06 Nov Global immunisation week reminds parents to take responsibility for protecting their child’s health by vaccinating

The last week of April is Global Vaccination Week. This project, initiated by the World Health Organisation (WHO), is intended to stimulate awareness of one of the world’s most successful and cost-effective health interventions responsible for saving millions of lives across the world. The theme of vaccination week in 2016 is Close the Immunisation Gap. It aims to celebrate the successes of reaching children all over the world with vaccines that prevent serious illness, but also to stress the challenges that still exist.¹

In terms of vaccination coverage, South Africa still has a number of important gaps of our own to address. In 2014 it was estimated that almost 19 million infants worldwide were not reached with routine immunisation services and more than 60 % of these children live in 10 countries, including Democratic Republic of Congo, Ethiopia, Nigeria, Uganda and South Africa.^{2  p3a} According to WHO, in 2013 less than 70 % of South African infants received their first dose of the diphtheria, tetanus and pertussis (DTP) vaccine, and only 65 % received the 3 doses required to complete the immunisation schedule.^{3 p161} South Africa is one of 65 countries whose coverage falls considerably short of the 2015 target of 90 % set by WHO for DTP vaccination.^{4  p2a} In contrast, 129 other countries do achieve at least that target.^{2 p1b}

The most recent introduction to South Africa’s immunisation schedule is the HPV vaccine. The gaps highlighted by this vaccine are surprising, where, unless families take responsibility for immunisation themselves, boys and children from wealthier families may be passed over by the national immunisation plan.

HPV, the human papillomavirus, is an infectious virus that causes cancer in men and women. It is responsible for cancer of the cervix (the opening to the uterus, or womb), the most common cancer in young women and the cause of the most number of deaths from cancer among South African women in general. ^{5,6  5. p3a; 6.p6a, 14a; piii} It may also cause other cancers including those of the mouth, throat, anus and penis.^{6,7  6. piii; 7.p1a}

HPV is sexually transmitted and adolescents and young adults aged 15 to 24 years of age are at highest risk of catching the virus. Nevertheless, at some time, almost everybody who is sexually active – around 8 out of 10 – will be exposed to the virus.  In most, however, the infection does not cause any symptoms or disease.^{5,8 5. p2b,c; 8. p71a} Although only a minority of people who are exposed to the virus will go on to develop cancer, at the present time there is no way of telling who that might be.

Vaccination against HPV is 90-100 % effective in causing immunity to develop to the most important viral strains that cause disease.^{9 p1003a, 10004a, 1005b} According to the WHO, by the end of 2014, the HPV vaccine was available in 63 countries around the world.^{2  p2a} In March of that same year the South African Department of Health, supported by WHO, introduced a national plan to vaccinate girls in Grade 4 (9 years and older) in public schools.^10,11

“Vaccination programs have been remarkably successful around the world, especially in countries like Australia and Rwanda”, says Professor Hennie Botha, Head of Gynaecological Oncology at the University of Stellenbosch. In Australia, in comparison to before the vaccine was routinely available, the proportion of women between the ages of 18 and 24 infected with the virus has decreased by 77 %!^12 p4a“In order to obtain good protection of the population as a whole, we need to vaccinate at least 70 % of schoolgirls”, explains Prof Botha. “So it is essential that parents understand how important it is to allow their daughter to be vaccinated. Myths that the vaccine is unsafe, causes infertility or leads to increased promiscuity have no basis and are simply not true! In contrast, not vaccinating your child leaves them at risk of devastating and potentially fatal disease in later life. At the moment only girls are receiving the vaccine, but there are plans to extend the vaccine also to boys in the future. Although the risk of cancer from HPV is lower in boys, young men can transmit the virus to their partners, so vaccinating them not only protects their own health, but adds to protecting the health of young women and those who are not vaccinated as well.”

Dr Trudy Smith, a Johannesburg-based gynaecologist agrees. “It would be ideal to vaccinate both boys and girls, but to have a significant impact on cancer, the most important and cost-effective strategy for the government is to start with girls”, she says. “The vaccine offered in schools helps to protect against two strains of the virus most commonly responsible for cancer (bivalent vaccine). However, there are also two other strains of HPV that cause genital warts and a different vaccine that covers all four of these strains (quadrivalent vaccine) is available that can protect boys and girls from both cancer and genital warts. HPV-associated cancer in men is relatively rare, so boys benefit more from receiving the quadrivalent vaccine and the bivalent vaccine is not registered for use in boys.”

Currently, the government does not provide free vaccination to children who are at private schools. “Parents with boys or children who are not at government-run schools need to be encouraged to take responsibility for their children’s health, because it is up to them whether the child gets an HPV vaccine or not”, says Dr Smith. “I strongly recommend that they speak to their local private vaccination clinic or GP about vaccinating. It can be done from 9 years of age and ideally before age 14, so that adolescents and young adults have the best possible protection long before they start any kind of sexual activity and are exposed to HPV. HPV is so common that almost everyone will be exposed at some point and most never know they are infected. So even if your son or daughter waits until marriage to have sex, or only has one partner in the future, they could still be exposed if their partner has been exposed to HPV.”

The quadrivalent vaccine to protect girls and boys from cancer and genital warts is available from your local private vaccination clinic or general practitioner.

References

1. World Health Organisation (WHO). World Immunization Week 2016: Close the immunization gap. Available at http://www.who.int/campaigns/immunization-week/2016/event/en/. Accessed 4 March 2016.
2. World Health Organisation Immunization coverage. Fact sheet N°378. Updated September 2015. Available at http://www.who.int/mediacentre/factsheets/fs378/en/#. Accessed 3 March 2016.
3. Immunization Summary. A statistical reference containing data through 2013. 2014 Edition. WHO & UNICEF 2014. Available at: http://www.who.int/immunization/monitoring_surveillance/Immunization_Summary_2013.pdf. Accessed 4 March 2016.
4. World Health Organisation (WHO). Global vaccination targets ‘off-track’ warns WHO. Available at: http://www.who.int/mediacentre/news/releases/2015/global-vaccination-targets/en/. Accessed 4 March 2016.
5. Weaver BA. Epidemiology and natural history of genital human papillomavirus infection. JAOA 2006; 106(3 Suppl 1): S1-S8.
6. Bruni L, Barrionuevo-Rosas L, Albero G, et al. ICO Information Centre on HPV and Cancer (HPV Information Centre). Human papillomavirus and related diseases in South Africa. Summary Report 2016-02-01. Available at: http://www.hpvcentre.net. Accessed 2 March 2016.
7. Centers for Disease Control and Prevention (CDC). Tips and time-savers for talking with parents about HPV vaccine 2016. http://www.cdc.gov/vaccines/who/teens/for-hcp-tipsheet-hpv.html. Accessed 3 March 2016.
8. Denny L. Cervical cancer in South Africa: An overview of current status and prevention. CME 2010; 28(2): 70-73.
9. De Vincenzo R, Conte C, Ricci C, et al. Long-term efficacy and safety of human papillomavirus vaccination. Int J Women’s Health 2014; 6: 999-1010.
10. World Health Organisation regional office for Africa.

http://www.afro.who.int/en/south-africa/press-materials/item/6395-who-hpv-vaccination-readiness-assessment-picture-story.html. Accessed 4 March 2016.

11. South African Government News Agency. HPV vaccination campaign to be rolled out in schools. 12 March 2014. Available at: http://www.sanews.gov.za/south-africa/hpv-vaccination-campaign-be-rolled-out-schools. Accessed 3 March 2016.
12. Bonanni P, Bechini A, Donato R, et al. Human papilloma virus vaccination: impact and recommendations across the world. Ther Adv Vaccines 2015; 3(1): 3-12.