Why the Cervical Cancer Vaccine Should be Included in the Universal Immunisation Programme (UIP)

by Team Onco
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Cervical cancer is one of the preventable cancers that accounts for 460,000 new cases and 231,000 deaths every year throughout the world. Globally, it is the fourth most common cancer in females. 

Well-organized screening programs, initiated in recent years, have been responsible for lowering the burden of cervical cancer in developed countries. However, these screening tests are either not available or are expensive or not implemented at a population level, as a result the burden of cervical cancer in developing regions is still high.

In India, cervical cancer accounts for about 6 to 29% of all cancers in women.  According to statistics, India is responsible for about one-quarter of the global burden of cervical cancer.  

Preventive measures against cervical cancer

Infection with one or more types of human papillomavirus (HPV) is one of the major risks linked with cervical cancer. Among the 50 types, 15 to 20 types of HPV infections are associated with cervical cancer. 

Additionally, sexual activity before the age of 25 years, multiple sexual partners, sexually transmitted infections, family history of cervical cancer, smoking, and immunocompromised conditions, such as HIV/ AIDS are some other factors that contribute to cervical cancer.

One of the best ways to prevent cervical cancer is to take necessary precautions to prevent HPV infections. 

Although the use of condoms has been found to provide protection against HPV-related conditions, conclusive evidence is lacking. Therefore, the only  options to prevent cervical cancer are to get vaccinated against HPV if you are eligible, and get regular screening for cervical cancer done. 

HPV vaccine

Types of HPV vaccines available in the market 

Currently, there are only three vaccines to prevent HPV infections. These include:

  • Gardasil

This vaccine helps in preventing infection by four types of HPV that cause genital warts and cervical, vaginal, vulvar, and anal cancer. It is available in the form of 0.5mL suspension and administered intramuscularly. 

Gardasil induces HPV type specific antibodies that combats 6, 11, 16, and 18 HPV types.

  • Gardasil 9

It prevents nine types of HPV infections that cause genital warts, certain precancerous conditions, and cervical, vaginal, vulvar, anal, and head and neck cancer. 

Additionally, it also prevents HPV-related penile cancer. It is available in the form of 0.5mL suspension and administered intramuscularly. 

Gardasil acts by stimulating the immune system to mount an attack against the viral proteins in HPV. In response, the immune system produces antibodies against the viral proteins. As a result, the immune system is primed against any future infection from the same viruses. 

  • Cervarix

This vaccine helps in preventing cervical cancer caused by HPV type 16 and 18. It is available in the form of 0.5mL suspension and administered intramuscularly. 

Cervarix acts by stimulating production of IgG neutralizing antibodies against HPV. 

Vaccination guidelines 

 The first HPV vaccine was Gardasil approved by FDA in 2006. The second vaccine was Cervarix approved in 2009. In the year 2018, the US FDA approved the use of HPV vaccine in both men and women over the age of 45 years. 

In India, both vaccines, Gardasil and Cervarix, are used for vaccination, and are considered safe and effective.

 According to the Advisory Committee on Immunization Practices (ACIP), girls can start HPV vaccination at the age of 11 or 12 years, but can also start at the age of 9 years. 

People between the ages of 13 to 26 years can start vaccination if they have not been vaccinated or have not completed the vaccination course. 

The Advisory Committee on Immunization Practices (ACIP) has given the following recommendation for HPV vaccination:

Children and adults between the ages of 9 to 26 years: Children can start HPV vaccination at the age of 11 or 12 years, but can also start at the age of 9 years. Individuals who are not adequately vaccinated are recommended to get catch-up vaccination for HPV till the age of 26 years. 

Adults over the age of 26 years: Adults over the age of 26 years are not eligible for catch-up vaccination. For some individuals between the ages of 27 to 45 years who have not received HPV vaccination adequately, a shared clinical decision is made regarding the use of HPV vaccination. HPV vaccination is not advised for people over the age of 45 years.  

Pregnant women: The safety data of HPV vaccination during pregnancy is not yet established. Therefore, it is safe to avoid HPV vaccination till childbirth. 

Dosage and administration

HPV vaccination is administered in the form of an intramuscular injection usually in the deltoid region of the upper arm or in the upper thigh region. The dosing schedule and doses remain the same for both vaccines, Gardasil and Cervarix.

Recommended doses Dosing schedule 
2 doses

(for girls between 9-14 years)

0 (first dose), between 6–12 months (second dose); with a gap of 5 months between the first and next dose.
3 doses

(for girls above 15 years and immunocompromised individuals)

0 (first dose), 1–2 months (second dose), 6 months (third dose);  with a minimum of 4 weeks gap between the first and second dose, 12 weeks gap between the second and third dose, and a gap of at least 5 months between the first and third dose.

Benefits of including the HPV vaccine in UIP 

Universal Immunisation Programme (UIP) is one of the largest vaccination programmes developed with an aim for protecting people from life-threatening conditions. 

Healthcare professionals and vaccine advocacy groups in India are planning to introduce the HPV vaccine in India’s UIP. In the year 2017, the National Technical Advisory Group on Immunisation had already approved the introduction of the HPV vaccine in the programme, but that needs to be put into action. 

Introduction of the vaccine in UIP would improve the vaccine coverage for all people and reduce the burden of the disease. 

 

 

Cost of HPV vaccination in India

The cost of a single dose of HPV vaccination in India ranges between Rs 2,000 and Rs 3,000. Depending on the age, the vaccination may be administered in a series of two or three doses, which further increases the cost. 

How safe are HPV Vaccines?

The safety of HPV vaccines has been established through years of extensive research and monitoring. All the three vaccines have been found to be safe and effective in clinical trials. However, like all vaccines, HPV vaccines also have side effects, but these side effects are mild and subside soon. 

The common side effects of HPV vaccines include:

  • Pain, redness, or swelling in the arm at the site of injection
  • Fever
  • Dizziness
  • Nausea
  • Headache 
  • Feeling tired
  • Muscle or joint pain

As these side effects are mild and go away quickly, these should not be a reason for not taking the vaccines. The benefits of the vaccines heavily outweigh the small risk associated with these side effects. 

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