The present description is about a consultation with a woman named Debbie, who has inquired about having the Human Papilloma Virus (HPV) vaccination. Ms.Debbie has provided valuable information as revealed from her decisions; and the main objective of this article is to highlight the key aspects of this consultation and to make possible the informed decision.
Ms Debby’s main concern was about vaccination against HPV as it is considered as the risk factor of cervical cancer. She says that nearly 6 million new genital HPV infections are reported to occur each year in the United States according to National Caner Institute.
So, this has indicated that there is a need to circumvent the spread of HPV through vaccinations which would be possible by conducting large intervention programs.
Initially, she emphasized on increasing the awareness of HPV among women in order to make sure of successful vaccination. According to a recent study, it was revealed that educational efforts should be concentrated on increasing women’s knowledge and awareness of HPV while expecting the availability of HPV vaccines and HPV tests for screening (Hanisch et al., 2007).
Therefore, I would encourage women through proper education that might facilitate them to choose HPV vaccination at the earliest stage of infection. I would primarily focus on women living in low socioeconomic conditions and conduct questionnaires. The information thus obtained would be conveyed to health care professionals and appropriate education programs would be undertaken.
She also says that there is a need of a medical screening method known as Pap test in addition to HPV vaccinations. Because, Pap tests have proven to be essential to detect cervical cancers and precancerous changes, even in women who have been vaccinated against HPVs according to National Cancer Institute.
So, I would implement screening programs targeted for HPV vaccinations by also including Pap test in order to ensure smooth detection of HPV infections. However, Ms.Debby has mentioned that age factor should be given prior importance while approaching any method of vaccination strategies. It was reported that vaccinating girls and women older than 12 years of age may accelerate the reduction in cervical cancer rates and there is a necessity of continued cervical cancer screening regardless of vaccination (Harper & Paavonen, 2008).
Therefore, I would concentrate on women of younger age in screening programs by approaching schools and other important locations where we could gather information about these populations with reference to HPV infection. Further, Ms.Debby has informed that there is a need to carry out large follow -up studies in order to make sure of the vaccine effectiveness. Stanley and Villa (2008) recently described that vaccinated populations should be followed-up for long-term safety, sustained immune responses and vaccine efficacy. This is because effective monitoring would benefit from linkage of vaccination history and screening history, as well as specific measurement of HPV exposure, both DNA and serological testing.
Hence, good number of vaccinated population would be approached and asked to participate in follow up studies. Ms. Debbie has mentioned that some people would be in a dilemma on whether or not to choose HPV test before vaccination. She denies the requirement of HPV test in all cases. It was reported that HPV testing prior to HPV vaccination is not recommended unless HPV tests are part of the established local routines for cervical cancer screening. This may be due to very low frequency of women who, at the time of vaccination, would show markers of prior/current exposure (HPV DNA or serological tests) to the HPV types included in the vaccine (Wright Jr & Bosch, 2008).
Therefore, I would advise women to choose direct HPV vaccination. Next, Ms. Debby has stressed that there is a need of prophylactic HPV vaccinations for women. Rambout et al. (2008) reported the available prophylactic HPV vaccines are aimed at preventing genital warts, precancerous cervical lesions and cervical cancer. They suggested that among women aged 15-25 years not previously infected with vaccine-type HPV strains, prophylactic HPV vaccination appears to be highly efficacious in preventing HPV infection and precancerous cervical disease. Hence, I would like to strongly encourage women to choose prophylactic HPV vaccination. To test the efficacy of this approach, I would also undertake a study by employing two groups of women with and without prophylactic HPV vaccinations.
Therefore, it can be inferred that HPV vaccinations need to be carefully considered before recommending to women. Ms.Debby has expressed her concerns that in order to facilitate HPV vaccinations there should be willingness from the parents. In a recent study, it was revealed that parents requested more information about cervical cancer, HPV, and HPV vaccination, before the vaccine is introduced (Lenselink et al., 2008). This would prompt us to approach more number of parents and conduct interviews to determine whether they would allow vaccinations for their children.
In addition, it is also reasonable to consider the opinion of general public regarding HPV testing and vaccination, according to Ms Debbie. So, while approaching parents I would also gather information from public by conducting random surveys and questionnaires with the help of health care workers and suggest appropriate interventions. This is because it was previously reported that public awareness of HPV is generally very low, particularly with respect to its relation to cervical cancer and significant education initiatives will be necessary to introduce HPV vaccination and/ or HPV testing (Cuschieri et al., 2006).
Next, it is the cost -efficiency topic that was focused on in the discussion when I consulted Ms.Debby. She reaffirmed that thorough knowledge regarding HPV would enable save unnecessary expenses. In connection with this, she has also emphasized on other prevention strategies like taking Pap test.This is because she says that vaccination doest not provide protection to all reported types of HPV infections. According to a study, Pap cytology screening programs were reported to improve with the advent of HPV DNA testing. This strategy is considered as the secondary prevention after immunization with highly efficacious HPV vaccines (Franco & Cuzick, 2008).
So, this report has further strengthened the beneficial role of Pap test. Hence, I would establish Pap test by initially reviewing the available scientific literature. As followed for HPV vaccination programmes, large population especially women of younger age will be screened and those found positive for HPV will be strongly encouraged to take Pap test in addition to HPV vaccinations. Ms. Debbie has further added that while recommending Pap test it is essential to follow a combination approach keeping in view of latest advancements.
Gazzaz (2007) undertaken a study for the early detection of human papillomavirus (HPV) in uterine cervix and suggested the need of using Pap test with techniques, hybrid capture 2 (HC2) and polymerase chain reaction (PCR) to ensure long term safety screening in women with double blind negative results. Therefore, it may indicate that the efficacy of Pap test would better improve when it is combined with other techniques. Hence, this approach if followed would work well for HPV infected women.
Finally, Ms. Debbie has concluded that vaccinations or Pap test might enhance financial burden if familiarity is not developed. Although intervention programs are helpful, she strongly suggests women to take painful initiatives to drive away the ill aspects of HPV. Hence, inspite of all considerations I would make the learning process a mandatory aspect to facilitate smooth detection and eradication of HPV through tests and vaccinations
References
- Hanisch, R., Gustat, J., Hagensee, M.E., Baena, A., Salazar, J.E., Castro, M.V., Gaviria, A.M., Sánchez, G.I. (2007). Knowledge of Pap screening and human papillomavirus among women attending clinics in Medellín, Colombia. Int J Gynecol Cancer. Web.
- Harper, D.M and Paavonen, J. (2008). Age for HPV vaccination. Vaccine, 26, A7-11.
- Stanley, M and Villa, L.L. (2008). Monitoring HPV vaccination. Vaccine, 26, A24-7.
- Wright, T.C Jr and Bosch, F.X. (2008). Is viral status needed before vaccination Vaccine, 26, A12-5.
- Rambout, L., Hopkins, L., Hutton, B., Fergusson, D. (2007). Prophylactic vaccination against human papillomavirus infection and disease in women: a systematic review of randomized controlled trials. Evid Based Nurs, 11, 11.
- Lenselink, C.H., Gerrits, M.M., Melchers, W.J., Massuger, L.F., Van Hamont. D., Bekkers, R.L (2008). Parental acceptance of Human Papillomavirus vaccines. Eur J Obstet Gynecol Reprod Biol, 137,103-7.
- Cuschieri, K.S., Horne, A.W., Szarewski, A., Cubie, H.A. (2006). Public awareness of human papillomavirus.
- Franco, E.L and Cuzick, J. (2008). Cervical cancer screening following prophylactic human papillomavirus vaccination. Vaccine, 26, A16-23.
- National Cancer Institute Fact Sheet. (n.d). Web.