Khaliq Sheikh Abdul, Shyum Naqvi Syed Baqir, Fatima Anab
Department of Pharmaceutics, Hamdard University, Karachi, Pakistan.
Pak J Pharm Sci. 2012 Oct;25(4):763-72.
Incidences of different types of cancer are increasing in Pakistan, among which cancer of Cervix and Respiratory pappilomatosis are of great concern because of their association with human Pappilomavirus (HPV). Cervical cancers typically distress women of middle age or older; however it may affect women in any age after the puberty. Two serotypes of HPV (16 & 18) accounts 70% of cervical cancer cases, while HPV (6 & 11) are considered low-risk viruses associated with genital warts (Condyloma acuminata) and Respiratory pappilomatosis in both gender. Generally, there is transient role of HPV in human body and are removed by immune system in or around 1 year. Data from different Pakistani hospitals provides sound evidence for increasing trends of cervical cancer, which is, being developing country imperative for us. As the cost of cancer management is increasing day by day with poor survival rate and its burden is borne by patient, their family or society in-large, so if screening or prevention is possible then there would be need to identify target population for screening and vaccination. By quality adjusted life year (QALY) measurement, the data from different sources indicates that adolescent age is the appropriate target population and is cost effective for vaccination. Two vaccines manufactured by recombinant DNA technology are licensed in some parts of the world for prevention of HPV related cancers, however both have certain advantage over another, as one of the vaccines contains viral like proteins of two HPV serotypes 16 & 18 and provide additional cross protection against HPV type 13 and 45 with 100% seroprotection, while the other vaccine, being quadrivalent offers protection against four serotypes 6, 11, 16 and 18. Both vaccines tolerability and safety profiles are similar and acceptable, however bivalent vaccine appears to provide long-lasting immunity by the development of memory B-cells hypothetically due to difference of adsorbing agent used by manufacturer, on the other hand, quadrivalent vaccine offers protection against cervical cancer but also offers additional protection against Condyloma acuminata and respiratory Pappilomatosis. As these vaccines are new in the market and initial trials indicate availability of antibodies for up to around 5 years i.e. why it is controversial at the moment that whether booster dose is recommended or not, however it is assumed that, there is no harm to have booster dose at 5th year of vaccination.
巴基斯坦不同类型癌症的发病率正在上升，其中宫颈癌和呼吸道乳头状瘤病因与人乳头瘤病毒（HPV）有关而备受关注。宫颈癌通常困扰中年或老年女性；然而，青春期后的任何年龄段女性都可能受到影响。两种HPV血清型（16型和18型）占宫颈癌病例的70%，而HPV（6型和11型）被认为是与两性尖锐湿疣（尖锐湿）和呼吸道乳头状瘤病相关的低风险病毒。一般来说，HPV在人体内起短暂作用，大约1年内会被免疫系统清除。来自巴基斯坦不同医院的数据为宫颈癌上升趋势提供了有力证据，作为一个发展中国家，这对我们来说至关重要。由于癌症治疗成本日益增加，生存率低，其负担由患者、他们的家庭或整个社会承担，所以如果有可能进行筛查或预防，那么就需要确定筛查和疫苗接种的目标人群。通过质量调整生命年（QALY）测量，来自不同来源的数据表明青少年年龄组是合适的目标人群，并且疫苗接种具有成本效益。两种通过重组DNA技术生产的疫苗在世界某些地区被批准用于预防HPV相关癌症，然而两者各有优势，其中一种疫苗包含两种HPV血清型16型和18型的病毒样蛋白，并对13型和45型HPV提供额外的交叉保护，血清保护率达100%，而另一种四价疫苗可预防6型、11型、16型和18型四种血清型。两种疫苗的耐受性和安全性概况相似且可接受，然而二价疫苗似乎通过记忆B细胞的发育提供持久免疫力，这可能是由于制造商使用的吸附剂不同，另一方面，四价疫苗不仅能预防宫颈癌，还能额外预防尖锐湿疣和呼吸道乳头状瘤病。由于这些疫苗在市场上是新产品，初步试验表明抗体可存在约5年，即为什么目前关于是否推荐加强剂量存在争议，然而据推测，在接种疫苗的第5年进行加强剂量接种并无危害。
