Going Viral RCSIsmj staff writer Julia Hunter
In the United States, approximately 90% of cervical cancers may be associated with Human Papilloma Virus (HPV).(1) HPV has also been identified as a carcinogen for cancers of the penis, vulva, vagina, anus and oropharynx. A 2012 study found that 4.8% of cancers occurring globally can be attributed to HPV infection.(2) While there are over 100 types of HPV,(3) including both carcinogenic and non-carcinogenic types, HPV 16 and 18 account for a large portion of the virusesâ€™ cancer burden.(1) Despite not being the most prevalent HPV types in the general population, these two types are the cause of 70% of cervical cancers.(4)
A quadrivalent HPV vaccine covering oncogenic HPV types 16 and 18 as well as two nononcogenic types (6 and 11) was first licensed in 2006 followed 3 years later by the release of a bivalent vaccine protecting against types 16 and 18 only.(5) More recently, the FDA approved a 9 valent vaccine which provides the potential to extend coverage achieved with prior bi and quadrivalent vaccines.(6) Although the long term benefits achievably by HPV vaccination will take years to elicit (owing to the slow rate of cancer development), investigation-to-date has been promising, revealing a significant reduction in the rate of vaccinated genotypes as well as possible herd immunity.(7) In addition, studies investigating adverse events reported following HPV vaccination have yielded insignificant results that support the vaccineâ€™s safety.(8-10)
Despite the promising early results of this vaccine, its uptake has been continually hampered by negative media coverage and adverse event reporting promoted by the general public and antivax groups. In Ireland, the HPV vaccine which is provided freely to girls aims to target all 12 to 13 year old girls in a 2-dose school based program.(11) This is in keeping with the World Health Organization guidelines which recommend 2-dose vaccination of girls between the ages of 9 to 13.(12) Unfortunately, over time, the uptake for the 2 step vaccination in Ireland has dropped off significantly with an uptake of 72.3% for the 2015-2016 academic year, down over 14% from the year prior.(13) Health officials in Ireland attribute this drop to unsubstantiated claims about risks of the vaccine and have disputed the claim that HPV is linked to chronic fatigue syndrome.(14) The HPV vaccine has garnered media attention around the globe due to adverse events that many believe to be due to the vaccine. In Ireland, a support group called REGRET exists for parents who are â€œcertainâ€ that the HPV vaccine is the cause of illnesses that their daughters have developed.(15) Another, highly publicized example of the ongoing negative media took place in Melbourne, Australia where a group of young women reported becoming unwell after receiving the vaccination.(16) This was later believed to be likely due to a condition called mass psychogenic illness (MPI) in which there are symptoms suggestive of an organic illness with no identified pathogen. These symptoms occur in a group of people who have a shared belief about the symptom etiology and the illness spreads via observation of others either directly or indirectly via alternative channels such as social media. (17,18)
It has been previously suggested that adverse event reporting and treatment discontinuation is driven by media coverage.(19-24) Two studies to date have looked specifically at the HPV vaccine and the effect that media coverage has had on adverse effect reporting. (23,24) One of these studyâ€™s found that media coverage in the preceding month was a predictor of adverse event reporting and the other reached a similar conclusion that heavy media coverage over a short period of time was associated with increased adverse event reporting.(23,24)
The HPV vaccine and itâ€™s international suboptimal uptake illustrates the ease with which modern-day electronic information sharing can impact evidence-based public health prevention tools. In an age in which users can share their thoughts and suspicions, (whether or not they are supported by medical professionals) on a platform that is accessible internationally, perhaps, moving forward, the best way to combat this type of web-based fear-sharing is to utilize the same information platforms to disprove such claims.
- Saraiya M, Unger E, Thompson T, Lynch C, Hernandez B, Lyu C et al. US Assessment of HPV Types in Cancers: Implications for Current and 9-Valent HPV Vaccines. JNCI: Journal of the National Cancer Institute. 2015;107(6).
- Forman D, de Martel C, Lacey C, Soerjomataram I, Lortet-Tieulent J, Bruni L et al. Global Burden of Human Papillomavirus and Related Diseases. Vaccine. 2012;30:F12-F23.
- Human papillomavirus (HPV) and cervical cancer [Internet]. World Health Organization. 2017 [cited 5 December 2017]. Available from: http://www.who.int/mediacentre/factsheets/fs380/en/
- Smith J, Lindsay L, Hoots B, Keys J, Franceschi S, Winer R et al. Human papillomavirus type distribution in invasive cervical cancer and high-grade cervical lesions: A meta-analysis update. International Journal of Cancer. 2007;121(3):621-632.
- FDA Licensure of Bivalent Human Papillomavirus Vaccine (HPV2, Cervarix) for Use in Females and Updated HPV Vaccination Recommendations from the Advisory Committee on Immunization Practices (ACIP) [Internet]. Cdc.gov. 2017 [cited 5 December 2017]. Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5920a4.htm
- Package Insert-Gardasil 9 [Internet]. U.S. Food and Drug Administration. 2017 [cited 5 December 2017]. Available from: https://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM426457.pdf
- Tabrizi S, Brotherton J, Kaldor J, Skinner S, Liu B, Bateson D et al. Assessment of herd immunity and cross-protection after a human papillomavirus vaccination programme in Australia: a repeat cross-sectional study. The Lancet Infectious Diseases. 2014;14(10):958-966.
- Cameron R, Ahmed S, Pollock K. Adverse event monitoring of the human papillomavirus vaccines in Scotland. Internal Medicine Journal. 2016;46(4):452-457.
- Stockman J. Efficacy of a prophylactic adjuvanted bivalent L1 virus-like-particle vaccine against infection with human papillomavirus types 16 and 18 in young women: an interim analysis of a phase III double-blind, randomised controlled trial. Yearbook of Pediatrics. 2009;2009:285-287.
- Markowitz L, Tsu V, Deeks S, Cubie H, Wang S, Vicari A et al. Human Papillomavirus Vaccine Introduction â€“ The First Five Years. Vaccine. 2012;30:F139-F148.
- HPV – Ireland’s Health Service [Internet]. Health Service Executive. 2017 [cited 5 December 2017]. Available from: http://www.hse.ie/eng/health/Immunisation/hcpinfo/OtherVaccines/hpv/
- Guidelines for the prevention and control of cervical cancer [Internet]. World Health Organization. 2017 [cited 5 December 2017]. Available from: http://www.who.int/reproductivehealth/topics/cancers/hpv-vaccination/en/
- HPV Immunisation Uptake Statistics – Health Protection Surveillance Centre [Internet]. Health Protection Surveillance Centre. 2017 [cited 5 December 2017]. Available from: http://www.hpsc.ie/a-z/vaccinepreventable/vaccination/immunisationuptakestatistics/hpvimmunisationuptakestatistics/
- Shannon J. Low HPV vaccination rates are a â€˜significant threat to public healthâ€™ [Internet]. Irish Medical Times. 2017 [cited 5 December 2017]. Available from: https://www.imt.ie/news/low-hpv-vaccination-rates-are-a-significant-threat-to-public-health-02-02-2017/
- R.E.G.R.E.T Support Group [Internet]. Reactions and Effects of Gardasil Resulting in Extreme Trauma. [cited 5 December 2017]. Available from: https://www.regret.ie/index.html
- Gardasil™ and mass psychogenic illness. Australian and New Zealand Journal of Public Health. 2007;31(4):387-387.
- BARTHOLOMEW R. Protean nature of mass sociogenic illness: From possessed nuns to chemical and biological terrorism fears. The British Journal of Psychiatry. 2002;180(4):300-306.
- Bartholomew R, Wessely S, Rubin G. Mass psychogenic illness and the social network: is it changing the pattern of outbreaks?. Journal of the Royal Society of Medicine. 2012;105(12):509-512.
- Matthews A, Herrett E, Gasparrini A, Van Staa T, Goldacre B, Smeeth L et al. Impact of statin related media coverage on use of statins: interrupted time series analysis with UK primary care data. BMJ. 2016;:i3283.
- Nielsen S, Nordestgaard B. Negative statin-related news stories decrease statin persistence and increase myocardial infarction and cardiovascular mortality: a nationwide prospective cohort study. European Heart Journal. 2015;37(11):908-916.
- Schaffer A, Buckley N, Dobbins T, Banks E, Pearson S. The crux of the matter: Did the ABC’s Catalyst program change statin use in Australia?. The Medical Journal of Australia. 2015;202(11):591-594.
- Faasse K, Gamble G, Cundy T, Petrie K. Impact of television coverage on the number and type of symptoms reported during a health scare: a retrospective preâ€“post observational study. BMJ Open. 2012;2(4):e001607.
- Eberth J, Kline K, Moskowitz D, Montealegre J, Scheurer M. The Role of Media and the Internet on Vaccine Adverse Event Reporting: A Case Study of Human Papillomavirus Vaccination. Journal of Adolescent Health. 2014;54(3):289-295.
- Faasse K, Porsius J, Faasse J, Martin L. Bad news: The influence of news coverage and Google searches on Gardasil adverse event reporting. Vaccine. 2017;35(49):6872-6878.