Public Health and Communicable Diseases - SA Health - SA.Gov.au
Public Health and Communicable Diseases - SA Health - SA.Gov.au Public Health and Communicable Diseases - SA Health - SA.Gov.au
cancer among aboriginal women. This represents morethan nine times the death rate of non-aboriginal women(3.0 per 100, 000 women). 11In some countries the incidence of cervical cancerappears to be increasing due to recent changes in risktaking behaviour in young women. 13 There was a 60%increase in incidence of cervical cancer in Finland inthe 1990s in young women. Over the same period oftime the number of lifetime sex partners significantlyincreased and the age at first intercourse decreased. 13Thus increasing exposure to HPV and other sexuallytransmitted infections is likely to explain the recentincrease in the incidence of cervical cancer observed inFinland in young women.Population studies in the 1980s and 1990s in variouscountries detected an association between humanpapilloma viruses (HPV) and cervical cancer. 14 Cervicalinfection with HPV is extremely common compared tothe incidence of cervical cancer. 15 However, particulartypes of HPV have a strong association with persistent14, 16-18infection and a high incidence of cervical cancer.Human Papilloma Virus as a cause of Cervical CancerThe association of cervical cancer and infectionwith a high-risk HPV type is supported by strongepidemiological evidence and by the detection ofHPV DNA in up to 99.7% of cervical cancers from allgeographic areas. 19 There are over 40 types of HPV,with 14 of these considered to be oncogenic. HPV16 isthe most prevalent high-risk HPV type and is presentin approximately 50% of cervical tumor specimensworldwide. HPV18 is the second most prevalent typeand is associated with approximately 16% of cervicalcancers, with the remaining tumors containing DNAfrom other high-risk types such as HPV45, 31 and 33. 20The persistence of HPV in the genital tract is a riskfactor for development of cervical cancer. 16-18Approximately 470,000 new cases of cervical cancerare diagnosed each year, and nearly 200,000 deathsare attributable to the disease. 21-23 Consequently, thesocial and economic costs of HPV-induced diseasesof the genital tract are enormous, and development ofprophylactic vaccines has been an important initiative.Human Papilloma Virus VaccineVaccines against the high-risk types HPV-16 and HPV-18 have been shown to be safe and immunogenicin previous trials, and have prevented incident andpersistent HPV-16/18 infection. The HPV vaccine isan inactivated virus vaccine which is not capableof replication or transfer of the virus to others. Twovaccines have been developed that are likely to beavailable in the next 12 months. Merck and Co. havedeveloped a quadrivalent vaccine, Gardasil whichcontains HPV 16, 18 (oncogenic types) and HPV 6and 11, benign types that are associated with genitalwarts. A bivalent vaccine, Cerverix has been developedby GSK which contains the leading oncogenic types,16 and 18. In Phase II and III studies, HPV vaccineshave been shown to be safe and 100% effective inpreventing persistent HPV infection. Recent publishedresults from a long term follow-up study of Cerverix,indicates long term (up to 4.5 years) protection againstpersistent infection and cervical intraepithelial neoplasia(CIN) changes with evidence of cross protection againstother oncogenic serotypes not included in the vaccine,including serotype 45. 24Pre-teen and young adolescent women will be animportant target population for vaccination, since itwill be important to protect prior to onset of sexualactivity and exposure to oncogenic HPVs. For HPVvaccine program to be effective, high coverage ratesespecially in high risk groups will need to be achieved.Linkages with other health care systems, improvedadult health services and education about the benefitsand availability of the HPV vaccine will be vital to theachievement of high levels of coverage. Implementationissues including provision of Government funding,decisions on whether both males and females willreceive the vaccine and the target age group are yet tobe determined.The future challenge for these new vaccines will beto develop innovative funding strategies to ensureadequate vaccine delivery to populations with thehighest burden of disease.References1. Global Alliance For Vaccines and Immunisation (GAVI).Fact sheet no. 169, March 2001.2. Parashar U, Hummelman E, Bresee J, Miller M et al.Global illness and deaths caused by rotavirus diseasein children. Emerg infect Dis. 2003;9:565-72.3. Bresee J, Glass R, Ivanoff B, Gentsch JR. Currentstatus and future priorities for rotavirus vaccinedevelopment, evaluation and implementation indeveloping countries. Vaccine. 1999;17(18):2207-22.4. Galati J, Harsley S, Richmond P, Carlin J. Healtheconomics and hospitalization data for RV infection.(Accepted to Aust N Z J Public Health subsequent tomanuscript amendment).5. Bonhoeffer J, Heath P. Update on new vaccinesand immunisation strategies. Current Paediatrics.2006;16:1-7.6. Simonsen L, Viboud C, Elixhauser A, Taylor R. More onRotaShield and intussusception: the role of age at thetime of vaccination. J Infect Dis. 2005;192(Suppl. 1):S36-43.7. Vesikari T, Matson D, Dennehy P, Van Damme P. Safetyand Efficacy of a Pentavalent Human – Bovine (WC3)Reassortant Rotavirus Vaccine. N Engl J Med.2006;354:23-33.8. Ruiz-Palacios G, Pérez-Schael I, Raúl Velázquez F,Abate H et al. Safety and Efficacy of an AttenuatedVaccine against Severe Rotavirus Gastroenteritis. NEngl J Med. 2006;354:11-22.9. Ponten J, Adami H,Bergstrom R,Dillner J, FribergL, Gustafsson l, Miller A, parkin D, Sparen P,Trichopoulos D. Strategies for global control ofcervical cancer. Int J Cancer. 1995;60:1-26.24
10. The Cancer Council of Australia. National CancerPrevention Policy 2001-2003; 2001. Available fromhttp://www.cancer.org.au/documents/National/CancerPreventionPolicy.pdf11. Australian Institute of Health and Welfare andAustralasian Association of Cancer Registries 2000.Cancer in Australia 1997: Incidence and MortalityData for 1997 and selected data for 1998 and 1999.Canberra: AIHW & AACR. Available from: http://www.aihw.gov.au/publications/can/ca97.12. The Australian Institute of Health and Welfare andAustralian Government Department of Health andAgeing for the National Cervical Screening Program2005. Cervical screening in Australia 2002-2003.Available from: http://www.aihw.gov.au/publications/can/csa02-03/csa02-03.pdf.13. Paavonen J, Halttunen M, Hansson B, NieminenP, Rostila T, Lehtinen M. Prerequisites for humanpapillomavirus vaccine trial: results of feasibilitystudies. Journal of Clinical Virology. 2000;19:25-30.14. Nobbenhuis M, Walboomers J, Helmerhorst T et al.Relation of human papillomavirus status to cervicallesions and consequences of cervical-screening: aprospective study. Lancet. 1999;354:20-5.15. Schiffman M, Brinton L, Devesa S, Fraumeni J.Cervical Cancer. In: Schottenfeld D, Fraumeni J.Cancer epidemiology and prevention. Second edition.New York.: Oxford University press; 1996.16. Bosch F. Epidemiology of human papillomavirusinfections: New options for cervical cancer prevention.Salud Pulica de Mexico. 2003;45(3):s326-339.17. Galloway D. Papillomavirus vaccines in clinical trials.The Lancet Infectious Diseases. 2003;3:469-475.18. Tyring S. Human papillomavirus infections:Epidemiology, pathogenesis and host immuneresponse. J Am Acad Dermatol. 2000;43:S18-26.19. Walboomers JM, Jacobs MV, Manos MM etal. Human papillomavirus is a necessary causeof invasive cervical cancer worldwide. J Pathol.1999;189:12-19.20. Clifford GM, Smith JS, Plummer M, Munoz N,Franceschi S. Human papillomavirus types in invasivecervical cancer worldwide: a meta-analysis. Br JCancer. 2003;88:63‐73.21. Parkin DM, Pisani P, Ferlay J. Estimates of theworldwide incidence from 25 major cancers in 1990.Int J Cancer. 1999;80:827-41.22. Parkin DM, Bray FI, Devesa SS. Cancer burdenin the year 2000. The global picture. Eur J Cancer.2001;37:S4-S66.23. Pisani P, Parkin DM, Bray F, Ferlay J. Estimates of theworldwide mortality from 25 major cancers in 1999.Int J Cancer. 1999; 83:18-29.24. Harper D, Franco E, Wheeler C, Moscicki A.Sustained efficacy up to 4.5 years of a bivalentL1 virus-like particle vaccine against humanpapillomavirus types 16 and 18: follow-up from arandomized control trial. The Lancet. 2006;10.1016/SO140 6736(06)68439-0.25VACCINE SAFETYand COMMUNITYATTITUDES IN SASarah DugdaleProject Officer, SA Vaccine Safety (SAVeS) Data LinkageProjectDepartment of HealthBackgroundSusan LewisNurse Consultant, South Australia ImmunisationCoordination Unit (SAICU)Department of HealthMike GoldSenior Lecturer, Department of PaediatricsUniversity of AdelaideHelen MarshallSenior Medical Officer, Paediatric Trials UnitUniversity of AdelaideDespite the immense public health benefit ofvaccination, 1,2,3 concern about the safety of vaccines isnow the most important issue to affect immunisationcoverage and the sustainability of immunisationprograms in developed countries. 4,5 Loss of confidencein vaccine safety can result in decreased vaccinecoverage and a resurgence of disease. 1,6,7 This hasbeen clearly demonstrated on a number of occasions,including the reappearance of whooping cough in Japanand Sweden in the 1970s, and measles in the UnitedKingdom in 1998. 6,7,8,9The three-in-one vaccine against diphtheria, tetanus andwhooping cough (DTP) was targeted by anti-vaccinecampaigners in a range of countries after a 1974 journalpublication stated it was linked to neurological reactions.In just two years DTP vaccine coverage in Japandropped from around 80% to 10%, and in Sweden from90% to 12% over 5 years. In some other countries thepersistent media reports even resulted in the vaccinebeing withdrawn from use. By the late 1970s whoopingcough epidemics affecting hundreds of thousands ofchildren were occurring in countries across the world,with 5000 cases in Australia by 1994. 6The UK measles outbreak in the late 1990s resultedfrom the controversial publication of an article byAndrew Wakefield in the Lancet, which purported anassociation between the Measles Mumps Rubella(MMR) vaccine and both autism and bowel disease.Although the article was later retracted, its effect onuptake of the vaccine was considerable; within 3 years
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10. The Cancer Council of Australia. National CancerPrevention Policy 2001-2003; 2001. Available fromhttp://www.cancer.org.<strong>au</strong>/documents/National/CancerPreventionPolicy.pdf11. Australian Institute of <strong>Health</strong> <strong>and</strong> Welfare <strong>and</strong>Australasian Association of Cancer Registries 2000.Cancer in Australia 1997: Incidence <strong>and</strong> MortalityData for 1997 <strong>and</strong> selected data for 1998 <strong>and</strong> 1999.Canberra: AIHW & AACR. Available from: http://www.aihw.gov.<strong>au</strong>/publications/can/ca97.12. The Australian Institute of <strong>Health</strong> <strong>and</strong> Welfare <strong>and</strong>Australian <strong>Gov</strong>ernment Department of <strong>Health</strong> <strong>and</strong>Ageing for the National Cervical Screening Program2005. Cervical screening in Australia 2002-2003.Available from: http://www.aihw.gov.<strong>au</strong>/publications/can/csa02-03/csa02-03.pdf.13. Paavonen J, Halttunen M, Hansson B, NieminenP, Rostila T, Lehtinen M. Prerequisites for humanpapillomavirus vaccine trial: results of feasibilitystudies. Journal of Clinical Virology. 2000;19:25-30.14. Nobbenhuis M, Walboomers J, Helmerhorst T et al.Relation of human papillomavirus status to cervicallesions <strong>and</strong> consequences of cervical-screening: aprospective study. Lancet. 1999;354:20-5.15. Schiffman M, Brinton L, Devesa S, Fr<strong>au</strong>meni J.Cervical Cancer. In: Schottenfeld D, Fr<strong>au</strong>meni J.Cancer epidemiology <strong>and</strong> prevention. Second edition.New York.: Oxford University press; 1996.16. Bosch F. Epidemiology of human papillomavirusinfections: New options for cervical cancer prevention.Salud Pulica de Mexico. 2003;45(3):s326-339.17. Galloway D. Papillomavirus vaccines in clinical trials.The Lancet Infectious <strong>Diseases</strong>. 2003;3:469-475.18. Tyring S. Human papillomavirus infections:Epidemiology, pathogenesis <strong>and</strong> host immuneresponse. J Am Acad Dermatol. 2000;43:S18-26.19. Walboomers JM, Jacobs MV, Manos MM etal. Human papillomavirus is a necessary c<strong>au</strong>seof invasive cervical cancer worldwide. J Pathol.1999;189:12-19.20. Clifford GM, Smith JS, Plummer M, Munoz N,Franceschi S. Human papillomavirus types in invasivecervical cancer worldwide: a meta-analysis. Br JCancer. 2003;88:63‐73.21. Parkin DM, Pisani P, Ferlay J. Estimates of theworldwide incidence from 25 major cancers in 1990.Int J Cancer. 1999;80:827-41.22. Parkin DM, Bray FI, Devesa SS. Cancer burdenin the year 2000. The global picture. Eur J Cancer.2001;37:S4-S66.23. Pisani P, Parkin DM, Bray F, Ferlay J. Estimates of theworldwide mortality from 25 major cancers in 1999.Int J Cancer. 1999; 83:18-29.24. Harper D, Franco E, Wheeler C, Moscicki A.Sustained efficacy up to 4.5 years of a bivalentL1 virus-like particle vaccine against humanpapillomavirus types 16 <strong>and</strong> 18: follow-up from ar<strong>and</strong>omized control trial. The Lancet. 2006;10.1016/SO140 6736(06)68439-0.25VACCINE <strong>SA</strong>FETY<strong>and</strong> COMMUNITYATTITUDES IN <strong>SA</strong>Sarah DugdaleProject Officer, <strong>SA</strong> Vaccine Safety (<strong>SA</strong>VeS) Data LinkageProjectDepartment of <strong>Health</strong>BackgroundSusan LewisNurse Consultant, South Australia ImmunisationCoordination Unit (<strong>SA</strong>ICU)Department of <strong>Health</strong>Mike GoldSenior Lecturer, Department of PaediatricsUniversity of AdelaideHelen MarshallSenior Medical Officer, Paediatric Trials UnitUniversity of AdelaideDespite the immense public health benefit ofvaccination, 1,2,3 concern about the safety of vaccines isnow the most important issue to affect immunisationcoverage <strong>and</strong> the sustainability of immunisationprograms in developed countries. 4,5 Loss of confidencein vaccine safety can result in decreased vaccinecoverage <strong>and</strong> a resurgence of disease. 1,6,7 This hasbeen clearly demonstrated on a number of occasions,including the reappearance of whooping cough in Japan<strong>and</strong> Sweden in the 1970s, <strong>and</strong> measles in the UnitedKingdom in 1998. 6,7,8,9The three-in-one vaccine against diphtheria, tetanus <strong>and</strong>whooping cough (DTP) was targeted by anti-vaccinecampaigners in a range of countries after a 1974 journalpublication stated it was linked to neurological reactions.In just two years DTP vaccine coverage in Jap<strong>and</strong>ropped from around 80% to 10%, <strong>and</strong> in Sweden from90% to 12% over 5 years. In some other countries thepersistent media reports even resulted in the vaccinebeing withdrawn from use. By the late 1970s whoopingcough epidemics affecting hundreds of thous<strong>and</strong>s ofchildren were occurring in countries across the world,with 5000 cases in Australia by 1994. 6The UK measles outbreak in the late 1990s resultedfrom the controversial publication of an article byAndrew Wakefield in the Lancet, which purported anassociation between the Measles Mumps Rubella(MMR) vaccine <strong>and</strong> both <strong>au</strong>tism <strong>and</strong> bowel disease.Although the article was later retracted, its effect onuptake of the vaccine was considerable; within 3 years
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