Capstone Project: HPV and Vaccination

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Human papilloma virus is among the most common diseases which are transmitted sexually. It is a dangerous public health issue because HPV leads to oncogenic complications of the anogenital area in both males and females without a strong correlation with age factors. Many countries have already implemented national HPV vaccination programs in accordance with WHO recommendations.

However, already in a number of countries, there is a potential for complete disappearance or decrease of anogenital warts within the population, which is associated with the short incubation period of this HPV and is the first marker of the effectiveness of vaccination in the population. Therefore, it is important to bring awareness to the importance of vaccination against HPV in order to prevent associated complications in terms of various oncogenic health abnormalities.

Background

Human papillomavirus (HPV) is a category of widespread and genetically heterogeneous DNA viruses that infect the epithelium of the mucous membranes and skin. Papillomaviruses affect a wide range of vertebrates, and HPV virions contain double-stranded, annularly twisted DNA and are devoid of a sheath. The capsid is an icosahedron about 55 nm in diameter, composed of several capsomeres. HPV is lipid-free and is inactivated by fat solvents (CITE).

During replication, the virus releases a number of proteins, the synthesis of which is controlled by early and late genes. Early genes control the processes of replication, transcription, and transformation.

They are responsible for the oncogenic properties of HPV, in part due to the fact that they bind proteins in epithelial cells – regulators of cell division, thus inactivating their suppressive functions. Late genes encode the structural proteins of the virion, and these are always found in tumor cells. Other fragments of the viral genome are not detected since they can be lost during its long-term replication.

The human papillomavirus replication process is divided into two main stages. The initial phase of the HPV infectious process is characterized by the persistence of the virus in episomal form. During this period, the cell is capable of producing viral particles, and this stage is called the stage of reproductive infection. The late-stage is an integrative infection, and at this stage, the virus DNA is inserted or integrated into the genome of the infected cells.

The true latency of HPV in the host organism corresponds to this stage. The initial stage is reversible, and many infected people can go into remission. The stage of integrative infection is the first step towards tumor cell degeneration and often ends with the development of carcinoma. These stages of viral infection correspond to two different clinical forms of the disease, such as transient and latent, respectively.

HPV and Associated Diseases

The high incidence of sexually transmitted infections in the population attracts the attention of specialists from all countries due to the frequent development of complications leading to dysfunction of the reproductive system. It is important to consider one of the urgent problems of modern medicine, which is a human papillomavirus infection. It ranks first in terms of prevalence among sexually transmitted diseases. Most of the sexually active population becomes infected with human papillomavirus during their lifetime.

HPV causes a wide range of cancers of the reproductive system, including cervical, vulvar and vaginal cancers, as well as anal and anogenital warts, which are common in both men and women (Hu & Ma, 2018). The only reliable method of preventing human papillomavirus infection is vaccination.

Historically, HPV has been infecting humans for a long time because warts, both on the hands and plantar, were known as early as the time of the ancient Greeks and Romans, and external anogenital warts are common across various populations. Human papillomaviruses that infect epithelial cells of the skin and mucous membranes are etiologically associated with the development of pathological changes in the cervix and cervical cancer as well as anogenital warts or condylomas and recurrent respiratory papillomatosis.

Increased Risk of Cancer

HPV causes a wide range of cancers of the reproductive system, including cancer of the cervix, vulvar and vaginal cancers, as well as cancer of the anal canal and anogenital warts. The occurrence of cervical cancer in young women is a serious social problem that leads to a deterioration in the quality of health, disability and a decrease in fertile function. HPV-associated diseases are a significant health burden in many nations. HPV is associated with other malignancies such as squamous cell cancers of the penis, vagina, vulva, anus, and neck and head (Bansal et al., 2016).

The diagnosis of papillomavirus infection is made on the basis of clinical manifestations, histological examination, colposcopy data, determination of the virus DNA by the polymerase chain reaction method. The most effective and promising is a complex combined method of therapy when the local removal of altered tissues is carried out against the background of systemic treatment. There is no specific antiviral therapy, and therefore, previous treatment cannot protect against the recurrence of the disease, which means that it is symptomatic.

Vaccination and Its Effects

Vaccination can be used as a highly effective preventative tool that ensures the human body immunization against HPV. It is stated that vaccination-based preventative measures can significantly reduce the occurrence rate of cervical cancer (Egli-Gany et al., 2019). Vaccination primarily contains virus-like particles that do not induce infection among the cells, but it triggers the immune response.

The immune system launches the process of antibody generation that can identify these virus-like particles through complementary protein-protein interaction. The fact that vaccines do not contain the entirely functional virus allows the body to form immunity-based memory, which will be ready for further infections of HPV. The basis for the prevention of HPV-associated pathological conditions, such as cervical cancer, is vaccination.

HPV vaccines have been registered and used in many countries for a long time. The main types of vaccines are the bivalent vaccine and the quadrivalent vaccine (Petrosky et al., 2015). The bivalent vaccine protects against cervical cancer, cancer of the vulva, vagina, cervical intraepithelial neoplasias of various degrees, and persistent HPV infection.

The quadrivalent vaccine protects against cervical cancer, cancer of the vulva, vagina, anal cancer, anogenital warts, cervical, anal, vulvar, and vaginal intraepithelial neoplasias, and adenocarcinoma in situ. International clinical trials have confirmed a wide range of protection of quadrivalent and nine-valent HPV vaccines and made it possible to recommend it for the prevention of not only cervical cancer but also cancer of the vulva, vagina, anal canal and anogenital warts in both sexes (Bergman et al., 2019).

It is critical to note that the use of a nine-valent version of the vaccine can be more effective at reducing the occurrence of certain forms of cancer compared to quadrivalent ones (Petrosky et al., 2015). Thus, vaccination provides effective protection against the most dangerous types of HPV, which are the cause of severe HPV-associated lesions and cervical cancer.

Vaccination prevents infection during the first sexual contact as a result of which its greatest effectiveness is observed during vaccination even before the onset of sexual activity. Vaccination is effective for the prevention of HPV infection and diseases associated with HPV, including precancer and cervical cancer.

Vaccination as a Prevention and Risk Reduction Tool

A special place in the primary prevention of human papillomavirus infection is occupied by the use of antiviral HPV vaccines. In order to protect against HPV-associated diseases, it is advisable to vaccinate girls and boys aged 12-13 years before the onset of sexual activity and potential exposure to HPV. It is stated that young girls can expect an improved level of outcome regarding HPV-related cancer due to vaccination (Brisson et al., 2020).

Thus, in order to obtain a meaningful result, the maximum coverage is required, which is possible within the framework of the implementation of regional health development programs. For example, extensive research in Kenya showed that vaccine-based prevention could be highly effective in addressing the issue of cervical cancer (Menon et al., 2016). Vaccination against HPV will indirectly affect such items of regional health development programs as the prevention of HPV-associated diseases.

In addition, it is important to improve the provision of specialized, including high-tech, medical care, the development and implementation of innovative methods of prevention, and the protection of the health of mothers and children. Vaccines can significantly reduce the global burden of HPV-associated disease (Jacot-Guillarmod et al., 2017).

In cities and regions where there is no government immunization program, pediatricians should inform patients and their parents about the possibility of vaccination in specialized centers to protect against the serious consequences of HPV infection. One should be aware that human papilloma virus is among the most influential factors of carcinogens that lead to oncogenic complications (Petrosky et al., 2015). The relationship between infection with HPV types of oncogenic risk and the development of cancer of the cervix, anogenital region, and oropharynx have been established and proven.

One of the most effective methods of preventing these diseases is vaccination against human papillomavirus. There are currently three HPV vaccines that are commonly used and safe in preventing HPV infection. These include bivalent, tetravalent, and nine-valent HPV vaccines, which protect against HPV 16 and 18; HPV 6, 11, 16, and 18; and HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58, respectively (Petrosky et al., 2015).

It is important to understand that human papilloma virus 16 and 18 are the leading cause of nearly all cervical cancers worldwide (Petrosky et al., 2015). HPV 6 and 11 are found in most of all anogenital warts. However, there are a number of problems associated with the implementation of the vaccination program, one of which is the low level of public awareness of the effectiveness and safety of vaccination.

Vaccination Awareness

It is critically important to bring elevated awareness on vaccination both globally and locally in order to ensure that citizens strive to acquire the immunization against HPV. It can be achieved through the active involvement of the government, which needs to allocate the necessary amount of budget to conduct nation-level vaccination. The benefit will be manifested in two forms, such as public health improvement and financial cost reduction of healthcare spending. Although HPV vaccination does not provide an immediate effect, the awareness campaign needs to present the program as a long-term investment into a public’s future.

Use of Vaccination in Different States

Given the high prevalence of HPV infection, its significant contribution to the structure of morbidity and mortality in women from cancer, it becomes clear that this problem needs to be addressed at the state level. Although global eradication of HPV requires to take place at a worldwide scale, the implementation and practical use need state-level integration. By ensuring each state allocates the required budget into the prevention program, it will be possible to reduce instances of oncogenic manifestation by a substantial margin.

Problematic Access to Vaccines in Poor Regions

The main issue of eradicating the HPV virus globally is the fact that many disadvantaged regions have no proper access to vaccination. For instance, the study concludes that the overall increase of cervical cancer instances in Asia is partially linked with the lack of access to vaccination-based prevention (Toh et al., 2017). Such regions require intervention from global organizations and charity foundations in order to ensure that vaccination is implemented and accessible. Delivering vaccines into these regions are necessary in order to reduce HPV spread and other measures, such as intercourse protection, might be needed.

Ways to Promote Awareness

One of the main approaches in promoting awareness on HPV vaccination is the governmental involvement in raising the concern. In addition, public and health officials need to be proactive in informing the masses on both potential dangers of HPV-related complications and possible solutions. Private institutions can also be active proponents of vaccination-based prevention by advancing vaccine access and developing screening methods. Thus, awareness is directly dependent on the commonality of knowledge regarding the issue.

Possible Improvements Due to Increased Awareness

Increased awareness regarding HPV prevention through vaccination can have a major impact on public health. It is important to note that although the latter approach is considered to be a primary prevention tool, it can be supplemented by secondary techniques, such as screening (Finocchario-Kessler et al., 2016).

The most probable improvement will come in a span of years when vaccinated HPV-immune young individuals will reach the average age of cervical cancer occurrence. A significant drop in the instances of HPV-related complications will be a powerful signal of the successful implementation of vaccination.

Perspectives

Screening and vaccination as a preventative tool alone can result in significantly improved outcomes in terms of public health. The current advancement in the prevention of HPV can be improved through modeling techniques that assist in ensuring effective prevention measures (Canfell et al., 2019). Some researchers suggest a new shift in the paradigm of understanding HPV’s oncogenic effects, but the support for vaccine-based prevention remains relevant (Chrysostomou et al., 2018). Modeling can be highly effective at predicting the movement pattern of the virus as well as generating a distribution map.

Conclusion and Recommendations

In conclusion, the human papilloma virus is one of the major causes of various forms of cancer, where the most prominent one is cervical cancer. Although there are no effective methods of virus elimination post-infection, vaccination can be highly effective at prevention of HPV-related complications. It is important to understand that there are a number of vaccine versions available, where quadrivalent and nine-valent forms are the most common.

A wide range of studies supports the fact that vaccines are effective at significantly reducing the instances of cervical cancer and other oncogenic complications. Therefore, the key recommendation is to raise the public’s overall awareness of the ramifications of HPV and available solutions to the problem.

References

Bansal, A., Singh, M., & Rai, B. (2016). Human papillomavirus-associated cancers: A growing global problem. International Journal of Applied Basic Medical Research, 6(2), 84-89. Web.

Bergman, H., Bucklery,B., Villanueva, G., Petkovic, J., Garritty, C., Lutje, V., … Henschke, N. (2019). Comparison of different human papillomavirus (HPV) vaccine types and dose schedules for prevention of HPV‐related disease in females and males. Cochrane Database Systemic Review, 2019(11). Web.

Brisson, M., Kim, J., Canfell, K., Drolet, K., Gingras, G., Burger E.A., … Hutubessy, R. (2020). Impact of HPV vaccination and cervical screening on cervical cancer elimination: A comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet, 395(10224), 575-569. Web.

Canfell, K., Kim, J., Kulasingam, S., Berkhof, J., Barnabas, R., Bogaards, R., … Jit, M. (2019). HPV-FRAME: A consensus statement and quality framework for modelled evaluations of HPV-related cancer control. Papillomavirus Research, 8, 100184. Web.

Chrysostomou, A., Stylianou, D., Constantinidou, A., & Kostrikis, K. (2018). Cervical cancer screening programs in Europe: The transition towards HPV vaccination and population-based HPV testing. Viruses, 10(12), 729. Web.

Egli-Gany, D., Zographos, A., Diebold, J., Masserey, V., Tirri, B., Heusser, R., … Low, N. (2019). Human papillomavirus genotype distribution and socio-behavioural characteristics in women with cervical pre-cancer and cancer at the start of a human papillomavirus vaccination programme: The CIN3+ plus study. BMC Cancer, 19, 111. Web.

Finocchario-Kessler, S., Wexler, C., Maloba, M., Mabachi, N., Ndikum-Moffor, F., & Bukusi, E. (2016). Cervical cancer prevention and treatment research in Africa: A systematic review from a public health perspective. BMC Women’s Health, 16, 29. Web.

Jacot-Guillarmod, M., Pasquier, J., Greub, G., Bongiovanni, M., Achtari, C., & Sahl, R. (2017). Impact of HPV vaccination with Gardasil® in Switzerland. BMC Infectious Diseases, 17, 790. Web.

Hu, Z., & Ma, D. (2018). The precision prevention and therapy of HPV‐related cervical cancer: New concepts and clinical implications. Cancer Medicine, 7(10), 5217-5236. Web.

Menon, S., Wusiman, A., Boily, M., Kariisa, M., Mabeya, H., Luchters, S., … van den Broeck, D. (2016). Epidemiology of HPV genotypes among HIV positive women in Kenya: A systematic review and meta-analysis. PLoS One, 11(10), e0163965. Web.

Petrosky, E., Bocchini, J. A., Jr, Hariri, S., Chesson, H., Curtis, C. R., Saraiya, M., Unger, E. R., & Markowitz, L. E. (2015). Use of 9-valent human papillomavirus (HPV) vaccine: Updated HPV vaccination recommendations of the advisory committee on immunization practices. Morbidity and Mortality Weekly Report, 64(11), 300-304. Web.

Toh, Z., Licciardi, P., Russel, F., Garland, S., Batmunkh, T., & Mulholland, E. (2017). Cervical cancer prevention through HPV vaccination in low- and middle-income countries in Asia. Asian Pacific Journal of Cancer Prevention, 18(9), 2339-2343. Web.

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