Context: Central Government is set to roll-out human papillomavirus (HPV) vaccination program for girls in the age group of 9-14 years. The roll-out of HPV vaccination is expected to reduce the incidence of cervical cancer, which is the second most common cancer in women in India. India accounts for one-fifth of the global burden of cervical cancer, recording 1.25 lakh cases and 75,000 deaths each year.
HPV Vaccination Campaign:
- The government plans to launch an HPV vaccination drive for girls aged 9-14 years to reduce cervical cancer rates.
- This campaign will be carried out in three phases over three years.
- The immunisation will be carried out through schools and existing immunization points.
- The two-dose HPV vaccine, which will be free under the government's immunization program, protects against various cancers and genital warts caused by HPV.
- This safe and effective vaccine can help prevent six HPV cancers. Five of these occur in women: vulvar, anal, vaginal, throat, and cervical. And other is penile cancer.
- The campaign aims to immunize one-third of girls in the target age group each year, with an initial phase requiring 6.5-7 crore vaccine doses.
- Currently, the two-dose HPV vaccine is commercially available for about Rs 2,000 per dose. However, once included in the immunization program it will be made available for free.
- Production Capacity Increase for HPV Vaccine:
- The Serum Institute of India (SII) is increasing its production capacity for Cervavac, a quadrivalent vaccine that protects against four HPV strains.
- The current capacity of 2-3 million doses per year is expected to increase to 60-70 million doses
Cervavac is a quadrivalent vaccine developed to protect against certain types of human papillomavirus (HPV).
Quadrivalent Vaccine: "Quadrivalent" means that the vaccine targets four different types of HPV. Specifically, Cervavac is designed to protect against HPV types 16, 18, 6, and 11.
Targeted HPV Types: HPV Types 16 and 18 are high-risk types that are responsible for the majority of cervical cancers, as well as other types of cancers like anal and oropharyngeal cancers.HPV Types 6 and 11 are low-risk types that commonly cause genital warts but are not typically associated with cancer.
Use and Effectiveness: Cervavac is primarily used to prevent cervical cancer, genital warts, and other HPV-related diseases. The vaccine is most effective when administered before individuals become sexually active, as it protects against HPV types that they have not yet been exposed to.
Administration: The vaccine is typically administered in a two-dose schedule for young adolescents, with the doses spaced several months apart. For older recipients or those with certain health conditions, a three-dose schedule might be recommended.
Development and Availability: Cervavac is developed by the Serum Institute of India (SII), one of the world's largest vaccine manufacturers. It represents a significant advancement in the global effort to combat cervical cancer, particularly in low- and middle-income countries where the burden of HPV-related diseases is highest and access to vaccines can be limited.
Importance in Public Health: By providing protection against key HPV types, Cervavac plays a critical role in reducing the incidence of cervical cancer and other HPV-related conditions. It is an important tool in public health strategies aimed at reducing the global burden of these diseases.
- Single-Dose HPV Vaccine Trials:
- National Immunization Technical Advisory Group (NITAG) has advised Indian Council of Medical Research (ICMR) to trial single-dose HPV vaccine efficacy in ages 9-15.
- While there is no global recommendation for a single-dose schedule, the WHO suggests it can be followed for public health programs. The ICMR is considering an antibody persistence study post-one dose instead of a Phase-3 trial.
- Combination of Screening and Vaccination:
- Scientists and health experts emphasize the importance of combining efficient screening programs with HPV vaccination to effectively tackle cervical cancer.
About Cervical cancer
It is a type of cancer that occurs in the cells of the cervix, which is the lower part of the uterus that connects to the vagina.
Types of Cervical Cancer:
- Squamous cell carcinoma: This type begins in the thin, flat cells lining the outer part of the cervix and accounts for the majority of cervical cancers.
- Adenocarcinoma: This type starts in the glandular cells that line the cervical canal.
Causes of Cervical Cancer:
- Human Papillomavirus (HPV) Infection: The primary risk factor for cervical cancer is a persistent infection with certain types of HPV/wart virus, a sexually transmitted virus.
- Other factors can increase the risk, such as smoking, having a weakened immune system, long-term use of oral contraceptives, and having multiple sexual partners.
Who is Impacted Most: Cervical cancer most frequently affects women over 30 years of age. It's less common in developed countries due to widespread screening with Pap tests which can detect precancerous changes in the cervix.
Symptoms of Cervical Cancer:
- Early stages often have no symptoms.
- Advanced stages may include irregular bleeding and discharge, pelvic pain, and bleeding after menopause.
Treatment for Cervical Cancer:
- Surgery: To remove early-stage cancers or precancerous cells.
- Radiation Therapy: Often used along with chemotherapy for more advanced stages.
- Chemotherapy: Used to treat advanced cervical cancer, often in combination with radiation.
Current Status of Cervical Cancer in India
- Incidence and Mortality: Cervical cancer is the second leading cause of cancer deaths among women in India, after breast cancer with age-specific incidence and mortality rates of 22 and 12.4 per 100,000 women per year, respectively.
- Globally: As of now, it is fourth most common cancer among women worldwide, cervical cancer claims the lives of more than 3,00,000 women every year, or one life every two minutes.
- 9 out of 10 women dying of cervical cancer live in lower- and middle-income countries.
- India: India accounts for 25% of all global deaths due to cervical cancer.
- Survival Rates: The overall 5-year relative survival rate for cervical cancer in India is 46%. This rate varies significantly with the stage of cancer at diagnosis, dropping to 7.4% for advanced stage disease compared to 73.2% for localized cancer.
Challenges
- Limited access to screening and treatment.
- Lack of health care infrastructure.
- Social and cultural barriers impact awareness and early detection.
- Healthcare Disparities: Geographic disparities exist in healthcare access and quality. E.g. rural urban divide Current Global Statistics of Cervical Cancer
- Incidence and Mortality: Cervical cancer is the fourth most common cancer in women globally, with 604,000 new cases and 342,000 deaths in 2020.
- Geographical Variation: The highest rates of cervical cancer incidence and mortality are found in low- and middle-income countries, particularly in sub-Saharan Africa, Central America, and South-East Asia.
- Risk Factors: Persistent infection with the human papillomavirus (HPV) is the primary cause of cervical cancer. Women living with HIV are six times more likely to develop cervical cancer compared to those without HIV.
Strategies and Initiatives by WHO to tackle Cervical Cancer
- The World Health Organization (WHO) has set goals, establishing targets of 90-70-90, to accelerate the elimination of cervical cancer with a set of three targets to be met by 2030:
- HPV Vaccination:
- Vaccination against HPV, particularly targeting 90% girls aged 9–14 years before they become sexually active, is a key preventive measure. As of 2023, six HPV vaccines are available globally, protecting against high-risk HPV types 16 and 18, which cause most cervical cancers.
- Cervical Screening and Treatment of Precancers:
- Regular cervical cancer screening is recommended for 70% of women, every 5–10 years starting at age 30, and every 3 years for women living with HIV starting at age 25. The use of high-performance HPV tests for screening is encouraged.
- Self-collection of samples for HPV testing is an option that has been shown to be as reliable as samples collected by healthcare providers.
- Awareness and Access to Information and Services:
- 90% of women detected with cervical pre-cancer and cancer lesions must receive treatment and care.
- Boosting public awareness and access to information and services are crucial for prevention and control of cervical cancer.
- Other prevention steps include being a non-smoker, using contraceptives.
Human Papillomavirus (HPV) It is a group of more than 200 related viruses, of which more than 40 are spread through direct sexual contact. Among these, several are known to cause cervical cancer.
Types of HPV:
Low-risk HPVs: These types generally do not cause cancer but can cause skin warts on or around the genitals, anus, mouth, or throat.
High-risk HPVs: These types can lead to cancer. Two high-risk HPVs, types 16 and 18, are responsible for the majority of cervical cancers.
Transmission: HPV is primarily transmitted through intimate skin-to-skin contact, most often through sexual transmission. It's possible to contract HPV even when an infected person has no signs or symptoms.
Symptoms: Most people with HPV do not know they are infected and never develop symptoms or health problems from it. In some individuals, the virus can cause genital warts, which may appear weeks or months after sexual contact with an infected partner.
Health Risks: In women, high-risk HPV types can cause cervical cancer. These viruses can also lead to other genital cancers and throat cancer.
- Prevention:HPV Vaccination: The best way to prevent HPV is through vaccination, which is recommended for preteens (both boys and girls) and for unvaccinated adults up to age 26.
- Safe Sex Practices: Using contraceptive and limiting the number of sexual partners can reduce the risk of HPV.
Screening: Regular cervical cancer screening (Pap smear and HPV test) is recommended for women to detect precancerous changes in the cervix caused by HPV.