HPV immunisation programme

 

Sir, – In recent times there has been considerable negative attention drawn upon the HPV (human papillomavirus) vaccine.

Common themes in negative comments include concerns regarding HPV vaccine safety and efficacy, distrust of pharmaceutical companies and government, and belief that school-age children are too young for HPV vaccination.

Since first being licensed at the beginning of 2006, more than 200 million doses of the vaccine have been distributed around the world. This vaccine has been repeatedly investigated and scrutinised globally with several common results. Pre- (pharma) and post-licensure (independent) studies have consistently reported a highly effective vaccine with an excellent safety profile.

Understanding the risk of HPV infection and subsequent disease is important given that genital HPV infection is commonly acquired shortly after sexual debut. HPV infection has been identified as a human carcinogen for six types of cancers, including cervix, penis, vulva, vagina, anus and oropharynx (tonsil and base of tongue).

Cervical cancer is the most preventable of all of the female cancers. Cervical cancer is also the second most common cause of death due to cancer in women aged 25 to 39 years in Ireland.

The risk of cervical cancer is directly related to amount and timing of exposure to HPV infection. This vaccine will save an estimated 70 per cent of these cervical cancer deaths and many of the remaining patients in the other cancer categories. In the United States, HPV-driven oropharyngeal cancers (tonsil and base of tongue) may exceed the cervical cancers by the year 2020. There is no pap test equivalent to screen for oropharyngeal cancers; thus primary prevention with vaccination should be emphasised.

Concerns about the vaccine fall into four main categories – chronic fatigue, complex regional pain syndrome and postural orthostatic tachycardia syndrome and autoimmune disease. Millions of girls have been investigated in pre- and post-licensure investigations and consistently report there is no evidence these syndromes are associated with HPV vaccination. The numbers of patients presenting with these disorders is similar in vaccinated and non-vaccinated populations. Correlation never has and never will prove causation.

The most common adverse events reported were considered mild. These findings are similar to the safety reviews of two other teenage vaccines, meningococcal vaccines and tetanus booster vaccines.

For serious adverse events reported, there has been no unusual pattern or clustering that would suggest that the events were caused by the HPV vaccine.

These are the findings in repeated international studies.

As the World Health Association has noted previously, policy decisions based on weak evidence, leading to lack of use of safe and effective vaccines, can result in real harm, with women and men being left vulnerable to HPV-driven cancers.

Continued vigilance is, of course, essential. Adverse events reported to the HSE need to be thoroughly investigated to maintain the public’s confidence in this vaccine. Patients and families deserve that at the very least.

The HSE has established an excellent vaccination programme for young girls. Gender-neutral vaccination (girls and boys) is now required immediately so that that the full benefits of the vaccination programme can be realised.

With demonstrated efficacy, cost-effectiveness, and safety, universal HPV vaccination of all adolescent girls and boys should be a national health priority.

Telling a patient they have cancer is terrible. Watching them fail treatment in the knowledge it could have been prevented cannot be allowed in modern Ireland. – Yours, etc,

Prof JAMES

PAUL O’NEILL,

Ear, Nose and Throat,

Head and Neck Surgery;

Prof FERGAL MALONE,

Obstetrics and Gynaecology,

Royal College of Surgeons

in Ireland Research Centre,

Beaumont Hospital,

Dublin 9.