HPV Vaccination – MOH viewpoint and more points to ponder

From the DG’s Facebook page

In the case of HPV vaccination our experience showed that the HPV is well tolerated. The side effects commonly reported are mild and within the accepted range of reported rates. In view of enormous public interest (locally and globally) rest assure our monitoring is very active. In our country all those who had vaccination (with or without adverse effect) will have to report to our school health team post vaccination, despite this the rate is very low, less than 1%). A report, as of June 22, 2011, approximately 35 million doses of the quadrivalent vaccine were distributed in the US and they received a total of 18,727 reports of adverse events i.e. 0.0535%, following vaccination (ours on average is about 0.08%).

Now with such data in hand do we need to ban the HPV vaccination or all vaccinations for that matter? More importantly the benefit far outweighed the risk and it should continue unless we have data to tell us otherwise

An important statement in the light of some persistent anti-vaccination sentiment and confusing news in the media like Japan Withdrawing HPV Vaccine Recommendation for Girls
Perhaps other important points are who to vaccinate and the implications of vaccination and proper counselling. In a previous post in the MMR by Dr. SF Lee: Mass Human Papilloma Virus (HPV) vaccination of women in the general population he pointed out that while the vaccine is effective in preventing HPV infection, he mentioned “it may have much lower levels of efficacy in a “real world” setting, particularly in women above aged of 18 and already sexually active”. While the MOH announced Free HPV vaccination for 18 year old women and allocated RM50 million in 2012 for this purpose, Dr. Lee points out :

The criteria of being 18 years old and single does not mean that the woman has not been infected with the HPV. Mass vaccination like this may give them a false sense of security and yet may not provide any benefit in terms of the natural progression of the disease in those already infected. There is concern that vaccinated women may feel protected from cervical cancer and may be less likely than unvaccinated women to pursue screening. Vaccination of secondary target populations of older adolescent females or young women is recommended only if this is feasible, affordable, cost effective, does not divert resources from vaccinating the primary target population or effective cervical cancer screening programs, and if a significant proportion of the secondary target population is likely to be naive to vaccine-related HPV types. With so many essential questions still unanswered, there is good reason to be cautious about introducing large-scale vaccination programs. Instead, we should be more selective and focus on the groups where the benefit is maximal. In view of this, the Government of Malaysia and the relevant Ministries should re-look again into this program of mass vaccination and evaluate whether the RM 50 million is worth it.