Durban - The second round of vaccinations for Grade 4 pupils at schools across South Africa begins on Monday in a government programme to curb a condition affecting 6 000 women a year - killing 3 000 and leaving many infertile.
The programme coincides with the start of Cervical Cancer Awareness Month.
The departments of Health and Basic Education and Training rolled out a national human papillomavirus (HPV) vaccination programme in March targeting 500 000 girls aged nine to 10 at 17 000 schools. But provincial health departments report that some parents have not returned consent forms and say anti-vaccine literature posted on social media appears to be putting them off.
KZN Health MEC Dr Sibongiseni Dhlomo said that of 79 657 Grade 4 girls targeted, 68 593 had been immunised - 86 percent.
“A total of 11 064 eligible girls were not immunised, either because they were absent from school on the day or parental consent had not been granted.”
The uptake is far higher than in Western Cape, where Health MEC Theuns Botha reported earlier this year that just 56 percent of Grade 4 girls had had the vaccination.
He expressed concern at parents missing a chance for their children to be protected against a virus that causes cervical cancer and genital warts, and has been linked to anal and penile cancer.
Cervical cancer was the most deadly cancer among women in South Africa, and research supported the use of HPV vaccine, he said.
In the latest issue of the SA Medical Journal, the HPV Advisory Board reports that the safety of HPV vaccines has been “rigorously tested in clinical trials”, and that studies have not shown any differences in conditions such as Guillain-Barré syndrome, stroke, appendicitis, seizures, allergic reactions, anaphylaxis and venous thromboembolisms in those vaccinated.
“It can be expected that anti-vaccine campaigners will take advantage of the HPV vaccine debate, focusing on concerns about safety and isolated reports of adverse events temporarily related to vaccination,” said the board, an independent group of clinicians and experts with a special interest in HPV-related disease. “It is imperative that health-care professionals are well-informed so they are able to answer questions and dispel the myths surrounding HPV vaccination to ensure maximum vaccine coverage and herd immunity.”
Although cervical cancer is on Monday almost completely preventable, it is still highly prevalent in southern Africa, with the estimated annual incidence five times higher than in developed countries, where screening is common practice and HPV vaccination has been available since 2006. The vaccination has been introduced into vaccination programmes in more than 40 countries.
HPV is the most common sexually transmitted infection globally, said medical virologist, Dr Karin Richter, of the Department of Medical Virology at the University of Pretoria/National Health Laboratory Service in Pretoria.
The virus is mainly spread by skin-to-skin contact, and sexually active women have a lifetime risk of up to 80 percent of being infected, the rate rising rapidly when they become sexually active and then declining with age, resulting in the highest prevalence being in women younger than 30.
When women develop cervical cancer, the most devastating effect for many was loss of fertility as, depending on the extent of the cancer, it was usually treated with hysterectomy (removal of the womb), said Professor Greta Dreyer, head of the Gynaecological Oncology Unit at the University of Pretoria and Steve Biko Hospital, and a member of the HPV Advisory Board.
But advances in surgery are changing that for some. When Kate Parker, 24, a Johannesburg speech pathologist working with autistic children, was diagnosed with cervical cancer last year, she was shocked.
“I had been for yearly pap smears since 18, and had the HPV vaccination when I was 20,” she said. “None of my paps detected the cancer, and it turns out I contracted HPV from my only sexual partner before I had the vaccination.”
Parker was referred to one of the gynaecological oncologists in South Africa now able to perform a radical trachelectomy - a procedure which allows suitable patients to preserve their fertility.
Dreyer has performed more than 20 of these procedures in her Pretoria unit in the past eight years, and in Durban, Dr Mani Moodley has done 13.
Possibilities are opening up too in cervical cancer prevention, with the arrival of HPV-based screening. In a pap smear, cells scraped from the cervix are analysed for abnormal features that may indicate cancer. In HPV screening, available in South Africa on request, the cells are tested for strains of HPV commonly linked to cancer.
“The advantage of the HPV test is that women can safely have longer intervals between screenings than with pap smears, and it will be more cost-effective,” said Dreyer. “It can also be useful in detecting cancer and pre-cancer that hides inside the cervical canal rather than on the surface, making it less easily detected by pap smear, which samples mainly ectocervical cells.”
But to Dreyer, the key lies in vaccination. “All girls from age seven to 25 should have their HPV shots. The government is doing a fantastic job, but can only afford to do girls up to age nine. Parents need to be responsible and protect older girls by getting a prescription from their doctors for the course of three shots (two for younger girls).”
Dreyer also recommends this for boys. “HPV vaccination helps protect boys against genital warts and cancers of the penis, anus and throat, and prevents them passing the virus to women and possibly causing cervical cancer,” she said.