Cervical cancer vaccine in the Indian population: Current trends and challenges ahead

Vaccine-PhialsCervical cancer is the leading cause of cancer-related death in Indian women. Vaccination remains the method of choice for its primary prevention. Several studies, all over world have reported the excellent efficacy and safety of the currently available HPV vaccine. But there are certain barriers for vaccination in India, like the cost of vaccination, vaccine coverage, and social acceptance of this vaccination.

Incidences of cervical cancer in India

Cervical cancer is one of the most common cancers among Indian women and is estimated to have been responsible for 134,420 new cases and 72,825 deaths in the year 2008. India has the largest burden of deaths due to cervical cancer and contributes to 25.4% and 26.5% of the global burden of cervical cancer cases and mortality, respectively [1,2].

Key Point: All of the available current epidemiological evidence and cancer surveillance systems justify the HPV vaccination programme in India. So, there is a need to take a step forward to increase the HPV vaccination for reducing morbidity due to the cervical cancer. It is important to raise general awareness about STDs and HPV, to educate the masses through different media, to destigmatize HPV infection, and to achieve acceptance of mass vaccination of pre-adolescent and adolescent girls before HPV vaccination is introduced.

HPV vaccines and strains

Almost all cervical cancers are initiated by HPV infections, with just two HPV types, 16 and 18, responsible for about 70 percent of all cases in India [3]. Currently, two HPV vaccines are available in India. A bivalent vaccine Cervarix™ made by GlaxoSmithKline (GSK) that protects against HPV strains 16 and 18, and a quadrivalent vaccine Gardasil™ by Merck, which protects against HPV strains 16, 18, 6 and 11 [4,5]. The other two strains (6 & 11) in Gardasil™ are useful in preventing Anogenital warts.

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  1. Sonali Natu
    Posted Sep 2013 at 3:57 pm | Permalink

    Gaurav your article has highlighted the social reasons behind why the vaccine uptake in India maybe poor. These are the very reasons why cervical smear testing may have failed. There are 12 high risk HPV subtypes that can lead to cancer. Currently UK has started a pilot study to see if HPV testing for high risk HPV subtypes should be used as the primary tool for cervical screening as opposed to using cervical smear cytology. The results should be available within the next few years and should hopefully tie in with the first cohort of vacinated girls being invited to cervical screening. There is no doubt in anyones mind that India does not lack the resources to plough into general population in order to save the millions of deaths from cervical cancer. Its not the janta but the policy makers that need to be educated who will then educate the masses about the use of HPV vaccine. But one can rant on about that but it would be futile. Anything I can do? Would love to help if doing a mass campaign of some sort.

  2. Dr. Gaurav Gupta
    Posted Oct 2013 at 8:33 am | Permalink

    Thanks for your astute comments Sonali,
    Unfortunately, while I do beleive very firmly in the need for HPV vaccine (& rotavirus & Pneumococcal for that matter), I am not a policy maker, and hence am not sure as to what I can do too. But such comments help us become more focused on the need for better prevention strategies…
    I am constantly amazed at the lack of knowledge in the medical fraternity regarding the HPV vaccine though, it really makes it difficult to promote the vaccination to the age group that requires it the most. Recently there was a comment by a leading mumbai gynecologist in the newspaper saying that due to the fact that a girl had been given the vaccine below 15 years when she is immature, she can suffer from side-effects due to the vaccination!!

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