Thursday, May 16, 2013

HPV Vaccine for Zambian girls

By Meluse Kapatamoyo

The statistics are alarming. Zambia’s cervical cancer burden ranks second in the world next to Guinea. Over 1,400 women die annually from the disease, according to Zambia’s Cancer National Registry.

“Cervical cancer is the most common cancer in Zambia.  It accounts for approximately 30 percent of new cancer cases seen in Zambia every year.  The incidence rate as at the last IARC report is 52.8 percent per 100,000 women,” says Dr Sharon Kapambwe, Program Head at the Cervical Cancer Prevention programme.

But as the country grapples with this disease, vaccines worth US$11 million were recently acquired by the Zambian government in a desperate attempt to save the next generation of women from Cervical Cancer, caused by the Human Papilloma virus (HPV), found in men and transmitted through sexual contact.

The HPV Vaccine, Gardasil, which prevents against HPV types 16 and 18, responsible for 70 percent of cervical cancer cases, will be rolled out in three districts of Lusaka province;  Lusaka, Kafue and Chongwe and shall be given to girls between the ages 10 and 13. 

The vaccination will reduce the prevalence of cervical cancer in years to come through protecting girls from not getting HPV, though the reduction will not be overnight but in many years to come when the girls get exposed to HPV.

“The HPV vaccination will definitely reduce the prevalence of cervical cancer in years to come through the protecting of girls. The girls we are looking at are in fourth grade and 90 percent of them are between ages 9 and 13. And because HPV is predominantly sexually transmitted, it will have to wait until these girls get sexually active for us to see the benefits. The girls have to grow into women for us to see the benefits, the impact and reduction of cervical cancer,” Dr Kapambwe explained.

And while, she says the vaccine will prevent adolescent girls from getting HPV infections and developing cervical cancer later in life, she is quick to point out that HPV vaccination will not replace screening and treatment but compliment  screening.

“Since 30 percent of the cancer cases will not be protected by the vaccine, girls who will not be vaccinated will need to be screened in future,” she explained, “Currently, Zambia does not have any means of making a diagnosis of whether a man has HPV or that a woman has contracted the virus hence leaving screening as the only option once a woman is exposed.”

For some Zambians however, despite the alarming statistics of cervical cancer, they are not keen to allow their daughters have the vaccine. Unfortunately, many have not forgotten the Mazabuka Microbicide Clinical trials which failed and left women infected with HIV.

Delphine Hampande, remains unconvinced that the vaccine is safe for her daughter and questions government commitment to taking responsibility in case of any adverse side effects from the vaccine. 

“Yes, while government has gone on record to say the vaccine is safe, it has done that before, a very good example is the case in Mazabuka. Even when there was evidence, that women were infected with HIV, government backed off. To date they do not want to take responsibility. So how can a parent be sure that this time they can be trusted to stick around in case of serious side effects? For my daughter, I will teach her the importance of screening,” Hampande emphasised.

And Like Hampande, Chela Chisulo, a father of two, wants trial tests conducted in Zambia even though the vaccine has been tried and tested in other countries.

 “Zambia and other countries are two different places. We need to do our own tests here, if it is a vaccine, clinical tests must be done. And it must be proven safe to be used in Zambia,” Chisulo says.

Addressing these concerns, Dr Penelope Kalesha, Acting Deputy Director-Child Health, Ministry of Community Development mother and child health said the HPV vaccine launched over 10 years is safe and has recorded a safety profile which has continued to be excellent.

“There is no controversy to warrant comparison of HPV to the Mazabuka trial. What was being undertaken in the Mazabuka trial was to test and see whether the microbicide was effective or not. They were testing the drug itself, which is not the case for HPV vaccine. They were testing to see whether the drug will work in women where as in the case of the HPV it has been proven that the vaccine contributes to preventing 70 percent of cervical cancers,” she clarified.

The vaccine is given as an injection in the upper arm. For a girl to be fully protected, she must receive 3 doses of HPV vaccine. The 2nd dose should be given 2 months after the 1st dose, and 3rd dose should be given 4 months after the 2nd dose.

Currently the HPV vaccine, manufactured by MERC, a USA pharmaceutical company, is being administered in several other African countries such as Rwanda and Uganda, which have already incorporated the vaccine as part of their routine vaccination country wide.

Other countries also on their way to introducing the vaccine and exploring how to reach eligible girls are Ghana, Kenya, Malawi, Mali, Nigeria, Niger, Sierra Leon and Tanzania.

Dr Kalesha says like any drug, following immunization, the vaccine has adverse side effects. The common ones include pain, discomfort, headache and swelling at the site of injection.

She adds that the HPV vaccine is not the first anti cancer vaccine being provided in the country. Zambia has been providing Pentavalent vaccine, a five in one vaccine which is provided in the first year of life which targets to reduce cancer of the liver and prevents infection of Hepatitis B.

“Like any other vaccination service all the country does is provide the service and encourage clients to seek these services. It is not compulsory. But using the Public Health Act, we are mandated to provide health services that are meant to protect and prevent diseases from the populations, so addition of the HPV is being carried out under such a mandate. We strongly encourage that people make use of these intervention."

The vaccine was provided through a donation that Zambia applied for amongst many other nations.

To address misconceptions, government has been carrying out massive sensitization in communities and has produced materials explaining not only the benefits, but who is eligible and where the vaccine is to be administered.

Working with various partners like the World Health Organisation (WHO), UNICEF, Centres for Infectious Diseases Research in Zambia (CIDRZ), PATH, Catholic Medical Mission Board (CMMB) and the American Cancer Society, the vaccine is expected to launch on May 15, 2013.

“Apart from administering the vaccine, part of the orientation include how to handle the vaccine, how to store and how to dispose of the waste that remains, that is the used, syringe and needle,” she explained.

On a positive note however, some people like Shamaoma Musonda are urging parents to take advantage of the vaccine aimed at saving their daughter’s lives.

“I know the HPV vaccine has passed the clinical stage, which is encouraging. Most fears come when things are at trial stage because you do not know the side effects seeing that Zambia has had a case of a clinical trial gone wrong. But this vaccine has been approved and is doing well in other countries, therefore, it is safe and the initiative has to be supported by all Zambia,” says Musonda.PYM

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