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Khalid sait saudi belgium seminal march 18 2014
This document summarizes information from a presentation on cervical cancer prevention in Saudi Arabia. It notes that cervical cancer incidence is low in Saudi Arabia but increasing cases are expected as seen elsewhere. The presentation discusses HPV as the primary cause, the availability of HPV vaccines, and the need for a national screening program in Saudi Arabia using HPV testing to help prevent additional cervical cancer cases and deaths. It provides details on an existing cervical cancer screening program in Jeddah as an example for a potential future national program.
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Khalid sait saudi belgium seminal march 18 2014
- 1. Saudi – BelgianCollaboration in Health: Improving Quality of Care: Methodology and Prevention Tuesday, March 18, 2014 Cervical Cancer Prevention in Saudi Arabia Prof. Khalid Sait Chairman of Scientific Chair of Prof. Abdullah Hussain Basalamah for Gynecological Cancer
- 2. 2 FerlayJ, et al.GLOBOCAN2008, Cancer Incidence and Mortality Worldwide. IARC CancerBaseNo.10. Lyon, France. 2010 Every 2 minutes a woman dies of cervical cancer.1 Every minute a woman is diagnosed with cervical cancer.1 New cases per year: ~ 530,000 Deaths per year: ~ 275,000 NA + Europe Africa Asia Latina 29,000 53,000 31,000 159,000 77,000 80,000 68,000 312,000 80% in developing countries = 2nd cause of cancer death in women
- 3. Incidence ofcervical cancer is low in Saudi Arabia (2:100,000) Every year, 152 women are diagnosed with cervical cancer and 55 die from the disease. SCR Report 2009
- 4. The Nobel Prizein Physiology or Medicine 2008 Harald Zur Hausen for his discovery of human Papilloma viruses causing cervical cancer
- 6. HPV18- Related 45, 39,59, 51, 56 HPV16- Related 31, 33, 35, 52, 58
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- 8. Author No ofpatients HPV prevalence Gazzaz 2007 100 5 (5%) Bondoggi 2013 485 27 (5.6 %) 1-Ann Saudi Med. 2007 Jan-Feb;27(1):1-5. 2- Saudi Med J. 2007 Dec;28(12) 3-Ann Saudi Med. 2013 Jan-Feb;33
- 9.
- 11. HPV Cervical canal Neutralizing antibodies Bloodvessel Epithelial tear Basement membrane Cervical epithelium Stanley M. Vaccine 2006; 24:S16–S22; Giannini S, et al. Vaccine 2006; 24:5937–5949; Nardelli-Haefliger D, et al. J Natl Cancer Inst 2003; 95:1128–1137; Poncelet S, et al. IPvC 2007; Abstract.
- 12. Cervarix is aregistered trade mark of the GlaxoSmithKline group of companies. Cervarix ® Antigen Specificity of the immune response Adjuvant Substances that potentiate the immune response to antigen Through MPL, AS04 Adjuvant System utilizes natural ‘danger’ signals AS04 Adjuvant System Aluminium salt + MPL (Al(OH)3) Giannini SL, et al. Vaccine 2006; 24:5937–5949. 20 µg L1 HPV 16 20 µg L1 HPV 18 + Manufactured in insect vector
- 13. Gardasil ® Merck Gardasil® Adjuvant Substances that potentiate the immune response to antigen (Al(OH)3) Manufactured in recombinant Saccharomyces Cerevisiae (yeast) 40 µg L1 HPV 16 + 20 µg L1 HPV 6 40 µg L1 HPV 11 20 µg L1 HPV 18 Antigen Specificity of the immune response
- 14. Sustained highAntibodies for up to 9.7 years.
- 15. Reducing the leep procedure from CIN2+. Longterm is reduction in cancer cervix incidence.
- 16. Harper D; ExpertReview Vaccines 2009
- 17. Gardasil(Merck) Quadrivalent Cervarix (GSK) Bivalent HPV 45 (relatedto 18) V/P 3/2 V/P 1/17 Reduction 94% HPV 31 (related to 16) V/P 5/21 Reduction 76% V/P 14/30 Reduction 54%
- 18. No head-head efficacystudies were carried out – those comparisons are only informative Gardasil® Combined protocols Future I, FutureII R-MITT-2 cohort (EOS* data)1 Lesion Gardasil® Control %Efficacy (95% CI)N n N n CIN2+, irrespective of causal HPV type 4616 77 4680 136 42.7 (23.7;57.3) CIN3+, irrespective of causal HPV type 4616 36 4680 64 43.0 (13.0;63.2)* Cervarix® Protocol 008 TVC-naïve cohort (48 months of FU)2 Cervarix® Control %Efficacy (95% CI)N n N n 5466 61 5452 172 64.9 (52.7;74.2) 5466 3 5452 44 93.2 (78.9;98.7) * for Gardasil® the endpoint was CIN3 N = number of evaluable women in each group; n = number of evaluable women reporting at least one event in each group; - : not available; Bold = statistically significant. * The median duration of follow-up for the combined protocols (005, 007, 013, and 015) was 3.6 years after receipt of dose 1 and maximum of 4.9 years. 1. Munoz et al. J Natl Cancer Inst 2010; 102:1–15; 2. HPV-008 Month 48 analysis.
- 19. The vaccinesdo not contain any living virus. More than 79 million doses of the quadrivalent vaccine have been distributed globally, with no serious adverse events found to be associated with the vaccine and with no greater risk of adverse events than with placebo. Approximately 7 million doses of the bivalent vaccine have been distributed worldwide. GARDASIL Product Monograph. Merck Canada Inc. August 2011. CERVARIX Product Monograph. GlaxoSmithKline Inc. August 2011. Data on file, Merck Canada Inc.
- 21. Phase I/IIstudy 2-dose schedules of the Cervarix and Gardasil were immunogenic and generally well-tolerated in girls aged 9–25 A 2-dose schedule may be more convenient for physicians and vaccinees, could facilitate implementation of HPV vaccination and may help optimise compliance in school- based immunisation programmes
- 22. Joura et al.Eurogin Nov 2013 Nonavalent vaccine (Merck) (HPV6/11/16/18/31/33/45/52/58) Followed for 4.5 years Similar immunological responses
- 23.
- 24. After given theman education material about HPV and vaccination , 381/500 (76.2%) were happy with the introduction of HPV vaccine to our community Sait , Saudi Med J. 2009
- 25. A totalof 85/200 (42.2%) will take the vaccine them selves A total of 100/200 (50%) physicians will recommend the vaccine to their patients. 94 /200 (47%) will recommend HPV vaccine to there daughter Sait , Saudi Med J. 2011
- 27. Education and Awareness IfHPV vaccine will be implemented in Saudi Arabia , it should be as part of the MOH routine vaccination program for all risk group Currently HPV vaccine in KSA is been given mostly for educated people and those whom can afforded it. (may be low risk group).
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- 29.
- 30. Very sensitive Hybrid Capture (HC2)
- 31. No nationalScreening If no action taken: The estimated number of new cervical cancer cases and deaths in 2025 triple (309 and 117, respectively) http://www.nationmaster.com/country/ sa-saudi-arabia/Age- _distribution
- 33. Proposal HPVtesting HC2 (high risk) Data base with recalling system Quality assurance and frequent monitoring
- 34. Dr. Nisrin Anfinan EarlyDetective Unit and JCSP Coordinator Rowaida Al Mehy GOU Secretary Maribi Marqueses GOU Office Assistant Dr. Faten Gazzaz Director of Virology Laboratory Eman Tayba JCSP Laboratory Team Aseel Alsobehi JCSP Laboratory Team Soheel Melebari JCSP Laboratory Team Prof. Jim Bentley International Advisor Prof. Khalid Sait Director of Scientific Chair of Professor Abdullah Hussain Basalamah Prof. Abdullah Hussain Basalamah General Advisor Amal Al Montasheri Nurse JCSP Reem Qubaidi Health Educator
- 35. Age 30-65year. Married for three years. Saudi & non Saudi.
- 36. Jeddah CervicalScreening program JCSP www.jcsp.sa.com
- 39. HR-HPV DNA inwomen 30 + years old Negative Pap test Negative Positive Positive Colposcopy Positive Repeat HR-DNA testing @ 5 year intervals till age 65 Repeat HR- HPV testing at 12 months Negative
- 40. Campaign (Malls) School (approval fromministry of education) Media and news papers
- 43.
- 44. Collecting sample atPHC Collecting sample in our hospital
- 45. START DATE:January 2012 Total Number: 4000 Our aim to achieve : 10,000 in four years
- 46. 0 50 100 150 200 250 300 350 400 Jan Feb MarApr May Jun Jul Aug Sep Oct Nov Dec 138 210 260 344 294 144 38 78 254 292 390 364 New Registration for Year 2012-2013
- 47. 0 50 100 150 200 250 300 Jan Feb MarApr May Jun Jul Aug Sep Oct Nov Dec 102 138 134 264 224 112 18 30 108 216 254 254 36 72 126 80 62 32 20 48 146 76 136 148 New Registration forYear 2012-2013 Saudi vs. Non-Saudi Saudi Non-Saudi
- 48. 0 100 200 300 400 500 600 30-34 35-39 40-4445-49 50-54 55-59 60-64 ≥65 302 416 522 576 512 322 122 34 Per Age GroupYear 2012-2013
- 49.
- 50. Guideline meetingfor cervical cancer screening المركزالسعوديللرعايهالصحيهالمبنيهعلىالبراهين. Agreed among panel members that HPV testing will be used as primary screening for cervical cancer in Saudi Arabia.
- 51. Official opening ofthe JCSP program January 2014
- 53. Affects young women andtheir families Al though not common in KSA, incidence will rise as it has done in other areas Screening Program