英國HPV疫苗接種計劃今年秋季將延伸至男孩
資料來源:彼得.羅素,2019年7月9日,Medscape每週回顧,財團法人台灣紅絲帶基金會編譯
健康專家說,今年秋天在英國男孩接種人類乳突狀瘤病毒(HPV)疫苗的成功可能取決於反制所謂的「反疫苗」( anti-vax )遊說活動。
從今年9月開始,英國8年級男生將首次獲得免費的HPV疫苗。英國公共衛生部(PHE)表示,此舉可能導致至2058年當這些男孩50歲時的口咽、陰莖和肛門的癌症減少28,952例。
青少年男孩的免費HPV疫苗接種也將在2020年春季和夏季於北愛爾蘭、威爾斯,以及在新學年開始的第一學期於蘇格蘭為男孩提供。
延伸該計劃是在去年7月由疫苗接種和免疫聯合委員會(the Joint Committee on Vaccination and Immunisation , JCVI)的建議之後所做出的決定。
子宮頸癌
自2008年以來,英國的女孩在國家健康服務( NHS )計畫中接種了HPV疫苗。
當JCVI推薦普遍的針對女孩接種HPV疫苗計劃時,其優先考慮的是降低子宮頸癌的發病率。它決定當女孩的接種的高覆蓋率將為男孩提供「群體保護」( herd protection )。
十年後,委員會決定現在有更強有力的證據顯示HPV與非子宮頸癌亦有關,這些癌症對男性和女性都有影響,疫苗接種有助於預防這些與HPV相關的其他癌症。
英國公共衛生部( PHE )表示,華威大學製作的模型估計,到2058年,HPV疫苗可預防多達64,138例HPV相關子宮頸癌和49,649例其他HPV相關癌症。
英國牙科協會(BDA)曾提出擴展協議,以幫助對抗口腔癌的上升率,並警告說,由於反對接種疫苗的活動人士越來越多,該計劃的成功處於危險之中。
協會說,由官方數據顯示,近兩年,女孩兩劑疫苗的接種率有所下降。
英國牙科協會呼籲政府加倍努力,教育父母了解男孩和女孩接種疫苗的重要性。
男孩們錯過了追補計劃
自2019年9月起,第一劑HPV疫苗Gardasil(Merck Sharp&Dohme)將如同年齡在12歲和13歲的8年級女生提供疫苗般的為男孩接種。第二劑將在6個月後至24個月之間提供。
15歲以後接種第一次疫苗的女孩和男孩需要接種三劑。
對於年齡較大的男孩,將不會有「追補」疫苗接種計劃。
PHE免疫接種主任Mary Ramsay博士說:「這項普及的計劃將為我們提供了以女孩計劃的成功為基礎並讓HPV相關疾病成為過去的機會」。
「向男孩提供疫苗不僅可以保護他們,還可以預防更多女孩罹患HPV相關癌症的病例,並減少未來男性和女性這些相關癌症的整體負擔」。
威爾斯首席醫療官Frank Atherton博士說:「最近的一項研究表明,有令人信服的證據顯示HPV疫苗接種計劃對女孩、婦女,男孩和男人的HPV感染和癌症前期增長產生了實質性影響」。
「我希望所有符合條件的男孩和女孩的父母都能接受這種拯救生命的疫苗」。
蘇格蘭政府發言人表示,確保符合條件的人接種疫苗將「在未來幾年拯救生命」。
英國國民健康服務部門表示,到目前為止,已經為15至24歲的年輕女性提供了1,000萬劑HPV疫苗 – 超過80%的世代。
反制反對疫苗接種的運動者
英國牙科協會(BDA)表示,接受比率仍然低於「群體免疫力」所需的90%至95%的涵蓋率,且雖然80%的疫苗接種目標得以實現,但區域接受比率之變化依然存在。
它表達了對社交媒體上虛假的聲稱中,將疫苗接種與嚴重健康狀況聯繫起來以及亦有報導稱已將反疫苗接種信息插入兒童書籍當中上的擔憂,。
BDA主席Mick Armstrong說:「一項普及的HPV計劃將為所有兒童提供保護,讓他們免受喉癌等改變生活的疾病的影響。但是,隨著女孩們接受比率已經衰退,部長們需要消除噪音,並明確表示令人信服的案例」。
「在線上和離線時,父母都被假新聞和糟糕的偽科學所轟炸。我們需要對一種堅實鞏固的、以證據為基礎的方法進行真正的投資,而不與這些神話製造者有任何牽扯」。
BDA表示,它也希望看到針對男孩的「補種」計劃。
英國免疫學會會長Arne Akbar教授說:「政府現在需要與英國國民健康服務部門( NHS )和地方當局合作,確保我們繼續努力,積極向家長和青少年傳達這種疫苗的重要健康益處」。
「我們鼓勵符合條件的男孩和女孩的父母接受這項提議,並用HPV疫苗保護後代免受這些可預防的疾病」。
劍橋大學病理學系主任Geoffrey Smith教授評論道:「我們應該始終記住疫苗接種的巨大好處。預防勝於治療,預防最容易透過疫苗接種實現。最終的疫苗接種可以導致如同根除夭花的成效」。
「只有權利」,男孩們也應提供相同的保護
英國醫學會理事會主席Dame Parveen Kumar教授評論道:「鑑於越來越多的證據表明HPV也是一系列可能影響男性的癌症的原因,這是非常重要的一步」。
「在女孩接種疫苗計劃取得成功之後,男孩現在得到同樣的保護是正確的J」。
Wolfson預防醫學研究所所長兼倫敦瑪麗女王大學癌症預防中心負責人Jack Cuzick教授對男孩接種疫苗計劃表示歡迎,但他說,最重要的優先順序是「保持或進一步提高女孩的疫苗接種率」。
Cuzick教授呼籲該計劃用Gardasil 9取代替目前的疫苗Gardasil 4,以防止更多類型的癌症。
Arne Akbar教授從生物技術和生物科學研究委員會(BBSRC),醫學研究委員會(MRC)和Dermatrust等機構獲得資助。
UK HPV Vaccination Programme Extended to Boys This Autumn
Peter Russell/ July 09, 2019/ Medscape Week in Review
The success of extending human papilloma virus (HPV) vaccination to boys in England this autumn could depend on countering the activities of the so-called ‘anti-vax’ lobby, health experts said.
From September this year, boys in school year 8 in England will be offered the free HPV vaccine for the first time. The move could lead to a reduction of 28,952 cases of oropharyngeal, penile, and anal cancers among boys in the 50 years up to 2058, Public Health England (PHE) said.
Free HPV vaccination for adolescent boys will also be made available for boys in Northern Ireland, Wales in Spring and Summer terms in 2020, and year S1 in Scotland at the start of the new academic year.
The decision to extend the programme followed a recommendation by the Joint Committee on Vaccination and Immunisation (JCVI) in July last year.
Cervical Cancer
Girls have been offered the HPV vaccine on the NHS in the UK since 2008.
When the JCVI recommended a universal HPV vaccine programme for girls its priority was to reduce rates of cervical cancer. It decided that high coverage in girls would provide ‘herd protection’ to boys.
Ten years later the Committee decided there was now stronger evidence that HPV was associated with non-cervical cancers, which affect men as well as women, and that vaccination would help prevent these other HPV-related cancers.
PHE said modelling produced by the University of Warwick estimated that the HPV vaccine could have prevented up to 64,138 HPV-related cervical cancers and 49,649 other HPV-related cancers by 2058.
The British Dental Association (BDA), which had pressed for the extension to help combat rising rates of oral cancers, warned that the success of the programme was in jeopardy because of the rising profile of campaigners opposed to vaccination.
It said that official data showed that uptake rates among girls for two doses of the vaccine had fallen in recent years.
The BDA called on the Government to redouble efforts to educate parents about the importance of vaccination for boys and girls.
Boys to Miss Out on Catch-up Programme
From September 2019, the first dose of the HPV vaccine, Gardasil (Merck Sharp & Dohme) will be offered to boys as well as girls aged 12 and 13 in year 8. The second dose will be offered between 6 months to 24 months later.
Girls and boys who have their first vaccination after the age of 15 will need to have three doses.
There will be no ‘catch-up’ vaccination programme for older boys.
Dr Mary Ramsay, head of immunisation at PHE, said: “This universal programme offers us the opportunity to make HPV-related diseases a thing of the past and build on the success of the girls’ programme.
“Offering the vaccine to boys will not only protect them but will also prevent more cases of HPV related cancers in girls and reduce the overall burden of these cancers in both men and women in the future.”
Dr Frank Atherton, the Chief Medical Officer for Wales, said: “A recent study has shown that there is compelling evidence of the substantial impact of HPV vaccination programmes on HPV infections and pre-cancerous growths among girls, women, boys and men.
“I hope that all parents of eligible boys and girls will take up the offer of this life-saving vaccine.”
A Scottish Government spokesperson said ensuring that eligible people were vaccinated would “save lives in years to come”.
NHS England said that so far, 10 million doses of HPV vaccine have been given to young women aged 15 to 24 – over 80% of the cohort.
Countering Campaigners Opposed to Vaccination
The BDA said uptake remained below the 90% to 95% needed for ‘herd immunity’, and that while the 80% vaccination target was being met, regional uptake variations persisted.
It expressed concerns over false social media claims linking vaccination with serious health conditions, and by reports that anti-vaccination messages had been inserted into children’s books.
Mick Armstrong, BDA chair, said: “A universal HPV programme will offer protection to all children from life-changing conditions like throat cancer. But with uptake among girls already in decline, ministers need to cut through the noise, and make a clear and compelling case.
“Online and off, parents are being bombarded with fake news and bad science. We need real investment in a hard-nosed, evidenced-based approach that pulls no punches with the myth-makers.”
The BDA said it also wanted to see a catch-up programme for boys.
Prof Arne Akbar, president of the British Society for Immunology, said: “The Government now needs to work with the NHS and local authorities to ensure that we maintain efforts to actively communicate the important health benefits of this vaccine to parents and adolescents.
“We encourage parents of eligible boys and girls to take up the offer and protect future generations against these preventable diseases with the HPV vaccine.”
Prof Geoffrey Smith, head of the Department of Pathology at the University of Cambridge, commented: “We should remember always the huge benefits of vaccination. Prevention is better than cure, and prevention is most easily achieved by vaccination. Ultimately vaccination can lead to eradication as was shown with smallpox.”
‘Only Right’ That Boys Are Offered the Same Protection
Prof Dame Parveen Kumar, chair of the British Medical Association’s Board of Science, commented: “Given the growing body of evidence that HPV is also responsible for a range of cancers that can affect men, this is a very important step.
“Following the success of the vaccination programme for girls, it is only right that boys are now afforded the same protection.”
Prof Jack Cuzick, director of the Wolfson Institute of Preventive Medicine and head of the Centre for Cancer Prevention at Queen Mary University of London welcomed the vaccination programme for boys but said the highest priority should be to “maintain or improve further the vaccine coverage in girls”.
Prof Cuzick called for the programme to substitute the current vaccine, Gardasil 4, for Gardasil 9, which protects against more types of cancer.
Prof Arne Akbar receives grant funding from the Biotechnology and Biological Sciences Research Council (BBSRC), Medical Research Council (MRC), and Dermatrust.