HPV vaccinations for girls to start in November

"The traditional pap test enables about 80% of cases of cervical cancer to be successfully prevented. But this good long-term trend has stopped, and incidence of the disease in young people has even increased slightly. We now want to address the problem by making human papilloma virus (HPV) vaccinations for girls part of the national vaccination programme," says Taneli Puumalainen, Senior Medical Officer at the MSAH.

In Finland, some 150 women are diagnosed with cervical cancer every year, and about 50 of them succumb to the disease. There are about 34 000 abnormal pap test results requiring follow-up procedures, and in some 3000 cases precancerous findings that require treatment.

Only some of the HPV group of viruses cause cancer. Others may be harmless, or may cause molluscum or genital warts. Cervical cancer is the most common cancer caused by HPV viruses.

About 80% of the population will contract an HPV infection that could potentially cause cancer. In some people, the virus induces a chronic infection that may bring about cellular changes, and eventually the development of cancer. The HPV vaccine has been proven to prevent the precancerous lesions otherwise leading to the development of the actual cancer.

"The purpose of reaching a whole age group with vaccinations is to prevent the precancerous lesions caused by HPV and cases of cancer," says Puumalainen. "Because the virus is so widespread, condom use is insufficient in halting the spread of the disease, and neither are pap tests enough in getting rid of the problem."

Vaccination works best when it is given before an individual becomes sexually active. The target group in Finland is 11-12 year-old girls. In the beginning of the program also girls aged 13-15 years will have a chance to be vaccinated. The recommendation is that vaccination should begin with ninth grade school pupils, so that they are protected from HPV before they end primary school. The vaccination series includes three shots given over a six-month period. Some 30 000 girls will be vaccinated annually.

"The vaccinations will begin in November. Municipal school healthcare services are ultimately in charge of the practical arrangements and the vaccination schedule," Puumalainen explains.

The vaccination of girls against HPV is already practiced in most parts of Western Europe, and other high-income countries. But developing and middle-income countries are also increasingly starting vaccination programmes for cervical cancer prevention.

The World Health Organization (WHO) has estimated that of the 270 000 deaths from the disease in 2013 worldwide, 80% were in developing countries, particularly sub-Saharan Africa.

HPV is the primary cause of cervical cancer, which is the second most common cancer, after breast cancer, in women aged 15-44 in the European Union (EU). There are about 33 000 cases of cervical cancer in the EU, and 15 000 deaths each year.

In Finland, procuring vaccinations for the national vaccination programme always entails a rigorous analysis of the public health and cost impact. As a result, Finland's deployment of HPV vaccination program is taking place a few years later than in many comparable countries. There are also differences in approach.

In Sweden the vaccine being used also prevents genital warts. In Finland, the MSAH selected a vaccine on the basis of tender that has a broader protective effect against cervical cancer but does not protect against genital warts. The vaccine prevents up to 95% of HPV 16 and HPV 18, which cause most of the precancerous lesions in the cervix.

HPV infections are asymptomatic. People are likely to be exposed to infection within the first three years after becoming sexually active. Preventive vaccinations protect from infection caused by several of the cancer-inducing types of HPV. The HPV vaccination does not cure an infection that is already there but when the vaccination is given early enough it can protect from most infections caused by cancer-inducing HPV types.

Puumalainen explains that the use of pap screening tests will continue following the HPV vaccine rollout. "We will take up issues concerning optimal pap screening process and the vaccination of boys in the coming years, once we have more research data."

He says that WHO statistics show that HPV vaccines have been given to some 170 million girls and young women.

"Vaccinated girls are as a rule 11-13-year.olds. It will take some time before they become sexually active and be exposed to HPV infection. After this, it will be possible to get final results on cancer prevention from the vaccination programme. However, research has been going on for a long time and it shows that the vaccine provides good protection and is well tolerated. The most significant reported side effects of vaccination are temporary pain and swelling."

Puumalainen considers HPV immunisation to be an important aspect of health promotion for the young.

He says that the issue has been extensively researched, including at the University of Tampere. "The findings show that having HPV vaccination does not, for instance, lower the age of sexual debut or reduce condom use. Vaccination, together with information and other measures, is a good way to safeguard young people's sexual health."