End of the line for genital warts is close

By Helen Petousis Harris 26/04/2013

This week is World Immunisation Awareness week so it is obligatory to mention NZ have now achieved pretty good immunisation coverage of its infants and the gap between ethnic groups and rich and poor is all but shut.

The good

In December 2012 NZ European and Maori had 90%, Pacific 93% and Asian 95%. The gap between rich and poor is almost non-existent (2 percentage points). More importantly, for a short time last year we appeared to be ahead of Australia who have been pretty smug about their excellent performance in this area.

In the BMJ this week  appears the latest Australian data on the impact of the HPV programme on genital warts. The progress is quite astounding and I admit to particular excitement over figures 1 and 2, Which are very pretty indeed. The study reports:

The significant declines in the proportion of young women found to have genital warts and the absence of genital warts in vaccinated women in 2011 suggests that the human papillomavirus vaccine has a high efficacy outside of the trial setting. Large declines in diagnoses of genital warts in heterosexual men are probably due to herd immunity.

figure 1:
figure 1: Proportion of Australian born women diagnosed as having genital warts at first visit, by age group, 2004-11 BMJ
figure 2
figure 2: Proportion of Australian born women aged under 21 years diagnosed as having genital warts at first visit to Sydney and Melbourne Sexual Health Centres, by vaccination status, 2009-11. Numbers are number diagnosed as having genital warts/number seen BMJ

Essentially the data indicate that the basic reproduction rate of HPV 6 and 11 has fallen below one. That’s the end of the line for genital warts. Auckland (and NZ) have shown a similar pattern but the particularly dramatic progress in Melbourne is likely attributable to the very high uptake of vaccine along with the relatively large age band eligible for funded vaccine (up to 26 years).

The bad

It came to my attention recently that some new mums turning up for their Ponsonby antenatal classes were being provided with a pamphlet along with, but not included in, their Bounty packs (Bounty packs have all sorts of evidence based parenting information and are given to women who have babies in NZ).

Not sure that Bounty were very pleased to know that this was being provided along with their information party bag. The Pamphlet, called “After the Birth, Your Choice” is produced by the Maternity Services Consumer Council with the intention of explaining the various tests and procedures that may occur after birth and what the patient rights, provider obligations are and (I understand) distributed by Parent Centre. The section called vaccinations is appalling.

“In New Zealand it is recommended that your baby have their first vaccinations when s/he is six weeks old. Every year new vaccinations are added to the infant vaccination schedule. While your LMC and other health professionals must recommend that your baby has all of them, vaccinations are not compulsory. It is important that you find out as much information as you can about each vaccine so that you can make an informed choice about which vaccines (if any) you want your baby to receive and at what age you want your baby to start receiving vaccinations. “It is worth noting that although babies are currently vaccinated against up to seven diseases at a time, almost no research has been done on the side effects and risks of having several different vaccinations at the same time.”

For a start there are not new vaccines added to the schedule each year. It’s a bit inflammatory about the health professionals too. Suggesting that a good parent should assess the data themselves and decide on a schedule for their child is bizarre. The NZ Immunisation Schedule has been developed based on more than 200 years of empirical global data collected and assessed by generations of scientists. The NZ recommendations are made by panels of experts in infectious diseases, paediatrics, epidemiology, public health and immunology. I am sure new parents have better things to do than become vaccine experts. By and large when one gets sick one visits their doctor rather than going to medical school to figure out what the problem is.

However it is the final sentence about safety that is a real clanger. This is a shameful lie. All infant vaccines are assessed for concomitant administration. This is a requirement for licensure if they are to be added to a schedule. There is a mindboggling amount of data on the safety of co-administering infant vaccines. For example, take pneumococcal vaccine, added in 2008. The safety of Synflorix (the pneumococcal vaccine we use) aka PCV-10 was initially evaluated in five pivotal studies conducted between 2005 and 2008, in which it was co-administered with a variety of DTaP-based and meningococcal vaccines. Findings are summarised in a paper titled

Safety and Reactogenicity of the 10-Valent Pneumococcal Non-typeable Haemophilus influenzae Protein D Conjugate Vaccine (PHiD-CV) When Coadministered With Routine Childhood Vaccines.

Another, more recent, example is the Finnish Invasive Pneumococcal disease (FinIP) vaccine trial which enrolled 47,369 children and co-administered the study vaccines with other childhood vaccines (published recently in the Lancet.

And, of course, post marketing safety surveillance all over the world.

0 Responses to “End of the line for genital warts is close”

  • So now we watch and wait as the females in this cohort go through life having regular cervical smears. With such outstanding results against warts I’m looking forward to evidence of a lower incidence of abnormal smears in those who were vaccinated compared with those who were not.

    A visit to the Maternity Services Consumer Council website provides some interesting reading. Despite self-promotion that they have hundreds of individual and community group members the names of supporting organisations are noticable in their absence.

    Selectively and conveniently they support the World Health Organization’s (WHO) recommendations on Appropriate Technology for Birth and Appropriate Technology Following Birth yet ignore the WHO Recommendations for Routine Immunization.

    They are a registered charity – an umbrella/resource body under health, education, training, research and social services with the supposed purposes of providing advice, information and advocacy. They’ve recently received grants from the Trust Community Foundation and the Lion Foundation, to cover administration and reprint their leaflets. Money that could have gone to groups that actually make a positive contribution to the health of our tamariki and communities.

    Seems to me that in the area of immunisation information at the very least they’ve contravened their charitable purpose. Like previous so called charitable organisations providing blatently misleading and deceptive information about immunisation they need to lose their charitable status.

    • It seems the possibility that there maybe replacement of HPV types, should some be removed by vaccination, is unlikely for a couple of reasons. One is because co-infection occurs, people may be infected with several types at once. The other reason is there does not appear to be any competition between different types. They act independently of each other. I think the Aussies mention that the complete absence of genital warts among the vaccinated in this study may be either due to types 6 and 11 causing virtually all cases in this population or that the vaccine confers some cross protection against the other genital warts types or possible the other types associated with genital warts are not generating disease.

  • @MissK, I notice the MSCC links to a certain other “charity” on their Links page. I have to assume the pamphet was written by someone who did their own “research”.

    I notice they also link to Kiwifamilies.co.nz which recently had a very good vaccination newsletter.

    Regarding the HPV results. That all looks fantastic and I (perhaps naively?) assume this is suggestive that replacement strains are not taking up the slack with regard to warts?

    A previous piece I wrote on the Gardasil vaccine attracted a commenter that was concerned that the vaccine came with risks and possibly not benefit as other strains would take the place of those countered by the vaccine and over-all incidence of warts and cancer would remain the same.

    Looks to me like this is not the case.

  • Welcome to SciBlogs Helen! Great to see you here and I look forward to future posts.

    I, too, noticed the link to a certain society and a friendly reminder email is making its way to the MSCC to point out their oversight.