Preventing the Preventable: Breaking Down Barriers to Vaccine Delivery in Africa
Preventing the preventable cancer
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Preventing the preventable cancer
Zero Cervical Cancer in
RAK / UAE by 2020
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Fact is ……. While it is possible for a
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Global Burden of Cervical Cancer
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Courtesy Dr Jalaa Taher, HAAD
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Cytology based screening for Cervical Cancer
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Limitations of cytology
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Reproducibility of Cervical cytology after reviewing 5000 slides
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Cytology Screen categoriesBethesda Scoring
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Management of women with LSIL
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Draw backs of cytology screening(Roche submission to US FDA March 2014)
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Harald zur Hausen 1984 isolated HPV 16 from Cx tissue
Awarded Nobel Prize 2008
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Relative sensitivities of cytology & HPV testing
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Co Testing
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Genotypes separately & simultaneously reported by Star Metropolis Clinical Lab
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Primary HR HPV Screening with reflux cytology
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Courtesy Dr Jalaa Taher, HAAD
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Courtesy Dr Jalaa Taher, HAAD
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Courtesy Dr Jalaa Taher, HAAD
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UAE study Age distribution
n = 314
2
33
84
63
48 46
21 18
0
10
20
30
40
50
60
70
80
90
< 20 21 - 25 26 - 30 31 - 35 36 - 40 41 - 45 46 - 50 > 51
number
number
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HPV Genotypes in UAEn = 126
8 LR genotypes 14 HR genotypes
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Genotype distribution in different age groups (n = 126)
Age group Genotypes
< 20 [39, 59]
21 - 25 [6, 6, 11,51] [16, 51,61,66] [53] [11,18,31,39,58][42]53, 66, 66, [66,59,52], [52,73], 31, [66,35,54,6]
26 - 30 [16] [42,43,51,66] [6] [16,39.52,61,68] [6,39,61,68,73][56,42,43], 33, [35,53], [52,70], 42, 16, 6, [51,39,42,6]
31 - 35 [52] [43,58,59,66] [11,16,42,43,53,61,61] [16,73,82] [6,52]66, 51, [58,16], [33,6], 44
36 - 40 [16,70] [6] 54, [59,31,42,11], [18,54], 18
41 - 45 [42,51,68] [42,53,59] [42,59] [16,16,18,52] [53,53,68,70]53,58,51
46 - 50 [16] [6, 42], 33
> 51 [16], 53, [33,82], 33, 53, [51,33,35,42,6]
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HPV genotypes in UAE
02468
10121416
geno
type
6 L
g 11
Lg
16 H
g 18
Hg
31 H
g 33
Hg
35 H
g 39
H
g 42
Lg
43 L
g 44
L
g 51
Hg
52 H
g 53
H
g 54
Lg
56 H
g 58
H
g 59
Hg
61 L
g
66 H
g 68
Hg
70 L
g
73 H
g 82
H
14 HR genotypes : 808 LR : 46
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HPV Genome
• E1-E7 = “Early” genes (nonstructural)
• L1, L2 = Capsid genes• URR = upstream regulatory
region
• E6 & E7 proteins play major role in immortality & malignant transformation of infected cells
• E5 has role, but not required to maintain cancer phenotype
Munoz et al. 2006.
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Why Cervical Cancer is preventable ?Natural History of HPV infection
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HPV-containing double stranded DNA
‘Empty’ non-infectious virus-like particle (VLP)
mimics the virus
Virus-like particles (VLPs) as HPV vaccine antigens mimic the virus structure
Stanley M, et al. Vaccine 2006; 24(suppl 3):S3/106–113.
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Vaccines
• Gardasil (2006) : – Contains HPV 16, 18, 6, 11
• Cerverix (2009): Contains HPV 16, 18– Females 10 through 25– For:
• Ca Cx• CIN• Adenocarcinoma in situ
– Gardasil for males too and for Ca Anus, warts etc
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Two Opportunities to prevent Cx Ca
Normal cervix
HPV infection
Cervical Intraepitheilial neoplasia
CIN
Cervical Cancer
HPV vaccine
HPV & Cx screen & t/t
10- 18 18 – 25 > 30
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Collection of Cx Swab
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Cervical Cancer is entirely preventable
1.Vaccination before exposure2.Screening after 30 yrs (every 5 yrs)
Though STI, it does not imply un-faithfullness
Cancer free RAK / UAE by 2020 Become a national achievable goal
Insurance be instructed to approveVaccination & Co-testing
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