• India – 122,844
• World – 527,624
Annual deaths due to
cervical cancer
• India –67,477
• World – 265,672
23%
77%
India
World
27%
73%
India
World
5. ANOGENITAL CANCERS OTHER THAN THE
CERVIX
• Anal cancer:
• average worldwide incidence of 1 per 100,000
• 27,000 new cases every year
• Vulvar cancer:
• 4% of all gynaecologic cancers
• Vaginal cancer:
• 2% of all gynaecologic cancers
• Penile cancer:
• 22,000 new cases every year
de Martel C et al. Lancet Oncol 2012;13(6):607-15
6. HUMAN PAPILLOMA VIRUS
• Papillomavirus genus
• Papillomaviridae family
• Non-enveloped virus
• 55 nm in diameter
• Icosahedral capsid composed of 72 capsomeres enclosing
a ds circular DNA genome
7. HUMAN PAPILLOMA VIRUS
• genome - 7900 base pairs
• the genome encodes several early genes (E1, E2, E4, E5,
E6, and E7)
• structural late genes (L1 and L2)
• 200 HPV types known
8. GENE
CATEGORY
GENE FUNCTION
Early genes
E1 Viral DNA replication
E2 • viral transcription
• DNA replication
• segregation of viral genomes
E4 • HPV genome amplification
• virus maturation
• release of virions
E5 • se activity of E6 and E7
• Generate aneuploidy and chromosomal instability
E6 • Bind and degrade the tumor-suppressor protein p53
• inhibit apoptosis
E7 Bind and degrade the tumor-suppressor protein pRB
Late genes L1 • Major capsid protein
• attachment to cell surface receptors
• highly immunogenic & induce the production of neutralizing
type-specific antibodies against the virus
L2 • Minor capsid protein
• helps packaging of viral DNA into capsids
17. THE NEED FOR VACCINATION
AGAINST CERVICAL CANCER
• Natural HPV infection induces a weak immune response
• Vaccination induces higher antibodies in blood and site of
infection which neutralizes virus.
18. WHY VACCINATION IS THE BEST FORM
OF PREVENTION
• All genital HPV infections can’t be prevented except by
abstinence and lifetime mutual monogamy
• Barrier methods of contraception confer a protection
against HPV infection – still questionable
• Asymptomatic infection except for genital warts
• In developing country like India, large-scale routine
screening is difficult to achieve.
19. HISTORY OF HPV VACCINE
• 1977 - Dr.Harald zur Hausen detected HPV in warts and cervical
cancer
• 2006 – US FDA approved Gardasil vaccine
• 2008 - Dr. Hausen received Nobel Prize for his work on HPV
• 2009 - FDA approved Cervarix vaccine
• 2014 - FDA approved 9-valent HPV vaccine
• 2016 - U.S. FDA approved adding a 2-dose schedule for 9-valent
HPV vaccine (Gardasil 9) for adolescents ages 9 -14 years
20. VACCINE PROFILE
• 2 licensed prophylactic HPV vaccines
• Bivalent (16,18)
• Quadrivalent (6,11,16,18)
• Both produced by recombinant technology
21. VACCINE PROFILE
• Virus-like particles (VLP)
• Purified L1 protein
• form empty shells
• do not contain viral genetic material or live biological product
• non infectious.
24. MECHANISM OF ACTION HPV VACCINES
Bind to viral particles
Transudate from capillaries to basal stem cells in the
genital epithelial mucosa
L1- Neutralizing serum IgG 1–4logs > natural infection
Anti-L2 antibodies cross-neutralizing
VLP(L1 & L2)-based HPV vaccination
25. NATURAL HISTORY OF HPV INFECTION
& CARCINOMA CERVIX
• In natural infection, antibodies against L1 appear 6–8
months following infection
• In 50–70% of infected individuals
• Other viral proteins (E1, E2 and E6) do not elicit antibody
responses
• IgM response occurs first and decays early
• IgG response appears late
27. WHOME TO VACCINATE
• Girls aged 9 to 14 years prior becoming sexually active
• Catch-up vaccination till 45 year old females
• Males
28. EVALUATION BEFORE VACCINATION
• Contraindicated :
• Known hypersensitivity to any vaccine components
• Serious bleeding disorders
• Pregnancy
• Delay vaccination - severe febrile illness
• HPV serologic or DNA testing or cervical cytology are not
recommended before vaccination
29. POSSIBLE HPV VACCINATION TARGET GROUPS
AND SPECIAL POPULATIONS
Primary target group of females:
• Girls 9–14 years of age
• HPV vaccines are most efficacious-
• before onset of sexual activity
• females naive to vaccine-related types
• Primary vaccine target group depend on
• country’s vaccine licensing indications
• age of initiation of sexual activity of females
30. POSSIBLE HPV VACCINATION TARGET GROUPS
AND SPECIAL POPULATIONS
Secondary or “catch-up” populations of females:
• females 15 years and older
• May decrease impact of vaccination on cervical cancer-
shorter interval between vaccination and sexual
exposure to vaccine related HPV types
31. SPECIAL POPULATIONS
Pregnant and lactating females:
• HPV vaccination not recommended in pregnant females
• If pregnant women vaccinated, vaccination be
discontinued until completion of the pregnancy
32. SPECIAL POPULATIONS
Immunocompromised individuals:
• Limited Data
• HPV vaccination of target group before onset of sexual
activity reduces risk of administering HPV vaccines to
HIV-infected individuals
• Countries with HPV vaccines in national immunization
programmes do not vaccinate females whose HIV status
is unknown
33. ACIP-RECOMMENDATIONS FOR HPV
• On 19 October 2016, CDC and ACIP recommended :
Females < 15 years should receive 2
doses of HPV vaccine at least 6
months apart rather than the
previously recommended 3 doses.
34. ACIP-RECOMMENDATIONS FOR HPV
4vHPV & 2vHPV vaccine:
• <15 years (Target group) – 2 doses (0, 6-12 months)
• If interval between doses is <5 months - 3rd dose given at least 6
months after the 1st dose
• 16-26 years (Catch-up group):
• 3 doses ( 0, 2, 6 month)
• Interval between 1st & 2nd dose - 6–12 weeks
• Interval between the 2nd & 3rd dose - 12–23 weeks
• >26 years- geometric mean titres lower than 16-26 years
• Concomitant Administration with Other Vaccines:
• meningococcal conjugate vaccine, tetanus, diphtheria, and acellular pertussis
vaccine; inactivated polio vaccine and hepatitis B vaccine
• No effect on seroconversion rates and geometric mean titres
• Pregnancy - Category B
35. ACIP-RECOMMENDATIONS FOR HPV
4vHPV & 2vHPV vaccine:
• Interchangeability of HPV Vaccine Products
• Vaccination completed with same HPV vaccine product
• if providers don’t have same HPV vaccine product either HPV vaccine
product may be used to continue or complete the series for females to
provide protection against HPV 16 & 18.
• Only 4vHPV used in males.
36. ADMINISTRATION
• HPV vaccine shaken well before administration
• Dose of vaccine - 0.5 ml
• Intramuscularly, preferably deltoid muscle or antero-
lateral thigh
37. INTERRUPTED SCHEDULE (0,2,6M)
• Interrupted after 1st dose:
• 2nd dose to be given as soon as possible and 2nd & 3rd dose be
separated by at least 12 weeks
• Interrupted after 2nd dose:
• 3rd dose to be given as soon as possible
39. SPECIAL SITUATIONS
Abnormal Pap Test, Known HPV Infection, Anogenital
Warts, or HPV-Associated Lesions:
• Protection against vaccine HPV types only
• Might not be infected by any of the vaccine HPV type
• Vaccination also recommended for:
females regardless of abnormal Pap test result
Females/males regardless of known HPV infection, HPV-associated
precancer lesions, or anogenital warts
Females with abnormal cervical cancer screening
40. SPECIAL SITUATIONS
Immuno-compromised Persons :
• Vaccine efficacy between immuno-compromised and immuno-
competent persons – unclear
• ACIP recommends same vaccination schedule for immuno-
compromised
Men Who Have Sex with Men:
• Higher risk of HPV infection
• ACIP recommends routine vaccination with 4vHPV
41. SPECIAL SITUATIONS
Lactating Women:
• Can receive HPV vaccine
History of Sexual Abuse or Assault:
• Risk of HPV infection
• ACIP recommends HPV vaccination beginning at age 9 years
with 2-dose series
• Older females & males victims should receive HPV vaccine
through the recommended ages
42. HPV VACCINES SHOULD
NOT BE GIVEN TO…
• History of allergies to any vaccine component
• 4vHPV & 9vHPV - hypersensitivity to yeast
(Saccharomyces cerevisiae)
• 2vHPV - anaphylaxis caused by latex
• Moderate or severe acute illnesses
• Pregnant women
43. DURATION OF VACCINE PROTECTION
• HPV vaccines offer long-lasting protection
• Studies followed vaccinated individuals for around ten
years - no evidence of protection decreasing over time
44. ADVERSE EFFECT OF HPV VACCINE
Common HPV vaccine reactions which resolve
spontaneously and rarely require treatment are:
• Redness, pain, swelling, or induration at injection site
• Fever
• Headache, myalgia, arthralgia
• Nausea, vomiting, diarrhea, abdominal pain
• Pruritis, rash, urticaria
• Syncope, dizziness
45. SHOULD BOYS BE VACCINATED??
• Benefits:
• protection against HPV-associated diseases in men
• enhanced herd immunity with consequent reduction in HPV
transmission in populations
• Can countries attain sufficiently high male vaccination
coverage rates?----Most promising question
46. HPV VACCINE DELIVERY STRATEGY
Ideal HPV vaccine delivery strategy outlined by WHO in
2013:
• compatible with existing vaccine-delivery infrastructure and cold
chain capacity
• affordable, cost-effective and sustainable
• able to achieve the highest possible coverage
HPV vaccine delivery strategies:
• Vaccine delivery at health-care facilities
• Vaccine delivery through outreach:
• School-based outreach
• Other outreach
• Vaccine delivery through campaigns
47. PROGRESS OF HPV VACCINE
IMPLEMENTATION
• January 2008, 13 countries had recommended catch-up
vaccination of older adolescent females or young women
• 2009 – 1st WHO paper on HPV vaccines published
• Both 4vHPV & 2vHPV vaccine licensed in > 100
countries
• July 2009 – HPV vaccines were WHO pre-qualified
• May 2011 – 32 countries worldwide introduced HPV
vaccine in their national immunization program
• 2015 – 65 countries worldwide introduced HPV vaccine
in their national immunization program
48. HPV VACCINE- INDIA
• HPV vaccines introduced under pilot projects in 2006
• GAVI states- a coverage of 25-70% over 10 years in a
country like India can save > 1 million lives.
• Pap testing & HPV DNA testing or HPV antibody before
vaccination is not needed
• Prevention of cervical cancer continues to be largely
neglected in India
49. AVAILABILITY OF VACCINE IN INDIA
• GlaxoSmithKline and Merck & Corp sell in India
• No manufacturing facility in India
• No Indian company selling HPV vaccines
• But some Indian companies have HPV vaccines in their
pipeline
• Cervarix and Gardasil have India import license of validity up
to December 2016 and June 2018 respectively.
51. HPV VACCINATION IN INDIA
Indian Academy of Pediatrics Committee
on Immunisation (IAPCOI) recommends
offering HPV vaccine to all females who
can afford the vaccine.
• Schedule same as given by ACIP
53. HPV VACCINE-RESEARCH
• Research carried out in India:
• Capsomere vaccines –
• more cheap
• manufactured in E.coli
• require no cold-chain.
• Monovalent vaccines (based on the L2 protein)-
• Broader protection
• Needle free delivery systems
55. OTHER WAYS TO PREVENT CERVICAL
CANCER
• Reduce high-risk sexual behaviours
• Condom use
• Avoid or reduce tobacco use and smoking
• Seek prompt treatment of sexually transmitted infections
56. THERAPEUTIC HPV VACCINE????
• Several types developed and tested in preclinical and
clinical trial
• Types :
• live vector
• protein or peptide
• nucleic acid
• cell-based vaccines
• Whole cell based type
• Tumour cell based type
• Majority target HPV onco-proteins E6 and E7
57. THERAPEUTIC HPV VACCINES
RECENTLY USED IN CLINICAL TRIALS
TYPE VACCINE ANTIGEN CONSTRUCT
Bacterial Vector
Based
Lm-LLo-E7
(ADXS11-001;
ADXS-HPV)
HPV-16 E7 prfA-
defective
Listeria
monocytogenes
strain
GLBL101c HPV16-E7
expressing
modified
version of HPV16-E7
Recombinant
Lactobacillus
casei
Viral Vector Based TA-HPV HPV-16/18 E6/E7 Recombinant
Vaccinia virus
TG4001 HPV-16
E6/E7
Recombinant
modified
Vaccinia Ankara-
expressing
HPV-16 E6, E7, and
IL-2
MVA E2 HPV-16 E2 Recombinant
Modified
Vaccinia Ankara
virus
58. THERAPEUTIC HPV VACCINES
RECENTLY USED IN CLINICAL TRIALS
TYPE VACCINE ANTIGEN CONSTRUCT
Peptide/Protein
Based
HPV16-SLP HPV-16 Combination of nine
HPV-16 E6 and four
HPV-16 E7
E6/E7 synthetic
peptides with incomplete
Freund’s adjuvant
GL-0810 HPV-16 antigen HPV-16 immunomodulatory
peptide with adjuvant
Montanide and GM-CSF
Pepcan + Candin HPV-16 E6 HPV16 E6 peptides
combined with Candida
skin testing reagent
candin
GTL001
(ProCervix)
HPV-16 and
HPV-18
Recombinant HPV16 and
HPV18 E7 proteins fused
to catalytically inactive
Bordetella pertussis CyaA
expressed in E. coli
59. THERAPEUTIC HPV VACCINES
RECENTLY USED IN CLINICAL TRIALS
TYPE VACCINE ANTIGEN CONSTRUCT
Peptide/Protein
Based
TA-CIN HPV-16 E6/E7/L2 HPV16 E6E7L2 fusion
protein
TA-CIN + TA HPV HPV-16/18 E6/
E7/L2
HPV16 E6E7L2 fusion protein and
vaccinia virus with HPV16/18 E6/E7
Nucleotide Based pNGVL4a-sig/
E7(detox)/
HSP70 + TAHPV
HPV-16/18 E6/E7 Plasmid encoding mutated form of
HPV16-E7 linked to sig and HSP70
and vaccinia virus with
HPV16/18 E6/E7
pNGVL4a-CRT/
E7(detox)
HPV-16 E7 Plasmid encoding mutated form of
HPV16-E7 linked to CRT
GX-188E HPV-16/18 E6/E7 Plasmid encoding fusion protein of
HPV 16/18 E6/E7 linked to Flt3L and
tpa
VGX-3100 HPV-16/18 E6/E7 Mixture of two plasmids
encoding optimized consensus of E6
and E7
antigen of HPV 16 and 18
60. THERAPEUTIC HPV VACCINES
RECENTLY USED IN CLINICAL TRIALS
TYPE VACCINE ANTIGEN CONSTRUCT
Whole Cell
Based
DC + KLH HPV-16 and
HPV-18 E7
Dendritic Cells pulsed
with HPV-16 and HPV-18
E7 and keyhole limpet
hemocyanin
DC HPV antigens DC pulsed with HPV+
tumor lysate
India has a population of 432.2 million women aged 15 years and older who are at risk of developing cancer.5 It is the second most common cancer in women aged 15–44 years
More than 184 are recognized
Three different types of tests are currently available:
— Conventional (Pap) and liquid based cytology (LBC)
— Visual inspection with Acetic Acid (VIA)
— HPV testing for high risk HPV types
, and he subsequently isolated and cloned different strains of HPV. His research concluded that patients infected with HPV types 16 and 18 were at an increased risk of developing cancer.
Purified L1 protein self-assembles to form empty shells or virus-like particles (VLPs)
that resemble a virus.
Purified L1 protein self-assembles to form empty shells or virus-like particles (VLPs)
that resemble a virus.
Systemic immunization with L1 VLPs generates antibody concentrations 1–4 logs higher than in a natural infection, possibly because of high antigen concentration and deliv- ery route that grants access to lymph nodes and spleen. There is still
Strategies such as concatenating multiple L2 proteins boost immunogenicity and show cross-protection against HPVs 16, 18, 45 and 58 pseudovirions.
Cross- protection from 6-month type-specific persistent infection from non-vaccine types was restricted to HPV 31 for Gardasil® and to HPVs 31,33,52,45 and 51 for Cervarix® in the corresponding naïve cohorts
Both vaccines show some degree of cross-protection for both HPV infection and lesions related to non-vaccine types
Because risk of HPV infection is high
within the first few years after onset of sexual activity, assessing risk factors for HPV
acquisition (e.g. number of sexual partners, condom use and smoking) before vaccination
accurately and confidentially would be challenging and labour intensive, and might
substantially reduce coverage.
Because risk of HPV infection is high
within the first few years after onset of sexual activity, assessing risk factors for HPV
acquisition (e.g. number of sexual partners, condom use and smoking) before vaccination
accurately and confidentially would be challenging and labour intensive, and might
substantially reduce coverage.
because HPV vaccines are non-infectious; the primary target group for HPV vaccines is girls before onset of sexual activity (i.e. before risk of sexual HIV exposure); potential benefits for HIV-infected females at increased risk of HPV-related disease are great; the burden of HPV-related disease is high; and potential benefits of vaccination outweigh potential risks.
(the vaccination series can be started beginning at age 9 years)
Advisory committee for immunization practices
(the vaccination series can be started beginning at age 9 years)
No evidence of impaired fertility or harm to the fetus
Advisory Committee on Immunization Practices (ACIP)
(the vaccination series can be started beginning at age 9 years)
no evidence of impaired fertility or harm to the fetus
Slight variation in the interval do not vary the GMT
Female can be infected with other HPV type not contained in the vaccine.
Female can be infected with other HPV type not contained in the vaccine.
, as for all males, and vaccination through age 26 years for those who have not been vaccinated previously or who have not completed the 3-dose series.
Female can be infected with other HPV type not contained in the vaccine.
, as for all males, and vaccination through age 26 years for those who have not been vaccinated previously or who have not completed the 3-dose series.
However, HPV vaccines have not been shown to cause any adverse pregnancy outcomes or adverse events for the mother or her developing fetus. If a woman is found to be pregnant after starting the HPV vaccine series, second and/or third doses should be delayed, and given after she is no longer pregnant.
Pregnancy testing is not needed before vaccination. If a pregnant woman does receive HPV vaccine, no intervention is needed.
The tip cap of prefilled syringes of HPV2 might contain latex.
Global alliance on vaccine and immunization
Compliance with cervical Pap smear screening is low in India
VIA & VILI – remains important tool
Indian Academy of Pediatrics Committee of
Immunization (IAPCOI) 2008 recommendations: “This vaccine has a
favorable tolerability profile and the IAP-COI recommends offering HPV
vaccine to all females as per label. The recommended age for initiation of
vaccination is 10-12 years and catch up vaccination is permitted up to the
age of 26 years. It is recommended to be given in three doses at 0, 2 and 6
months.”
(Category 2 of IAP categorisation of vaccines)
