Halima Shaban
20 April 2009
Kampala — Evace Abwoli, a health worker at Kampala City Council immunises City High School students against measles in 2003. The cervical cancer vaccine targets girls aged 10 to 12
THE pressures of modern day living expose many women to preventable health risks. When we live a healthy lifestyle, we can plan for the future, be there for our families and raise our children.
One such health risk is cervical cancer, caused by the Human Papilloma virus (HPV). It remains the leading cause of cancer deaths among women in Uganda, with 46 out of 100,000 women suffering from it.
Dr. Dan Murokora of the Uganda Women Health Initiative says since HPV is sexually-transmitted, life-long sexual abstinence or vaccination prior to the first sexual encounter offer the greatest protection against infection.
It is unlikely that many women will be able to abstain from sexual intercourse their entire lives, and neither does vaccination encourage them to begin sex early. "Vaccination is the most practical primary prevention activity to prevent cervical cancer," Murokora says.
The Programme for Appropriate Technology in Health (PATH), in collaboration with the Ministry of Health, piloted cancer vaccination in Nakasongola and Ibanda districts. It has also been carried out in India, Vietnam and Peru.
According to Dr. Emmanuel Mugisha, the country manager for Cervical Cancer Vaccine Project, the vaccine has not registered adverse side-effects. He says it specifically blocks two types of HPV, 16 and 18 and gets at the root of the cancer. In essence, the vaccine stops cervical cancer before it manifests.
The cervical cancer vaccine also blocks HPV types 6 and 11, which are not associated with cervical cancer, but are associated with genital warts and mild pap test abnormalities.
Vivian Tsu, the senior programme manager of PATH, says the vaccination targets girls aged between 10 and 12. "Women are at risk as soon as they start engaging in sexual activities. The vaccine is effective when one is vaccinated before becoming sexually active," she says.
Mugisha says the vaccine may also be used on girls as young as nine. This allows a girl's immune system to be activated before she is likely to get in contact with the HPV. Vaccination at this age also allows for the highest anti-body levels. The higher the antibodies, the greater the protection.
"Girls in Nakasongola have already received three doses of the vaccine, while those in Ibanda are awaiting their third dose. We registered coverage of over 90% for all the three doses in Nakasongola," Mugisha says.
The vaccine is given as a series of three injections over a six-month period. The second dose is given two months after the first dose and the third dose is given four months later.
"In early clinical trials, researchers observed that the anti-body levels in women continued to go up with each of the three doses of the vaccine. Since anti-body levels inevitably fall once you stop getting a vaccine, it makes sense to start with high anti-body levels to get the greatest HPV protection for the longest possible time - years or even decades," Mugisha says.
According to the World Health Organisation, about 510,000 new cases of cervical cancer are reported each year.
Tsu says HPV vaccination could reduce cervical cancer deaths in developing countries to the low levels currently observed in many developed countries, especially when combined with simple, evidence-based screening and treatment approaches.
Murokora says cervical cancer forms in the tissues of the cervix, an organ that connects the uterus to the vagina. It is usually a slow-growing cancer that may not have symptoms, but can be found with regular Pap tests, a procedure in which cells are scraped from the cervix and looked at under a microscope.
Mugisha says the cervical cancer vaccine has proved to be remarkably safe. "The most common complaint is soreness at the injection site (the upper arm). Low-grade fever or flu-like symptoms are also common. Sometimes dizziness or fainting occurs after the injection, especially in adolescents. Overall, the effects are usually mild."
Murokora says the cervical cancer vaccine is not intended to replace pap tests. "Routine screening for cervical cancer through regular pelvic exams and pap tests remains an essential part of a woman's preventive healthcare."
Dr. Olive Ssentumbwe from the World Health Organisation, says to detect cervical cancer in the earliest stages, one should have regular pelvic exams and pap tests.
"Seek prompt medical attention if you notice any signs or symptoms of cervical cancer - vaginal bleeding after sex, between periods or after menopause; foul-smelling watery or bloody vaginal discharge, pelvic pain, or pain during sex."
Cervical Cancer Facts
Cervical cancer affects an estimated 490,000 women worldwide each year and leads to more than 270,000 deaths
About 85% of women who die from cervical cancer reside in developing countries
If current trends continue, by 2050 there will be over one million new cases annually.
Cervical cancer can be prevented if precancerous lesions are identified and treated early
Most women in the developing world do not have access to screening and treatment programmes, making routine vaccination an important disease control strategy
New vaccines are safe and effective in preventing HPV and type-specific cervical lesions.
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