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Human Papilloma Virus (HPV)

The HPV "cervical cancer" vaccine

Informed choice and Immunisation programmes - Womens Health Action Update Article - Feb 2009

The school-based phase of the HPV (human papillomavirus) immunisation programme which will provide Gardasil vaccine for girls from 12 years old is about to start.  Given the debate on the failure of informed consent processes with the MeNZB immunisation programme, and a troubling start to the national HPV immunization programme launched in September last year, it is timely to raise concerns about the fate of informed choice and consent in the school-based phase of the programme.  Christy Parker looks at some of the ethical issues surrounding mass immunization programmes targeting children and young people and argues that the principles of informed choice and consent must not be compromised by population health objectives.

Click here to read the full article including references

Gardasil Side Effects - Feb 2009

Concerns about the safety of Gardasil (the HPV "cervical cancer" vaccine) are growing following recent reports from both Australia and the United States of serious adverse effects in young women.  The United States based vaccine watchdog, the National Vaccine Information Center has just realeased an analysis of the reported Gardasil side effects in the United States, comparing these side effects with those of another commom childhood vaccine for meningococcal.  For more information see the National Vaccine Information Center website: http://www.nvic.org/Vaccines-and-Diseases/hpv.aspx or click here.

NZ Herald commentary: 'When a shot in the arm's no silver bullet', March 2009

To read Tapu Misa's opinon piece on Gardasil click here.

Cartwright anniversary seminar: 'Gardasil - Cartwright's Daughter?'

5th August 2008

Twenty years ago New Zealand reeled at revelations over the treatment of women with cervical abnormalities at National Women's Hospital. Today we know a lot more about the disease and its treatment. We also have a 'miracle' vaccine and a national programme to deliver it to our young women.  What were the issues raised by Cartwright and how much have we learned about patient rights and informed consent in the last 20 years? 

Lynda Williams, the first patient advocate at National Women's Hospital will give us a provocative and entertaining tour of the issues.

Read the paper from the August 2008 event

The potential impact of mass HPV vaccination on cervical cancer prevention: population and clinical perspectives, July 2007

Dr Hazel Lewis, Clinical Leader of the National Cervical Screening Programme considers how the HPV immunisation programme may impact upon the life saving success of the National Cervical Screening Programme.  Click here for her paper.

 

Update on Gardasil

November 2007 Women's Health Update

Gardasil has been approved for use in but in May this year former Minister of Health Pete Hodgson announced that Gardasil would not get government funding for inclusion in the childhood vaccination schedule, but the decision would be reviewed in a year or two. Prime Minister Helen Clark, at the Labour Party conference in at the beginning of November, said she was seeking urgent advice on the vaccine after the British government decided to go ahead with it in October. Lynda Williams looks at what is happening with the vaccine. Read More (pdf)

Cervical Cancer vaccine doesn't rule out the need for screening

May 2007 Women's Health Update

Gardasil, the new Cervical cancer vaccineThe new cervical cancer vaccine has taken the world by storm. Jesse Solomon looks at cervical cancer in New Zealand and the implications of the vaccine for New Zealand women. Cervical Screening has had a dramatic impact on the incidence of cervical cancer and cervical cancer mortality in developed countries including New Zealand. The New Zealand screening programme started in 1991 and now achieves around 75% coverage of eligible women. However, this is significantly lower amongst some groups including Maori women at 55%...

Cervical Screening is availible to all women in New Zealand and women can be screened by their GP, Family Planning or sexual health clinic. Cervical Cancer Screening is the single most effective intervention against cervical cancer...

A vaccine for some types of HPV has been approved for use in New Zealand...Concerns have been raised about some safety aspects of the vaccine, including the aluminium content and its long term neurological effects. The FDA in the United States have required Merck (the makers of Guardasil) to undertake further trials for safty amongst younger girls as the studies so far have not included many girls.... Read More

Cervical cancer vaccine on the horizon

May 2006 Women's Health Update

An HPV vaccine is on the horizon, potentially reducing the risk of cervical cancer. Two vaccines are battling to get to market; both GSK and Merck (marketed by CSL in New Zealand) have HPV vaccines ready for approval from drug regulators throughout the world. An HPV vaccine would be a welcome advance. However WHA remains cautious as clinical trials have been short and we have yet to see the long term impacts of the new vaccines....Read More

Will vaccination end cervical screening?

January 2003 Women's Health Update

Sandra Coney reports on recent advances in the development of a vaccine against cervical cancer and the New Zealand connection in ongoing research... Read More

The cervical cancer vaccine study results

January 2003 Women's Health Update

The double-blind study randomly assigned 2,392 women between 16 and 23 years old to receive three doses of placebo or an HPV-16 virus-like particle vaccine, and followed them for approximately 17 months. The primary end-point was persistent HPV-16 infection, defined as the detection of HPV-16 in samples at two or more visits. In the vaccine group, 99.7% developed anti-bodies to the virus. In the placebo group, the incidence of persistent HPV-16 infection was 3.8 per 100 woman-years compared to 0 in the vaccine group. All nine cases of HPV-16-related CIN occurred among placebo recipients.
Reference: NEJM 2002; 347:1645-51

Debate over HPV testing

June 2001 Women's Health Watch

 

The British Medical Journal is calling for further investigations into conflicting reports about the value of testing for human papillomarvis DNA to manage women with borderline cervical smear tests.

An editorial in the BMJ says two large United States studies support testing for human papillomavirus DNA but another British study has urged caution. Testing for human papillomavirus is carried out because a proportion of patients with mildly abnormal smears will harbour high grade disease and colposcopy does not reliably identify this high grade disease. The British study investigated whether testing for human papillomavirus would help identify these women.

The editorial suggests methodological differences may account for some inconsistencies between study results. The two large American studies involved women with abnormal cells of undetermined significance. However the British study included a larger number of women with higher grade abnormalities.

The British Medical Journal suggests reinvestigating the specimens collected in the British study and restricting analysis to women with abnormal squamous cells of undetermined significance.

In the British study. 333 new patients referred for colposcopy with persistent borderline or mildly abnormal smears were tested for human papillomavirus. The authors report subjects under 30 years were more likely to test positive for HPV and to have high grade disease. However the authors warn high grade disease could be missed in a small number of those testing negative and not referred. This risk is higher in younger women, if they face less intensive surveillance.
Ref: BMJ 2001; 322:878-879

Testing for human papillomavirus recommended

June 2000 Women's Health Watch

Testing for human papillomavirus is a cost-effective way of detecting cervical cancer in some women, according to the US National Cancer Institute. The Institute recommends testing women over the age of 30 years when smear tests reveal abnormal cells of unknown significance (atypical squamous cells of unknown significance or ASCUS.)

Certain strains of the human papillomavirus virus have been linked to the development of cervical cancer and women with these strains of HPV may run a high risk of developing cervical cancer.

Researchers at the US National Cancer Institute have studied 5000 women with ASCUS and found testing for human papillomavirus alone detected 96 percent of high-grade lesions. Cytology picked up only 45 percent of the lesions. Cytology was particularly poor at detecting small high-grade lesions, and HPV-positive high-grade lesions commonly did not have the typical appearance expected on colposcopy.

Ref: Lancet 2000; 355:1245-52

HPV resources popular

January 2000 Women's Health Update

A new set of resources on human papillomavirus (HPV) is proving popular with consumers and health professionals alike. Produced by the New Zealand HPV Project, the resorce includes a consumer guide 'HPV in Perspective', 'Some Questions and Answers about HPV and Genital Warts' and guidelines for health professionals in the management of genital warts and genital HPV.

Claire Hurst, project coordinator, says that in a short time 5000 resources have been distributed: 'The response has confirmed what we thought. A gap was seen by health professionals and patients.'

Already a reprint has been ordered.

The resources were developed by a professional advisory board, chaired by Aucland gynaecologist Ron Jones. 'The board represented any health professionals who ever see HPV,' says Hurst, 'It was important to get buy-in at a college level.'

Nurses and consumers had input and the resources were pretested on consumers.

Copies of the resources are available from New Zealand HPV Project, PO Box 2437, Auckland, New Zealand, email: info@hpv.org.nz, tollfree helpline 0508 181818, ph +64 9 360 1966, website www.hpv.org.nz

Cervical cancer- from 'Feeling Fabulous at 40, 50 and Beyond' 1996 Read Here

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