8. prof butler - hpv for boys - hse.ie · high rates of infection across all age groups impacted by...
TRANSCRIPT
![Page 1: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/1.jpg)
HPV for BoysKarina M Butler, MB, FRCPI
Chair, National Immunisation Advisory Committee, RCPIOur Lady’s Children’s Hospital Crumlin
Temple Street Children’s University HospitalUniversity College Dublin, Ireland
![Page 2: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/2.jpg)
Disclosures (5 yrs)• Prof Butler’s institution has received funding to support conduct of influenza adverse event vaccine surveillance from SP‐MSD. No personal funding received.
• 6 slides adapted from a MSD sponsored presentation, ESPID 2019.
![Page 3: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/3.jpg)
• 300 women in Ireland develop cervical cancer every year
• 90 women die every year
• 90% can be prevented
![Page 4: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/4.jpg)
“ No man is an island”…
Equity of Access
![Page 5: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/5.jpg)
HPV: Common infectionThe aim:
Maximun protection for all
![Page 6: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/6.jpg)
Global: 569,847 new cases, 311,365 deathsEurope: 61,000 new cases, 25,829 deaths
Cervical Cancer 2018
![Page 7: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/7.jpg)
![Page 8: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/8.jpg)
The Tools• 3 licensed vaccines
• HPV2 (Cervarix) 16, 18• HPV4 (Gardasil licensed 2006) 6, 11, 16, 18• HPV9 (Gardasil 9 licensed 2015) 6, 11, 16, 18, 31, 33, 45, 52 & 58
• Recommended by WHO in 2009• All girls aged 12‐13 years ‐most effective at this age
• 2 doses over 6‐12 months if initiated < 15yrs• 3 doses if initiated at ≥ 15 yrs
• HPV4 protects against 70% cervical cancers and pre cancers
• HPV 9 protects against 90% • Less common but high oncogenic potential, 35, 39, 51, 56, 59
![Page 9: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/9.jpg)
HPV vaccine
• HPV4 will prevent 70% of cervical cancers
• HPV9 will prevent 90% of cervical cancers
• But that’s not all…..
![Page 10: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/10.jpg)
Patel C et al. Euro Surveill 2018;23 (41) pli=1700737
Pre –Vaccine Post Vaccine
HPV type Population prevalence Vaccinated Unvaccinated
6 5.5% 0.2% 2.7%
11 1.5% 0% 1.3%
16* 21.3% 1.5% 12.1%
18* 8.4% 0.6% 7.4%
31* 5.0% 2.7% 8.1%
33* 4.0% 1.4% 2.0%
45* 1.0% 1.7% 6.0%
52* 7.4% 6.9% 9.4%
HPV6/11/16/18
28.7% 2.3% 18.8%
![Page 11: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/11.jpg)
• HPV prevalence
• High grade cervical anomalies
• genital warts• Juvenile onset recurrent respiratory papillomatosis
Patel C et al. Euro Surveill 2018;23 (41) pli=1700737
![Page 12: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/12.jpg)
The Journal of Infectious Diseases, Volume 216, Issue 5, 1 September 2017, Pages 594–603, https://doi.org/10.1093/infdis/jix244
Prevalence of individual human papillomavirus (HPV) types among females aged 14–19 years (A) and 20–24 years (B)
![Page 13: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/13.jpg)
A: Females
B: Males
![Page 14: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/14.jpg)
Histological abnormality: (% of women screened) by year of birth and
immunisation status.
Tim Palmer et al. BMJ 2019;365:bmj.l1161
©2019 by British Medical Journal Publishing Group
• Compared with unvaccinated women born in 1988, vaccinated women born in ‘95 and ‘96 showed
• 89% (95% CI 81 – 94) CIN ≥3
• 88% (95% CI 83 – 92) CIN ≥2
• 79% (95% CI 69 – 86) CIN ≥1
Routine immunisation of girls 12 13 yrs with the bivalent vaccine has led to a dramatic reduction in
pre‐invasive cervical disease
![Page 15: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/15.jpg)
• Nationwide cohort 17 – 25 yrs, 2006 ‐2016• 590,093 women, 215,309 (36%) vaccinated @ <16yrs, 19% received 3 doses
• Vaccine effectiveness vs CIN3: 63%• 1 dose IRR*0.38 (95%CI 0.14‐0.98)
• 2 doses IRR 0.38 (95%CI 0.22‐0.66)• 3 doses IRR 0.37 (95%CI 0.30‐0.45)
CID 2019, March
*IRR: incidence risk ratio
![Page 16: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/16.jpg)
Does it work?
Months Years Decades
Costa Rica
![Page 17: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/17.jpg)
Real world benefits of HPV vaccine
Vaccine Type infection:
AustraliaBelgiumGermanySwedenUSA
Genital warts:
AustraliaBelgiumCanadaEnglandDenmarkFranceGermanyNew ZealandSwedenUSA
CIN:
AustraliaCanadaDenmarkScotlandSwedenUSA
Cancer
FinlandUSA
![Page 18: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/18.jpg)
Durability of antibody response
![Page 19: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/19.jpg)
What about the boys?
Increase herd protection
Direct protection
![Page 20: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/20.jpg)
HPV Vaccine Uptake
15,000 girls not
vaccinated
www.hpv.ie slide courtesy Dr. Brenda Corcoran, NIO
![Page 21: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/21.jpg)
Turning the TIde
![Page 22: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/22.jpg)
After 70 yrs with 40% vaccine uptake:‐
• Girls only: prevalence by
‐ 53% in girls ‐ 36% in
males.
• GNV: prevalence by 71%
![Page 23: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/23.jpg)
![Page 24: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/24.jpg)
HPV and Cancer
• HPV cause other cancers:‐90% anal70% vaginal50% penile40% vulvarAnd 13‐ 72% head and neck cancers
![Page 25: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/25.jpg)
HPV and Cancer
• HPV cause other cancers:‐90% anal70% vaginal50% penile40% vulvarAnd 13‐ 72% head and neck cancers
![Page 26: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/26.jpg)
Genital HPV prevalence higher in males than females and does not decrease with age
Slide courtesy of MSD
![Page 27: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/27.jpg)
Anal and Penile Cancers 2010‐2014
36 cases/yr90% HPV related
32 cases/yr50% HPV related
National Cancer Registry: Cancer Trends No 33 4th May 2017
![Page 28: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/28.jpg)
ESPID 2019 Slide courtesy of MSD
![Page 29: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/29.jpg)
Slide courtesy of MSD
![Page 30: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/30.jpg)
National Cancer Registry: Cancer Trends No 33 4th May 2017
Oropharyngeal Cancer: 2010‐2014
![Page 31: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/31.jpg)
Oropharyngeal cancer (OPC)Ireland• 2009 ‐ 2013: 123 cases /yr• 2014 ‐ 2018: 168 cases/yr• 33‐43%+ are p16INK4a posUS • 1988‐2004• HPV OPC by 225% (0.8 to 2.6/100,00) Estimate 70% HPV related
UK • Doubling of OPC cases 2002‐2011, 50% HPV related
HIQA:HTA of HPV in boys, 4th Dec 2018
37% Increase
![Page 32: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/32.jpg)
Why Boys?High rates of infection across all age groupsImpacted by certain diseases and cancersRemain susceptible throughout life – low rates of seroconversion after natural infectionNo recommended routine screeningGNV programmes accelerates HPV cancer and disease elimination
1. Giuliano A et al. Cancer Epidemiol Biomarkers Prev 2008. 2 De Martel C. Int J Cancer 2017:141,6643. Giuliano A et al. Papilloma Res2015;1:109.4 Pamani JID 2018;1219. 5 Brotherton Papilloma Res 2016;2:1066 Elstrom JID 2016;203:199
![Page 33: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/33.jpg)
Is HPV vaccine safe?• > 80 publications
• RCT: 72, 835 subjects
• Cohort studies
• Post licensure studies
• Systematic reviews
• Safety reviews
http//www.who.int/vaccine_safety/vaccrates/en/index.html
![Page 34: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/34.jpg)
![Page 35: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/35.jpg)
Be PreparedWhat can you do:
![Page 36: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/36.jpg)
Youare so
important
![Page 37: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/37.jpg)
• Be informed• Reliable information sources
www.hpv.ie
![Page 38: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/38.jpg)
What we can do:
• Provide a strong, presumptive message for vaccination
• Present it as part of the routine vaccinations• Emphasize the anti‐cancer message• Focus on disease prevention• Ask their concerns, Acknowledge their fears, Advise vaccination
• If they decline try again at a later visit
![Page 39: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/39.jpg)
Together we can……….
![Page 40: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/40.jpg)
Acknowledgements
• NIAC Committee members, the National ImmunisationOffice
• The HPSC, and especially……
• All of those parents and adults who choose to get vaccinated to protect themselves and to protect those who cannot be vaccinated
ThankYou
![Page 41: 8. Prof Butler - HPV for boys - hse.ie · High rates of infection across all age groups Impacted by certain diseases and cancers Remain susceptible throughout life –low rates of](https://reader030.vdocuments.site/reader030/viewer/2022040423/5e16ead840085c3c4030739d/html5/thumbnails/41.jpg)