HPV vaccine: Uganda’s call to eliminate cervical cancer

Cancer of the cervix is the most common cancer type among women worldwide. In Uganda, it accounts for 80 per cent of all female cancers and 40 per cent in the Kampala cancer registry.
It is also the commonest cancer in Uganda. As of 2018, new cases of cervical cancer were 6,413, while deaths stood at 4,301.
Dr Noleb Mugisha, an oncologist at the Uganda Cancer Institute, Mulago, defines cancer of the cervix as abnormal and uncontrolled growth of cells in the cervix, resulting in wounds and bleeding caused by the Human Papilloma Virus (HPV).

Dr Mugisha says what makes cervical cancer the most common is because its risk factors are more prevalent among Ugandans.
The World Health Organisation (WHO) indicates that there are more than 200 types of HPV. Type 16 and 18 account for 70 per cent of all cervical cancer cases worldwide. HPV also causes vaginal, vulvar and anal cancers while HPV type 6 and 11 are responsible for genital warts.
Dr Mugisha says HPV mode of transmission is sexual contact, adding that anyone who has had sexual contact with a person infected with HPV is at risk of infection.

Risk factors for HPV infection are sexually active girls and women, those who have sexual intercourse at an early age, females with multiple sex partners, other genital infections and weakened immune systems caused by HIV/Aids.
Dr Mugisha says it is possible to get HPV without even knowing it because the virus often has no signs or symptoms. The symptoms of cancer of the cervix may sometimes appear when the disease has reached advanced stage and include bleeding and pain during sexual intercourse, lower abdominal pain, inter-menstrual bleeding, heavy menstrual bleeding and abnormal vaginal discharge with a bad smell.

The HPV vaccine
The Ministry of Health promotes a comprehensive approach towards the prevention of cancer of the cervix through immunisation with the HPV vaccine, screening, early treatment and sexual behaviour change.
The HPV vaccine targets HPV type 6, 11, 16 and 18.
According to the Ministry of Health, it is best used to immunise girls before the onset of any sexual activity. Majority girls, who are at least 10 years of age, are less likely to be sexually exposed. Therefore, immunisation reduces the cancer of the cervix by 60 to 70 per cent.

The girls can be immunised in schools or at health facilities currently providing routine immunisation services. Dr Mugisha says regular screening to check for pre-cancerous lesions that could be treated early is a cost-effective preventive measure against cervical cancer. Screening services can be accessed at hospitals and selected health facilities.

The Ministry of Health recommends a two-dose schedule for the vaccine. The first and the second doses are given six months between each other. The vaccine is administered by injection in the upper arm.
The Ministry of Health HPV vaccine fact sheet also indicates that the vaccine was first licensed for use in 2006 across the world. Studies conducted so far demonstrate that the vaccine is safe and effective.
WHO reports that reductions of up to 90 per cent in HPV infections and genital warts in teenage girls and young women were registered in Australia, New Zealand, Belgium, Germany, Sweden, the United Kingdom and the United States as a result of using the vaccine.

In neighbouring Rwanda, for example, HPV vaccination achieved 93.23 per cent coverage in 2011, protecting up to 98,792 girls within the target age bracket of nine to 14 years. Rwanda’s incidence rate currently stands at about 42 cases per 100,000 women per year, which is lower than many African nations.
All vaccines introduced into the routine immunisation schedule are pre-qualified and approved by the WHO following rigorous scientific review for safety and any adverse events following immunisation.
There have been negative perceptions of the HPV vaccine among Ugandans, with some shunning the immunisation exercise.
“Inspite of the pre-vaccination sensitisation; introduction of the HPV vaccine triggered several negative rumours that threatened acceptability among targeted adolescents and their parents. Some girls refused vaccination because they heard that those vaccinated could become barren or would face a greater risk of life-threatening childbirth complications,” reads in part a research article titled ‘Effect of School-based Human Papillomavirus (HPV) Vaccination on Adolescent Girls’ Knowledge and Acceptability of the HPV Vaccine in Ibanda District in Uganda’ conducted by the Makerere University School of Medicine.

However, a release by the Ministry of Health debunks some of the myths associated with the HPV vaccine.
It indicates that HPV vaccine does not cause menstrual periods in babies, as alleged, because at that age, the hormones are inactive and neither does it cause hormonal imbalances, because it is not a hormone.
The ministry explains that menstrual periods in girls are triggered by hormonal actions, oestrogen and progesterone. The vaccine is given only to adolescent girls, not babies, and it does not have a contraceptive component or cause sterility as reported.

Also contrary to allegations on social media, the release indicates that the HPV vaccine does not cause cancer. The vaccine does not contain any live or killed HPV virus. It is made from a single protein like the one the virus has on its outer coat. When an individual has been vaccinated, the body produces antibodies, which it uses to fight the real virus if one is ever exposed to it.
The ministry also indicates that it is also not true that the HPV vaccine was banned in most European countries. The vaccine is still in use throughout the whole of Europe, the US and globally.

Prevalence
The World Health Organisation (WHO) indicates that there are more than 200 types of HPV. Type 16 and 18 account for 70 per cent of all cervical cancer cases worldwide. HPV also causes vaginal, vulvar and anal cancers while HPV type 6 and 11 are responsible for genital warts.

Common Cancers

Cancer in HIV patients
Kaposi’s sarcoma
Aids associated lymphomas
Children and youth
Burkitt’s Lymphoma
Retinoblastoma
Leukaemia
Lymphoma
Breast cancer
Gastrointestinal cancer
Oesophageal cancer
Gastric cancer
Liver cancer
Pancreatic cancer
Gall bladder cancer
Colorectal cancer
Anal cancer
Head and Neck cancer
Thyroid cancer
Ovarian cancer
Endometrial cancer
Lung cancer
Prostate cancer
Renal cancer
Bladder cancer
Testicular cancer
Penile cancer
Skin cancer.

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