About vaccination for carcinoma cervix, all are true EXCEPT:
ANSWER: (A) Does not require further examinationsREF: APPENDIX-71 APPENDIX - 71HPV VACCINE- CERVARIXType: Protein subunit Pregnancy category: BTarget disease: Human papillomavirus (Types 16 and 18, additionally some cross-reactive protection against virus strains 45 and 31 were shown in clinical trials)Cervarix vaccine will not block infection from cervical cancer-causing HPV strains other than HPV 16, 18,31 and 45 (ie however bivalent protects against four)"Two of these types (16 and 18) are believed to cause 70 per cent of these cases (76.7 per cent in Indian women).Type 16 is also associated with oropharyngeal squamous-cell carcinoma, a form of throat cancer.Cervarix shots will not block infection from cervical cancer-causing HPV types other than HPV types 16 and 18, so experts continue to recommend routine cervical Pap smears even for women who have been vaccinated.IngredientsHuman Papillomavirus type 16 LI protein 20 microgramsHuman Papillomavirus type 18 LI protein 20 microgramsAdjuvanted by AS04 (Adjuvant system 04) containing: 3-0-desacyl-4'- monophosphoryl lipid A (MPL) 50 micrograms adsorbed on aluminium hydroxide, hydrated (Al(OH)3) 0.5 milligrams *41 3 + in totalThe other ingredients are sodium chloride (NaCl), sodium dihydrogen phosphate dihydrate (NaH2P04.2 H20) and water for injections.BiotechnologyCervarix is created using the LI protein of the viral capsid. Recombinant activity in a baculovirus vector produces LI protein spheres, which are very immunogenic. The viral proteins induce the formation of neutralizing antibodies. The vaccine contains no live virus and no DNA, so it cannot infect the patient.LI protein is in the form of non-infectious virus-like particles (VLPs) produced by recombinant DNA technology using a Baculovirus expression system which uses Hi-5 Rix4446 cells derived from the insect Trichoplusia ni.HPV Vaccine AdministrationThe vaccine should be delivered through a series of three intra-muscular injections over a six-month period. The second and third doses should be given two and six months after the first dose (0,2,6)The vaccine can be administered at the same visit as other age-appropriate vaccines, such as Tdap, Td, MCV4, influenza, and hepatitis B vaccines.Storage:The vaccine should be stored at 2degC-8T (36degF-46degF) and not frozen.Cervarix vs Gradasil CervarixGradasilValencyBivalent vaccineQuadrivalent vaccineStrainsHPV viruses Types 16 and 18HPV viruses 16,18, 6,11ProtectionTypes 16 and 18, 45 and 31Types 16,18, 6,11Age group10 to 45 yrs9 to 26yrsImmune responseStronger and longerWeaker and shorterPregnancySafeContraindicatedOn the face of it a quadrivalent vaccine seems to be the better choice. In reality that is not so. The vaccine protects against the HPV viruses 16, 18, 6,11, of which only the first two are responsible for cervical cancer, while the other two are responsible for genital warts.On the other hand Cervarix gives protection against 16 and 18. It is better because, there is cross- reactive protection against the virus strains 45 and 31, two other viruses causing cervical cancer.Cervarix is formulated with AS04, a propriety adjuvant that boosts the immune system response for a longer period of time.Both vaccines are against the human papilloma virus but Cervarix seems to be more effective against cancer cervix.Cervarix can be given to females between 10 to 45 yrs old, whereas Gardasil can be given to females between 9 to 26 years only.Both the vaccines are given in the schedule of 0, 2t 6 months. Cervarix is the costlier one being priced at Rs. 3200 per dose. Cervarix seems to win against Gardasil because of its stronger immune response and broader protection.The study found that Cervarix generated more than 2x more antibodies than Gardasil for HPV type 16 and more than 6x more for HPV type 18 at seven months in all women aged 18-45 years (P<0.0001).At seven months Cervarix also induced 2.7x more memory B cells than Gardasil for both HPV types 16 and 18 (P< 0.0001) in women with no detectable B-cell response before vaccination.The vaccine has also been proven to be 99% effective in the prevention of genital warts caused by HPV types 6 and 11, which are responsible for 90% of all genital warts casesGardasil is not recommended for use in pregnant women, have immune problems, like HIV infection, cancer, or you take medicines that affect your immune system, have a fever over 100degF (37.8degC)Clinical trialsPhase II trials demonstrated 100% protection of the vaccine against types 16 and 18 HPVVaccination has been shown to offer protection for at least 6.4 years. In the clinical trials, women were given three doses over a six-month span--at 0 month, 1 month, and 6 months.Phase 3 trial data also suggest that the vaccine, formulated with a proprietary adjuvant system called AS04, is highly immunogenic and generally well-tolerated, with antibody levels at least 10 times greater than those produced by natural infection.Side effectsSerious side effects are less common. The most common side effects include:1. Reactions at the injection site, such as: Pain, Swelling, Redness, ItchingFeverUpset stomach (nausea)Dizziness.Groups for Which Vaccine is Not LicensedVaccination of Females Aged <9 Years and >26 YearsRecommendations for Routine Use and Catch-UpRoutine Vaccination of Females Aged 11-12 YearsCatch-Up Vaccination of Females Aged 13-26 YearsVaccination of MalesQuadrivalent HPV vaccine is not licensed for use among males. Although data on immunogenicity and safety are available for males aged 9-15 years, no data exist on efficacy in males at any age. Efficacy studies in males are under way.Special Situations among Females Aged 9-26 YearsEquivocal or Abnormal Pap Test or Known HPV InfectionFemales who have an equivocal or abnormal Pap test could be infected with any of approximately 40 high-risk or low-risk genital HPV types. Such females are unlikely to be infected with all four HPV vaccine types, and they might not be infected with any HPV vaccine type. Vaccination would provide protection against infection with HPV vaccine types not already acquired. With increasing severity of Pap test findings, the likelihood of infection with HPV 16 or 18 increases and the benefit of vaccination would decrease. Women should be advised that results from clinical trials do not indicate the vaccine will have any therapeutic effect on existing HPV infection or cervical lesions.Genital WartsA history of genital warts or clinically evident genital warts indicates infection with HPV, most often type 6 or 11. However, these females might not have infection with both HPV 6 and 11 or infection with HPV 16 or 18. Vaccination wrould provide protection against infection with HPV vaccine types not already acquired. However, females should be advised that results from clinical trials do not indicate the vaccine will have any therapeutic effect on existing HPV infection or genital wTarts.Lactating WomenLactating women can receive HPV vaccine.Immunocompromised PersonsBecause Quadrivalent HPV vaccine is a noninfectious vaccine, it can be administered to females wrho are immunosuppressed as a result of disease or medications. However, the immune response and vaccine efficacy might be less than that in persons who are immunocompetent.Vaccination During PregnancyQuadrivalent HPV vaccine is not recommended for use in pregnancy. The vaccine has not been causally associated with adverse outcomes of pregnancy or adverse events in the developing fetus. However, data on vaccination during pregnancy are limited. Until additional information is available, initiation of the vaccine series should be delayed until after completion of the pregnancy. If a woman is found to be pregnant after initiating the vaccination series, the remainder of the 3-dose regimen should be delayed until after completion of the pregnancy.
Does not require further examinations
Can be taken with other live vaccines at different site
Bivalent vaccine is more efficient than Quadrivalent
Administered intramuscularly at 0, 2 and 6 months
Management (Carcinoma Cervix)