Dear Editor

PLEASE permit me space in your letters column to highlight some misinformation being spread on social media about the HPV vaccine.

Essentially, rumours are being circulated that the HPV vaccine is closed to expiration, hence the rush by the Government to have it administered to children when they do not need it. I do not know how true this is but I do believe that persons who are spreading this misinformation on social media should do the responsible thing and ensure that they have facts and not operate based on hearsay.

As a result of this misinformation, many persons on social media are stating that their kids will not be having such a vaccine. A lady who was informed that the vaccine will soon be administered to students at my alma mater, Queens College, flatly said not to her daughter. Many may not have heard of the British doctor, Dr. Andrew Wakefield. He fabricated data that the MMR vaccine causes autism. As a result, many parents have stopped their children from having the vaccines. We now live with the consequences. A worldwide increase in the deadly measles virus infections. Dr. Wakefield was rightfully struck off the medical register for his reckless action.

There is irrefutable evidence that the HPV virus is associated with cervical, anal and throat cancer. Cervical cancer is the most prevalent of the three. Cervical cancer is the third most common gynaecologic cancer diagnosis and cause of death among gynaecologic cancers in the United States. There are around 3,200 new cervical cancer cases in the UK every year; that’s nearly nint every day (2013-2015).There are around 870 cervical cancer deaths in the UK every year, that’s more than two every day (2014-2016). Unfortunately, in countries that do not have access to cervical cancer screening and prevention programmes, cervical cancer remains the second most common type of cancer (17.8 per 100,000 women) and cause of cancer deaths (9.8 per 100,000) among all types of cancer in women.

The PAP smear was championed to reduced the incidence of the potentially deadly cervical cancer. It has been effective, but not as effective as doctors may wish. The fact is that many women were not having their regular PAP smear, hence the medical fraternity had to develop novel ways of addressing cervical cancer. Education played a critical role in increasing the uptake in PAP smear. In about 2006, the HPV vaccine was approved to reduce the development of HPV infection and transmission. The aim was to administer the vaccine before the patient becomes sexually active. This may vary for different countries and cultures, hence it is important that Government be aware of this.

The fact is that various modelling studies that were undertaken have outlined the potential benefits of the HPV vaccination, which appears to be cost-effective for the recommended age range. One study suggests that vaccination of the entire United States population of 12-year-old girls would annually prevent more than 200,000 HPV infections, 100,000 abnormal cervical cytology examinations, and 3300 cases of cervical cancer, if cervical cancer screening continues as currently recommended. In settings where there has been a high uptake of vaccine among females, there is also evidence of herd immunity among males of similar age, reflected by a reduction in genital warts.

So when is the optimum age to administer HPV? No randomised controlled trials (RCT) have been undertaken to determine this. RCT is the gold-standard in the medical fraternity. In accordance with the Advisory Committee on Immunisation Practices (ACIP) in the United States, it is recommended that routine HPV vaccination be administered to all eligible females and males. The ACIP-recommended age ranges for vaccination are as follows: Female: HPV vaccine is recommended at 11 to 12 years. It can be administered starting at nine years of age, and catch-up vaccination is recommended for females aged 13 to 26 years who have not been previously vaccinated, or who have not completed the vaccine series.

Males: HPV vaccine is recommended at 11 to 12 years. It can be administered, starting at nine years of age, and catch-up vaccination is recommended for males aged 13 to 21 years who have not been previously vaccinated, or who have not completed the vaccine series. Among males 22 to 26 years old, catch-up HPV vaccination is recommended, if they are men who have sex with men or immunocompromised (including HIV-infected males). Otherwise, “permissive use” of HPV vaccination is recommended for this age range. Permissive use means that the vaccine is recommended but not considered to be of sufficient priority to include on routine vaccination schedules.

The Department of Health in the UK recommends that the first dose of the HPV vaccine is routinely offered to girls aged 12 and 13. The second dose is normally offered 6 to 12 months after the first.

Girls can have the HPV vaccination on the National Health Service up to their 18th birthday. Girls who start the HPV vaccination after the age of 15 will need 3 doses as they don’t respond as well to 2 doses as younger girls do. For boys the first dose of the HPV vaccine will be offered routinely to boys aged 12 and 13 in the same way that it is currently offered to girls.

Men who have sex with men (MSM) do not benefit in the same way from the girls’ programme so may be left unprotected from HPV. From April 2018, MSM up to and including the age of 45 became eligible for free HPV vaccination on the NHS when they visit sexual health clinics and HIV clinics in England.

What is obvious is that the schedule is different for America and the UK which may be because of different demographics. Also it is only a little under a year ago that the UK started administering the HPV vaccines to boys.

The argument being articulated on social media, by persons who are non-medical, is that booster HPV vaccines are being administered to students at Lochaber Primary when it should be administered in secondary. It is their argument that the vaccination programme was brought forward since the HPV vaccine in Guyana is closed to being expired. I do not know the facts and would not speculate but I do believe that it is dangerous to spread such misinformation on social media without concrete evidence since the consequences can be deadly. As I outlined earlier, the HPV vaccine schedule is different for America and the UK.

The vaccination schedule was not determined by the gold standard RCT. It may very well be that the government has a good reason for the schedule being used in Guyana. I would humbly ask that the Health Ministry address this urgently before the misinformation on social medial becomes fact.
Regards

Dr. Mark Devonish MBBS MSc MRCP(UK) FRCP(Edin)
Consultant Acute Medicine
Nottingham University Hospital
UK