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Risk for Cancer-Causing Infections Highest in Low- and Middle-Income Countries


Human Papillomavirus Vaccines

Since 2006, another vaccine has been approved that provides protection against several types of HPV infection, which cause the majority of HPV-related cancers. WHO recommends that girls and boys ages 9 to 13 years receive 2 doses of the HPV vaccine (at 0, 6 months) to prevent infec­tion with the virus types responsible for most of the cases of cervical cancer.7 As such, girls in more than 55 countries are routinely administered the HPV vaccine and more women in low- and middle-income countries have been introduced to the vaccine via immunization schedules, with support from Gavi, the Vaccine Alliance.7 Established in 2000, Gavi is a global vaccine alliance that brings together private and pub­lic sectors, with the shared mission of creat­ing equal access to both underused and new vaccines for children in the world’s most impoverished nations.8

However, even with influential organiza­tions such as Gavi, access to HPV vaccination still is highest in nations where incidence and mortality related to HPV infection remain the lowest. From 2006 to 2014, for example, an es­timated 118 million individuals were targeted by HPV vaccination programs, yet only 1% were from low-income and lower- to middle-income countries. And in higher income regions, 34% of women aged 10 to 20 years received the full HPV vaccine series whereas only 3% of similar-aged women in lower-income nations received the full series.9 For receipt of 1 HPV dose, in particular, 43% received the vaccine in higher-income regions compared with 3% in lower-income re­gions. Regions with the lowest rates of receipt of 1 dose of the HPV vaccine among females included Africa (at 1%) and Asia (at 1%), which also happen to be where rates of incidence and mortality due to cervical cancer are the highest.9

Although more research is needed to develop strategies to prevent infection from most oncogenic viruses and/or progression from chronic infection to cancer, innovative science and discovery have already led to the development of vaccines that can help to prevent infection with 2 of the most common oncogenic viruses: HBV and HPV together cause more than 1 million cases of cancer each year worldwide. Whereas the HBV and HPV vaccines have been effectively implemented in regions in which incidences of associated cancers remain low, more work is needed in nations that are most devastated by these viruses. Increased sup­port is needed for organizations such as Gavi. Furthermore, regional leaders and community members need to devise strategies for vaccine receipt that are feasible for national institutions and that align with the cultural norms, values, lifestyles, and environmental conditions of communities in some of the most underserved regions of the world. Together, we can do bet­ter. Together, we need to do better, to improve receipt of life-saving cancer prevention vaccina­tions among those who need it most.

Most Common Oncogenic Viruses Worldwide
Dr. Kepka is a Huntsman Cancer Institute (HCI) investigator and an assistant professor in the College of Nursing at the University of Utah. She is a member of the Cancer Control and Population Sciences research group and director of the Intermountain West HPV Vaccination Coalition. She received her PhD from the University of Washington in Seattle in Health Services and completed a post-doctoral fellowship in the Cancer Prevention Fellowship Program at the National Cancer Institute in Bethesda, Maryland.

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  4. American Cancer Society. What is Kaposi Sarcoma? Accessed 6/19/2017.
  5. World Health Organization. Global Hepatitis Report, 2017. Accessed 7/19/2017. 
  6. World Health Organization. Immunziation, Vaccines, and Biologicals. Hepatitis B. Accessed 6/19/2017.
  7. World Health Organization. Guidelines for the Prevention and Control of Cervical Cancer. Accessed 6/19/2017.
  8. Gavi. The Vaccine Alliance. Accessed 6/19/2017.
  9. Bruni L, Diaz M, Barrionuevo-Rosas L, et al. Global estimates of human papillomavirus vaccination coverage by region and income level: a pooled analysis. Lancet Glob Health. Jul 2016;4(7):e453-463.
  10. American Cancer Society. Viruses that Can Lead to Cancer. Accessed 6/19/2017.
  11. National Cancer Institute. H Pylori Fact Sheet. Accessed 6/19/2017.

The Centers of Disease Control and Prevention (CDC) held a recent briefing on flu season as 49 states report widespread flu activity.