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Get the right HPV vaccine, says T&T’s lead gy­nae­co­log­i­cal on­col­o­gist

By Bobie-Lee Dixon, Trinidad Guardian

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(TRINIDAD GUARDIAN) — The Gar­dasil vac­cine, one of the two vac­cines used in the pre­ven­tion of the Hu­man Pa­pil­lo­ma Virus (HPV), which is the pri­ma­ry cause of cer­vi­cal can­cer, is on­ly utilised by five to six per cent of T&T’s fe­male pop­u­la­tion at pub­lic health cen­tres and hos­pi­tals.

This was wor­ry­ing ac­cord­ing to T&T’s lead gy­nae­co­log­i­cal on­col­o­gist Dr An­tho­ny Pot­tinger, par­tic­u­lar­ly be­cause cer­vi­cal can­cer is the sec­ond lead­ing cause of death among women in T&T.

He said T&T had a very high in­ci­dent rate of cer­vi­cal can­cer and this was be­ing “down­played.”

He even dis­missed the of­fi­cial sta­tis­tics from the Can­cer Reg­istry, which cur­rent­ly in­di­cates a rate of 29 per 100, 000 cas­es, claim­ing he knows for a fact, this fig­ure has dou­bled.

“With the num­ber of cas­es I deal with on a dai­ly to week­ly ba­sis, in my prac­tice alone, I know this fig­ure has to be in­ac­cu­rate and needs to be up­dat­ed,” he said.

Asked what he thought might be the rea­son for women still not ac­cess­ing the vac­cine, Pot­tinger said, the way in which the vac­cine was in­tro­duced to the pub­lic near­ly nine years ago, might be the cause. He said pri­or to the in­tro­duc­tion of the vac­cine there were no ed­u­ca­tion or aware­ness dri­ves to sen­si­tise the pub­lic.

“Be­fore the vac­cine was rolled out, there should have been a mas­sive na­tion­wide ed­u­ca­tion dri­ve, at least for two years in ad­vance to raise aware­ness and to sen­si­tise the pop­u­la­tion. There should have been vis­its to schools, hos­pi­tals, clin­ics, and com­mu­ni­ties, but this was not done. So I be­lieve it is very lit­tle, peo­ple know about the vac­cine,” he reck­oned.

Pot­tinger was speak­ing to Guardian Me­dia on the oc­ca­sion of Cer­vi­cal Can­cer Pre­ven­tion Week, which will be ob­served from Jan­u­ary 21-27. The en­tire of Jan­u­ary is al­so not­ed glob­al­ly by the Unit­ed States Con­gress as Cer­vi­cal Health Aware­ness Month.

Ad­di­tion­al­ly, Pot­tinger who has done thou­sands of life sav­ing surg­eries in his prac­tice, al­so ar­gued the Min­istry of Health need­ed to switch ful­ly from the Gar­dasil vac­cine, the pri­ma­ry one pub­licly avail­able, to the Cer­var­ix vac­cine, which he says is the bet­ter one, as it guards against the two more dan­ger­ous HPV strains—HPV 16 and 18, which cause around 70 per cent of cer­vi­cal can­cer cas­es.

There are two vac­cines that pro­tect against the var­i­ous HPV strains- Cer­var­ix, used in the UK, blocks HPV 16 and 18; where­as Gar­dasil pro­tects against strains 6, 11, 16 and 18. The strains 6 and 11, are which cause most cas­es of gen­i­tal warts, which are not life-threat­en­ing, but can pose var­i­ous health chal­lenges.

Pot­tinger ex­plained since its dis­cov­ery, there have been known to be at least 200 types of the HPV virus ex­ist­ing. One hun­dred of these dif­fer­ent types he said, in­fect an­i­mals and 100 in­fect hu­mans. Out of the 100 that in­fect hu­mans, 30 can cause in­fec­tions in the gen­i­tal and anal re­gion. And out of these 30, 15 are onco­genic–can­cer­ous. Of these that cause can­cer, Pot­tinger re­it­er­at­ed rough­ly 70 per cent of cer­vi­cal can­cer world-wide is due to in­fec­tions of HPV 16 and HPV 18.

HPV 45 and 31 make up an­oth­er 10 per cent while HPV 33, 35, 52 and 58 make up a fol­low­ing ten per cent.

“Again, of all the types men­tioned, HPV 16 and HPV 18 call for more con­cern if one is di­ag­nosed with ei­ther of the two,” he warned.

It is with this fact, he in­sist­ed, the Min­istry of Health need­ed to work fast on mak­ing the Cer­var­ix vac­cine avail­able at pub­lic health­care in­sti­tu­tions. Pot­tinger said op­pose to Cer­var­ix, the Gar­dasil vac­cine does not pro­duce as many an­ti­bod­ies, not even one third as much of the an­ti­bod­ies in Cer­var­ix, which are far su­pe­ri­or.

He re­vealed, for all the peo­ple who were vac­ci­nat­ed with Gar­dasil, with­in five years of the shot, for as much as 35 per cent of them, the an­ti­body lev­els would fall be­low the lev­el that does not pro­tect against the HPV strains that cause cer­vi­cal can­cer. And af­ter eight years it falls at even low­er lev­els in 15 per cent of those peo­ple vac­ci­nat­ed, where­as with Cer­var­ix there is a life­time as­sur­ance.

Pot­tinger was al­so quick to dis­miss the fal­la­cy that the HPV vac­cine was on­ly for women, he said men should al­so be vac­ci­nat­ed as they can trans­mit HPV through sex­u­al in­ter­course.

He al­so ad­dressed an­oth­er mis­tak­en be­lief that the vac­cines could on­ly be tak­en be­fore a par­tic­u­lar age. Pot­tinger said there was no spe­cif­ic age that dis­qual­i­fies a woman from get­ting the vac­cine as has been ru­moured. (Ac­cord­ing to the Cen­tre for Dis­ease Con­trol and Pre­ven­tion (CDC), all chil­dren who are 11 or 12 years-old should get two shots of HPV vac­cine six to 12 months apart. Ado­les­cents who re­ceive their two shots less than five months apart will re­quire a third dose of HPV vac­cine.)

“All women with the Gar­dasil can go as far as 45-year-old. The peo­ple be­tween 30 and 40 who get vac­ci­nat­ed, the ze­ro con­ver­sion rate is like 100 per cent, mean­ing that every­body will pro­duce an­ti­bod­ies,” he ex­plained.

He claimed even to­day, doc­tors as well the pub­lic health cen­tres con­tin­ue to ir­re­spon­si­bly in­form women that if they pass the age of 25, they can­not be vac­ci­nat­ed.

“I want every­one to know this is not true, as stud­ies have shown that with Gar­dasil women can go up to 45 -years- old and 55 with Cer­var­ix.”

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One comment

  1. 01/15/2019

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