Transcript Slide 1

HUMAN PAPILLOMAVIRUS
(HPV) VACCINATION
PROGRAM
GARDASILTM
Cristi Froyman
4th Year Pharmacy Intern
University of Saskatchewan
Email: [email protected]
Mikki Millar RN (NP)
Primary Care Nurse Practitioner
Cypress Health Region
[email protected]
WHAT IS HPV?

Common virus: Human Papillomavirus

Many different types of HPV
• Types 6, 11, 16, and 18

Can cause diseases of the genital area
• cervical cancer
• precancerous lesions
• genital warts
PREVALENCE OF HPV

Infects half of all sexually active women
aged 18 to 22 in North America

~75% of sexually active Canadians will
have at least one HPV infection during
their lifetime

Most common in women aged 20-24 years
HOW DO PEOPLE GET HPV?

Affects both men and women

Sexual contact with an infected person

INTERCOURSE IS NOT NECESSARY!

HPV is easily transmitted
• may not show any signs or symptoms
• can pass the virus on without even knowing it
WHAT DISEASES ARE
ASSOCIATED WITH HPV?
Cervical cancer
 Vulvar cancer
 Vaginal cancer
 Precancerous lesions
 Genital warts

WHAT IS CERVICAL CANCER?

Cancer of the cervix: the lower part of the
uterus that connects to the vagina
Cervical Cancer
Continued…

Is the second most common type of cancer
in Canadian women ages 20 to 44

Over 1350 Canadian women were
diagnosed with cervical cancer in 2001,
and 400 women died from it
Cervical Cancer
Continued…
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May be caused by certain types of HPV
Usually the HPV goes away on its own
within 1 or 2 years
If infected with these types, and the virus
does not go away on its own
• abnormal cells  pre-cancerous  cancerous
Progression to Cancer
CERVIX
Healthy
Cancerous
POSSIBLE SYMPTOMS


Early cervical cancer may not cause
noticeable signs or symptoms
Signs and symptoms may include:


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Vaginal bleeding not during period
Unusual vaginal discharge
Pain
Pain during sexual intercourse
SCREENING FOR
CERVICAL CANCER
Tests that examine the cervix:

Pap Smear: a piece of cotton, a brush, or a small wooden
stick is used to gently scrape cells from the cervix and
vagina to be viewed under a microscope

Colposcopy: a thin, lighted tube is inserted through the
vagina into the cervix to look for abnormal tissue

Biopsy: a sample of abnormal tissue is cut from the
cervix and viewed under a microscope to look for cancer
SCREENING FOR
CERVICAL CANCER

Pelvic Exam: an exam of the vagina, cervix,
uterus, fallopian tubes, ovaries, and rectum. The
doctor or nurse inserts one or two lubricated,
gloved fingers of one hand into the vagina and
the other hand is placed over the lower abdomen
to feel the size, shape, and position of the uterus
and ovaries. A speculum is also inserted into the
vagina and the doctor or nurse looks at the
vagina and cervix for signs of disease.

Endocervical Curettage: a spoon-shaped
instrument is used to collects cells or tissue from
the cervical canal
CERVICAL CANCER
TREATMENT

Cryosurgery: pre-invasive cancer cells frozen off

Laser Surgery: pre-invasive cancer cells burned off

Cone Biopsy: cone-shaped piece of tissue removed
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Simple Hysterectomy: uterus is removed
CERVICAL CANCER
TREATMENT

Radical Hysterectomy:
 uterus, and tissues next to the uterus, the upper part of
the vagina, and lymph nodes from the pelvis are
removed
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Pelvic Exenteration:
 uterus, lymph nodes, bladder, vagina, rectum, and
part of colon removed
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Radiation Therapy

Chemotherapy
WHAT IS VULVAR CANCER?

Vulva: the outside part of the vagina
 Labia majora: two prominent skin folds
 Labia minora: two small, hairless skin folds
 Clitoris: found below the spot where the two
labia minora meet
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Cancer of the vulva most often affects the inner
edges of the labia majora or the labia minora,
but it can also occur on the clitoris
Vulvar Cancer
Continued…
VAGINAL CANCER
WHAT ARE GENITAL WARTS?

Flesh-colored growths that appear in or
around the genital area:
Genital Warts
Continued…
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Caused by different types of HPV than cervical
cancer
Can occur on the penis, in and around the
vagina, or in and around the anus/rectum
2 out of 3 people who have sexual contact with a
person who has genital warts will also get them
It can take weeks, months or years after contact
with an infected partner for warts to occur
Lifetime risk of getting genital warts is > 10%
TREATMENT FOR
GENITAL WARTS

They can be treated
 HOWEVER…25% of warts will come back within 3
months if HPV is still present in the body
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Treatment depends on the size, amount, and
location of the warts
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applying a solution directly to the warts
freezing or burning
laser therapy
surgery
PROTECTION AND
PREVENTION

Protection:
 avoid genital contact
 always use condoms
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Prevention:
 GARDASIL
HUMAN PAPILLOMAVIRUS
VACCINE
WHAT IS GARDASIL?



New vaccine
Protects against HPV
Helps guard against diseases caused by:
 HPV Types 16 and 18
- 70% of cervical cancer cases
 HPV Types 6 and 11
- 90% of genital warts cases
GOAL

PROTECT BEFORE EXPOSURE!
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BEFORE SEXUALLY ACTIVE!
CAN THE GARDASIL
VACCINE CAUSE HPV?
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NO!
Made of virus-like
particles prepared
from HPV Types 6,
11, 16, and 18
Particles do not
contain viral DNA
 cannot infect cells
 cannot reproduce
WHO SHOULD BE VACCINATED
WITH GARDASIL?

Girls and women ages 9 to 26 years
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To prevent infection caused by the Human
Papillomavirus types 6, 11, 16, and 18

GARDASIL works when given before a
person has any contact with HPV Types 6,
11, 16, and 18 (before sexually active)
HOW IS GARDASIL GIVEN?


Injected into the upper arm or thigh
muscle
3 separate 0.5-mL injections over 6
months:
 First dose: At a date you and your
doctor or healthcare professional choose
 Second dose: 2 months later
 Third dose: 6 months after the first dose
Dosing Schedule
Continued…
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Getting all 3 doses will allow you to get the full
benefits of GARDASIL
All 3 doses should be given within 1 year
WHY IS IT IMPORTANT TO
BE VACCINATED EARLY?

To help prevent illness before there is
any contact with HPV Types 6, 11,
16, and 18

To protect against future cervical
cancer and genital warts
WHAT IF I ALREADY HAVE
HPV?

Vaccination is still beneficial

GARDASIL covers 4 types of HPV

It is unlikely that you have been
infected with all 4 types of HPV
IMPORTANT INFORMATION
ABOUT GARDASIL

GARDASIL is not for women who are
pregnant

GARDASIL will not treat diseases

GARDASIL will not protect against
diseases caused by other types of HPV
POSSIBLE SIDE EFFECTS
OF GARDASIL

Pain, swelling, itching, and redness at the
injection site

Fever

Nausea

Dizziness
ARE PAP TESTS STILL NECESSARY
AFTER BEING VACCINATED?
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YES!
Vaccination with GARDASIL does not take the
place of Pap tests:
 may not fully protect everyone
 does not prevent all types of cervical cancer
It is important to continue regular cervical cancer
screenings
Pap tests have been proven to help save lives.
PAP TESTS

Cervical cancer screenings

Look for abnormal cells in the lining
of the cervix before they have the
chance to become precancerous or
cervical cancer
ABNORMAL PAP TESTS
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The more severe the abnormality, the more likely
it is that cervical cancer could develop in the
future
Abnormal Pap? Don’t panic—it does not always
mean that you are at risk for cancer or even have
HPV
Your doctor or healthcare professional may
repeat the Pap test or do other tests as needed
WHO SHOULD GET PAP
TESTS?

Women 21 years or older
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Females under 21 years of age who have
been sexually active for three years or
more
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No age limit!
HOW OFTEN?
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Once you become sexually active
One year later
Every 2 to 3 years
 if 2 normal pap tests and not on any
birth control or hormones
Every year
 if on birth control or hormones
Pap tests are an important
part of taking control of
your health—and taking
care of yourself!
GARDASIL is not included on any
provincial vaccination programs
 However, a doctor can provide a
written prescription for the three
required shots
 One Dose = $169.52 ( x 3 doses)
 Total cost / person = $508.56


Gordon Stueck has chosen to sell the
GARDASIL vaccine at cost +
expense of refrigeration of the
product

$156.42 x 3 = $469.26
The benefit of vaccination with
GARDASIL far outweighs the
expense!

In the long run, vaccination with
GARDASIL will save the health care
system money

The overall yearly cost of invasive
disease and death in Canada from
cervical cancer has been estimated to
be ~ $270 million
CONSIDER…

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Travel time for treatments
Emotional turmoil and uncertainty
associated with further testing and delays
More frequent monitoring is required if
infected with HPV
 Ex: Colposcopy every 6 months with
HPV type 16 and 18
TESTS ARE NOT PLEASANT!
SUMMARY




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Human Papillomavirus infection can cause
cancer and genital warts
It is important to protect yourself from HPV
infection
Using condoms or abstaining from genital
contact may help prevent infection
GARDASIL is a new vaccine that protects
against HPV types 6, 11, 16, and 18
Pap tests are still important after vaccination
References:

1) Merck. Gardasil [Online]. [cited 2007Jan 04]; Available from: URL:
http://www.gardasil.com

2) Cervical cancer vaccine approved in Canada. CBC News [Online]. 2006
Jul 18. [cited 2007 Jan 04]; Available from:
URL: http://www.cbc.ca/health/story/2006/07/18/cervical-cancer.html

3) Compendium of Pharmaceuticals and Specialties. Gardasil Product
Monograph [online version (e-CPS)]. CPhA, 2007.
[cited 2007 Jan 04]; Available from: URL: https://www.e-therapeutics.ca

4) American Cancer Society. Cancer Reference Information [Online]. [cited
2007 Jan 09]; Available from: URL: http.www.cancer.org
Cristi Froyman
4th Year Pharmacy Intern
University of Saskatchewan
Email: [email protected]
Mikki Millar RN (NP)
Primary Care Nurse Practitioner
Cypress Health Region
[email protected]