As we deal with the COVID-19 vaccination drive in Kenya, a single dose of the HPV vaccine could save thousands of lives each year but it is facing pushback from key players due to misinformation
One of the crucial vaccines that has been overlooked as the government focuses on rolling out the COVID-19 vaccine is the Human Papillomavirus (HPV) vaccine which has been shown to cut cases of cervical cancer by nearly 90 per cent, according to this report by Lancet published early this month.
Cervical cancer is the fourth most common cancer in women around the world, killing more than 300,000 each year. Almost nine-in-10 deaths are in low and middle-income countries where there is little access to cervical cancer screening. In Kenya, 33 in every 100,000 women in Kenya have cervical cancer and 22 in every 100,000 die from the disease. All women are at risk for cervical cancer and this disease occurs most often in women over the age of 30. Kenya has a population of 16.2 million women ages 15 years and older who are at risk of developing cervical cancer. Current estimates by the WHO indicate that every year 5,236 women are diagnosed with cervical cancer and 3211 die from the disease which can be prevented by taking the HPV vaccine.
Cervical cancer ranks as the second most frequent cancer among women in Kenya and the second most frequent cancer among women between 15 and 44 years of age. About 9.1% of women in the general population are estimated to harbour cervical HPV-16/18 infection at a given time, and 63.1% of invasive cervical cancers are attributed to HPVs 16 or 18. HPV 16 and 18 are high-risk types known to significantly increase the risk of cervical, vaginal, and vulvar cancer in women, as well as penile cancer in men. The strains can also cause anal cancer and throat cancers in men and women.
The HPV vaccine can only prevent infection but it cannot rid the body of the virus once someone is infected. The viruses are so widespread that immunisation is targeted at children before they become sexually active.
Kenya rolled out the HPV vaccine programme two years ago— in November 2019. During the well-publicised launch, the Ministry of Health committed to vaccinating 800,000 10-year-old girls every year. The girls would receive the free two doses of the vaccine in six-month intervals. At the time, then Health Cabinet Secretary Sicily Kariuki revealed said the HPV vaccine had the potential to cut the burden of cervical cancer by 70%. “In Kenya, nine women die every day from cervical cancer,” she said.
Only 25% of those targeted in 2019 received their first dose. There is no information about the number of those who received their second dose that year. Last year, and despite the challenges presented by the COVID-19 pandemic, 33% of those targeted received their first dose and 16% were able to get their second dose.
“Young 10-year-old girls are getting vaccinated though there was a gap/shortage during the covid season,” said Dr Hillary Mabeya who is the is the founder and lead surgeon of Gynocare Fistula Centre, and is a Lecturer and a Senior Obstetrician and Gynecologist at Moi University School of Medicine and Moi Teaching and Referral Hospital.
However, even one dose of the vaccine has been recently found to be as effective as multiple doses by the Kenya Medical Research Institute (KEMRI). This could be a gamechanger for countries like Kenya where the vaccines are scarce and expensive and there is low vaccine uptake for the second and third doses. KEMRI acting Director-General Prof. Sam Kariuki said, “KEMRI will work closely with the Ministry of Health and the researchers in the translation of these findings into action and ensure that every girl and young woman gets this single shot.”According to Prof Kariuki, a randomized controlled trial of 2,275 women in Kenya showed that a single dose of HPV vaccine was highly effective. The current standard for women is a three-dose regimen.
“These findings are a game changer that may substantially reduce the incidence of HPV-attributable cervical cancer and positions single-dose HPV vaccination as a high value and high impact public health intervention that is within reach for us,” said Prof. Sam Kariuki.
Kenya was among 115 countries, 12 of them in East and Southern Africa, who have added their vaccine to their routine immunization programmes. Kenya piloted the HPV vaccine between 2013 and 2015 in Kitui County where 22,500 children of ages 9 to 11 were vaccinated. The reported result of the demonstration project was a 95% evidence-based success rate.
The Nairobi City County was the first to officially launch the HPV vaccine on October 31, 2019, at Westlands Health Centre. The target was to vaccinate 40,000 ten- year old girls in the county.
The HPV vaccine roll-out was objected to by individuals and organisations including the Kenya Catholic Doctors Association who claimed that the vaccine increased one’s risk of getting cervical cancer. They claimed insufficient tests on the efficacy and safety of the vaccine had not been conducted and that by targeting adolescent girls the government of Kenya was validating the defilement of minors, instead of focusing its attention on pursuing paediatric sex offenders.
So what is the truth about the HPV vaccine and why is it recommended for young children?
According to the World Health Organization (WHO), the human papillomavirus (HPV) is a group of more than 100 types of viruses that infect the reproductive tract. It is mostly transmitted via sexual contact which means vaginal, anal, oral sex or general skin-to-skin genital contact with someone who has the virus. Most infections do not usually cause any symptoms —although some types of HPV infections can cause warts (small non-cancerous growths) which may appear on your hand, foot, genitals or inside your mouth. Most people, however, will not know they're infected and their bodies will get rid of the virus without treatment.
However, high-risk types of HPV such as the HPV 16 and 18 can cause abnormal tissue growth which can lead to cancers.
Can you get HPV if you are a virgin? Can a faithful couple get HPV?
Globally, it is the most common sexually transmitted infection; so common, in fact, that most sexually active men and women will be infected with the virus at some point in their lifetime and some may be reinfected. While HPV is usually sexually transmitted, it can also be transmitted by any skin-to-skin contact in the genital and oral areas
You can also get infected with HPV without being sexually active. The HPV virus spreads easily through skin-to-skin contact. Prolonged contact with infected skin, such as holding hands with someone who has the virus, may cause transmission of the virus. Apart from sexual transmission, HPV can also spread through sharing of utensils, drinks and deep kissing. This means that it is not impossible to get HPV even as a virgin or being with one dedicated partner.
The Centres for Disease Control and Prevention (CDC) reports that any sexually active person can get HPV, even if it is their first time having sex. Symptoms can also develop years after sexual contact with an infected person. This makes it more difficult to determine when you first became infected.
“It is also good to note that anyone can get HPV, even someone who is having sex for the first time,” said Dr Obwaka.
There is no cure or treatment for the virus itself but there is a test. “There is a way to test for the virus and it is widely available in Nairobi. It's called HPV DNA or Digene test. It is done like a pap smear,” says Dr Christopher Obwaka, a Senior Registrar of Obstetrics and Gynaecology at the Nairobi Hospital and the Executive Director at Gilead Women’s Centre. “You can even do it yourself at your home or office using what's called the Evalyn Brush ®” he adds.
The Evalyn Brush is a self-sampling kit that you can use at home to screen for cervical cancer without having to go to the hospital or clinic.
Most of the time, HPV goes away on its own with no long term effects. However, in some cases, it does not go away and causes various ailments such as genital warts, respiratory papillomatosis (which causes tumours to grow in the air passages from the nose, mouth and into the lungs) or cancer.
HPV and cervical cancer
HPV can lead to different types of cancers including cancer of the vulva, vagina, penis, anus, back of the throat, the base of the tongue and tonsils (oropharynx). The WHO reports that at least 14 types of the virus, known as high-risk types, have been linked to causing these cancers.
Two types of HPV (16 and 18) cause 70% of cervical cancers and pre-cancerous cervical lesions. In other words, almost all cervical cancer cases can be linked to HPV.
Though there is no way to test for the virus itself, there are HPV tests that can be used to screen for cervical cancer. These tests are only recommended in women aged 30 years and above. HPV tests are not recommended for men, adolescents, or women under 30 years of age.
The WHO reports that cervical cancer is the fourth highest occurring cancer in women with approximately 570,000 new cases in 2018 representing 6.6% of all female cancers. Additionally, about 90% of deaths from cervical cancer occurred in low- and middle-income countries.
In Kenya, cervical cancer is the highest most frequent cancer among women; higher than breast and oesophagal cancer.
Though HPV mostly clears up on its own, all women who contract the virus are at risk of developing invasive cervical cancer. The HPV Information Centre found that this equates to 14.3 million Kenyan women being at risk for cervical cancer.
Why HPV vaccine is recommended for adolescents
Though the Kenya Government is focusing on vaccinating young girls, the HPV vaccine is actually recommended for both young girls and boys.
This is because nearly all unvaccinated people who are sexually active will get HPV in their lifetime.
The HPV Information Centre found that in 2019, the prevalence of HPV among women with cervical cancer was a whopping 63.1%. It also shows that the age at first sexual intercourse is about 17 for girls and 18 for boys.
Therefore, targeting young children as vaccine participants catches them before they become sexually active. Taking the vaccine at later ages when one is already sexually active may be useless. “The vaccine is administered from about 9 years for girls and 10 years for boys, but it can be given to anyone up to the age of 45 who has never had sex and is not sexually active or sexually active women who are HPV negative on testing. So that aspect of giving it only to young girls because of promiscuity is false. It is simply an act of prevention before you are exposed to the disease,” said Dr Obwaka.
Young boys are also vaccinated because they can become carriers of the disease and pass it on to female sexual partners where it could develop into cancer. Therefore vaccinating them before they become sexually active is also beneficial. “Yes boys are supposed to be vaccinated but I think the availability of the vaccine is the main reason why it’s not yet being done in Kenya but technically at private arrangements boys should be vaccinated,” said Dr Mabeya.
How does the HPV vaccine work?
The first and best method of combating HPV is through vaccination. The WHO recommends 2 doses of the vaccine 6-12 months apart. It is best administered to children between the ages of 11 -12 years of age but can be given to children as young as 9 years old. Waiting for them to get older than 15 years old can result in the need for 3 doses instead of 2.
People up to the age of 45 can get the vaccine after consulting their doctors. HPV vaccination for this age group (27-45 years) provides less benefit, as they may have already been exposed to HPV.
“It’s just a vaccine like any other,” said Dr Obwaka. “Before any vaccine is released it goes through stages of testing before it’s certified safe for humans. The latest HPV vaccine, Gardasil 9® has been approved since 2006 by the FDA [United States Food and Drug Administration] and the CDC.”
As Gardasil is expensive and rare, Kenya is using the Cervarix vaccine which is administered in a series of three shots. After the first shot, you receive the second after a month then the third after six months.
Dr Obwaka also told The Star that all vaccines have known side effects, such as pain or fever, however that should not stop the rollout of the vaccine because the benefits outweigh the potential side effects.
The potential side effects of the HPV vaccine include pain, redness, or swelling in the arm where the shot was given, dizziness or fainting, nausea and headaches. The rumours about the HPV vaccine causing infertility, neurological problems, increased risk of blood clots or complex regional pain syndrome have been proven false by the revisions by WHO’s Global Advisory Committee on Vaccine Safety (GAVCS).
Whether young girls receive the vaccine or not is highly associated with obtaining sufficient information regarding the cervical cancer vaccination program.
Women continue to be at the forefront of the dissemination of the importance of the vaccine. In 2010, an estimated 95% of Kenyan women were willing to have their daughters vaccinated. A women-led group, the Women 4 Cancer Early Detection and Treatment has trained 70 champions across Kenya - including survivors of cervical cancer - to address apprehension about the vaccine in different communities.
This information also needs to be disseminated at schools as well as this is where children get most of their health-related information.
“This article was produced by the Africa Women’s Journalism Project (AWJP) in partnership with Article 19, Meedan and the International Center for Journalists (ICFJ).”
