人乳头瘤病毒疫苗:消除宫颈癌的重要工具

Veena Pampapati, Arpitha Anantharaju
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引用次数: 0

摘要

世界卫生组织(卫生组织)呼吁在全球消灭宫颈癌,这基本上意味着实现全世界年龄标准化发病率<4/100 000名妇女,从而使其不再是一个公共卫生问题。人乳头瘤病毒(HPV)疫苗接种、宫颈癌筛查和癌前病变治疗是实现这一目标的有效工具。建议将HPV疫苗接种作为初次性行为前的初级预防措施,并建议对性活跃的妇女进行宫颈癌筛查。HPV疫苗有三种类型——二价、四价和九价疫苗。推荐的标准剂量是3剂方案,然而,在9至15岁的年轻女孩中,发现2剂方案与3剂方案具有同样的免疫原性。像澳大利亚这样的国家已经实施了使用四价HPV疫苗的疫苗接种,并且在澳大利亚已经注意到HPV相关疾病的巨大影响。宫颈癌的筛查可以通过宫颈细胞学,醋酸(VIA)应用后的目视检查或HPV DNA检测来完成。低成本的筛查技术如VIA在我国是有用的大规模筛查。实现消除宫颈癌的挑战是多方面的,包括疫苗的生产和交付、疫苗的犹豫、建立子宫颈筛查和有效治疗前体,以及最重要的是,是否有资源为大量人口提供筛查和疫苗接种资金。在像我国这样的发展中国家,只有通过邦和中央政府以及非政府组织的承诺才能实现世卫组织的目标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Human papillomavirus vaccination: An important tool in cervical cancer elimination
The World Health Organization (WHO) has called for global elimination of cervical cancer, which essentially means achieving age-standardized incidence rates of <4/100,000 women worldwide, so that it ceases to be a public health issue. Vaccination against the human papillomavirus (HPV), screening for cervical cancer, and the treatment of precancerous lesions are effective tools for achieving this goal. HPV vaccination is recommended as a primary prevention measure in young girls before their sexual debut, and screening for cervical cancer is recommended for sexually active women. Three types of HPV vaccines are available-bivalent, quadrivalent, and 9-valent vaccines. Standard dosing recommended is the 3-dose regimen, whereas, in young girls between 9 and 15 years, 2-dose schedule is found to be as immunogenic as the 3-dose schedule. Countries like Australia have implemented vaccination using the quadrivalent HPV vaccine, and a large impact on HPV-related disease has been noted in Australia. Screening for cervical cancer can be done by cervical cytology, visual inspection after application of acetic acid (VIA), or HPV DNA testing. Low-cost screening techniques like VIA are useful in our country for large scale screening. Challenges in achieving elimination of cervical cancer are manifold and include vaccine manufacture and delivery, vaccine hesitancy, setting up of cervical screening and effective treatment of precursors, and, most importantly, availability of resources to fund screening and vaccination to a huge population. In developing countries like ours, the WHO goal can be achieved only by the commitment of state and central governments and nongovernment organizations.
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