HPV vaccination saves lives. Get the facts and not the false stories. The HPV vaccine is safe and effective. HPV vaccination is cancer prevention.

What is HPV?

HPV (human papillomavirus) is a group of highly contagious and very common viruses.

There are more than 100 types of HPV, of which at least 14 can cause cancer. HPV types that can cause cancer are also known as ‘high risk HPV types’. (1)

Most people (at least 80%) will be infected with a form of HPV in their lifetime. HPV infection is most common in people in their late teens and early 20s. (2)

How is HPV transmitted?

HPV is transmitted through intimate sexual skin to skin contact during vaginal, oral or anal sexual intercourse or genital contact with an infected person. Anyone who is sexually active can contract it. Condom use reduces, but does not eliminate, the risk of transmission of HPV (2).

Most HPV infections do not need treatment because your body can clear the virus on its own. However, in some people, the HPV infection can develop into cancer or genital warts. (2)

Which cancer types are associated with or caused by HPV?

HPV causes 1 in 20 cancers worldwide. (2) A report in 2017 by the National Cancer Registry (NCRI) estimated that HPV infection cause up to 420 cancer cases (or up to 130 cancer deaths) per year in Ireland. Most of which are potentially preventable by HPV vaccination.

Virtually all cases of cervical cancer (>99%) are caused by sexually acquired infection with certain types of HPV. (2)

Two HPV types (HPV 16 and 18) cause 70% of cervical cancers and pre-cancerous cervical lesions.

Vaccines that protect against HPV 16 and 18 are recommended by WHO and have been approved for use in many countries. (1)

HPV can also cause cancer in boys and men. HPV infection can cause cancer of the anus, throat, penis and head and neck. By vaccinating both boys and girls – the better we can control the spread of HPV infection. (2)

HSE school’s vaccination programme

The HPV vaccine has been offered to girls in their first year of secondary school since 2010.

HPV vaccine has now also been offered to boys in their first year since September 2019.

The vaccines protect against types of HPV that cause nine out of 10 cervical cancers. Used with regular cervical screening later in life, the HPV vaccine is an effective way to prevent cervical cancer developing. (2). They can also protect boys from cancer types caused by high risk HPV and from genital warts.

The HPV vaccine is free for girls right up to sixth year, if not vaccinated in 1st year. It is currently only free for boysin their first year.

Two doses of the vaccine are required if under age 15, three doses are necessary for age 15 and older. (2)

Is the HPV vaccine safe?

The HPV vaccine has been studied internationally in over 1 million people since it was first introduced in 2006.

There is no scientific evidence in Ireland, or in any other country, that indicate that the HPV vaccine causes any long-term medical condition. (6)

Vaccines are strictly monitored and reviewed regularly by international bodies including:

• World Health Organization
• European Medicines Agency
• Centers for Disease Control and Prevention in the USA

A number of studies have been conducted that show there is no link between the HPV vaccine and chronic fatigue like conditions. A recent study in the US in June of this year also shows that there is no association between HPV vaccination and infertility in US females between 18–33 years old. (6,7)

Over 84 countries now have an HPV vaccine programme, with more than 20 of these countries giving the vaccine to both boys and girls (2)

Recent research carried out for more than 12 years to June of this year also indicate that there is no evidence of waning immunity, suggesting that there is currently no need for a booster dose of the HPV vaccine. (6)

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In the Irish Cancer Society, we are keenly aware of the devastation caused to people and families by HPV cancers.

Every day in Ireland, someone is diagnosed with a cancer caused by HPV, and more than two people die from this source of cancer every week.

Over nine in ten cervical cancer diagnoses are caused by HPV infections leading to around 90 deaths every year. They are also associated with other incredibly difficult diagnoses such as cancers of the throat, mouth, anus, cervix, vagina and penis.

The HPV vaccine in use at the moment is the most effective we have ever had, and has been proven time and again to be safe.

Elimination of HPV cancers

Through vaccination, we now have a unique opportunity to eliminate these cancers for future generations of our young people.

HPV vaccinations have come a long way in the last number of years. In Ireland, we are at a big advantage due to a number of important advances, including the introduction of HPV vaccinations for both boys and girls in the first year of secondary school.

The HPV vaccine in use at the moment is the most effective we have ever had, and has been proven time and again to be safe.

Uptake of the vaccine is expected to top 80% this year, according to the HSE, in what is a really encouraging sign as we seek to protect as many people as possible.

If we can make the right decisions now, both individually and as a community, then we in the Irish Cancer Society firmly believe that a future without HPV cancers will be achieved.

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As the demand for a global COVID-19 vaccine grows, increasing challenges emerge on misinformation around vaccinations.

This pandemic, the worst global health crisis in a century, has demonstrated the critical role vaccination has to play in keeping people safe, economies ticking over and threats to global health security at bay.

The fact is, we simply can’t end this crisis without COVID-19 vaccines. But as we race to develop them, this pandemic has also shown that there’s one thing that can spread faster than a virus during a pandemic – misinformation. This has led to what the World Health Organization (WHO) has dubbed an “infodemic” about COVID-19 and vaccines that now represents one of the biggest challenges to bringing this crisis to a swift end.

Vaccines need to be accessible to all

That can only happen if everyone has access to COVID-19 vaccines, regardless of where they live or of their ability to pay. Because until everyone is protected, this coronavirus will continue to spread, and the risk of resurgence will persist. So, not only do we have to develop COVID-19 vaccines that are both safe and effective, but we have to ensure that they are made available to everyone quickly, as soon as they are ready.

This pandemic has also shown that there’s one thing that can spread faster than a virus during a pandemic – misinformation.

That is why Gavi is working with partners to build a model for COVID-19 vaccine distribution which, for the first time in history, will ensure that every country gets access to COVID-19 vaccines at the same time, regardless of wealth.

Together with the WHO and the Coalition for Epidemic Preparedness Innovations (CEPI), this multilateral approach aims to avoid the mistakes of the past, such as what happened with swine flu in 2009 where only small number of countries cornered global supply of vaccines.

The most vulnerable can be most at risk of misinformation

But this effort, which has already received expressions of interest from more than 150 countries, and which will effectively be the single biggest vaccine deployment in history, now threatens to be undermined by a tsunami of fake news and misinformation about COVID-19 vaccines. This is particularly pernicious because those who are most vulnerable to the pandemic and its economic impacts, the poorest communities with the least level of support, are also where low levels of digital literacy make people more susceptible to misinformation and where limited access to reliable information can help it spread.

Improving digital literacy to reduce misinformation

We urgently need to build resilience to this false information and rebuild confidence in vaccines by raising levels of digital literacy, ensuring easy access to credible information and working with social media platforms, whose algorithms make it so easy for harmful rumours to propagate.

If trust in vaccines is undermined, not only will it hamper our efforts to end the misery and suffering this pandemic has brought, but it also threatens the huge strides we’ve made in recent decades in increasing equitable access to countless other life-saving vaccines. So, if we want to avoid outbreaks of other diseases as well, we need to ensure that everyone has access to vaccines and everyone sees the value of one world, protected.

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Vaccination is one of the most cost-effective health interventions available, saving millions of people worldwide from illness, disability and death each year.

I believe that vaccines are the best gift we can give our children and, even better, the health service gives them to us for free. If my son’s first birthday hadn’t been on a Sunday, he would have had his 12-month vaccines on his birthday. You never know when they will be exposed to infections, so it is really important to get vaccinated as soon as they are due.

In Ireland today, vaccines are offered to protect against 14 diseases: diphtheria, haemophilus influenzae (Hib) type b, hepatitis B, HPV infection, influenza, measles, meningococcal disease (types A, B, C, W & Y), mumps, pertussis (whooping cough), pneumococcal, polio, rotavirus, rubella and tetanus.

Vaccines protect the wider population

The World Health Organization (WHO) recommends a target uptake of 95% for childhood vaccines to protect everyone. We have reached the target uptake for some childhood vaccinations including diphtheria, tetanus, pertussis, polio and hepatitis B vaccines; however, we have not reached the target for measles, mumps, rubella, meningococcal, Hib and rotavirus vaccinations in Ireland.

When the majority of us are vaccinated we protect our children and ourselves.

When the majority of us are vaccinated we protect our children and ourselves. We also protect those who can’t be vaccinated, either because they’re too young, or because they have a weakened immune system.

There is a lot written on the internet about vaccines so sometimes it can be difficult to tell where to find accurate information. I would recommend looking at sources accredited by the WHO, with the Vaccine Safety Net (VSN) logo.

Communication with vaccine heroes

You can also talk to a health professional like your GP, pharmacist or practice nurse who can answer your questions.

We are asking everyone to be a vaccine hero, you can do this by

1. Getting vaccinated on time and completing your vaccination schedule
2. Sharing the facts about vaccine preventable diseases and the importance of vaccines
3. Look for information from credible sources like www.immunisation.ie and speak to a trusted health professional

Check your eligibility for the flu vaccine

It is important to remember that smallpox is the only vaccine-preventable disease that has been eradicated, so we need to keep vaccinating to prevent outbreaks of vaccine-preventable diseases.

As we approach flu season, I would encourage everyone eligible for the HSE flu vaccine programme to get vaccinated to protect themselves from flu. For the first time this year we are also offering the nasal flu vaccine to all children aged two to 12 years old. Both vaccine and administration are free for those eligible for the HSE programme.

www.immunisation.ie ||#KeepVaccinating

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The Varicella-Zoster virus affects almost all of us in our lifetime but there are now vaccines that could prevent this.

Varicella-Zoster virus (VZV) causes chickenpox (Varicella) and shingles (Zoster). Primary infection results in chickenpox. The virus then becomes dormant and can later reactivate to cause shingles. In unvaccinated populations, in temperate climates, almost 90% of people have had chickenpox by adulthood. Almost 80% of cases occur in children, mostly those one to five years old. Disease severity is greater in adults than children. Chickenpox is highly contagious and is transmitted by aerosol, droplet, and direct contact. Shingles is not as contagious as chickenpox, however a susceptible person who has direct contact with shingles can become infected and will develop chickenpox.

The chickenpox rash appears 10-21 days after exposure. The pox evolves from flat pink spots that blister with clear, then cloudy, fluid and ultimately dry and crust. Symptoms include temperature up to 38.5^oC, occasionally higher, loss of appetite, headache, and malaise for two to three days.

Complications as a result of chickenpox

Complications, infectious and neurologic, although uncommon, can be serious with highest risk for infants, adults, pregnant women, smokers, and the immunocompromised.  Bacterial infections can affect skin, bones, joints etc. Streptococcal necrotising fasciitis, a life-threatening gangrenous skin infection, is a rare complication. Any child with chickenpox with high temperature lasting more than two to three days, with new fever after initial improvement, with significant pain, or refusing to bear weight needs urgent evaluation.

Antiviral treatment

Antiviral treatment is generally unnecessary for uncomplicated chickenpox in children. It can be considered for adolescents and adults because of risk for varicella pneumonia.

The use of the varicella vaccine

Varicella vaccine, a live attenuated vaccine (i.e weakened virus), was first licenced in 1984. The US introduced it for routine childhood immunisation in 1995. It is routinely recommended in many countries. Varicella vaccines are proved to be highly immunogenic, efficacious and safe. Vaccination can protect approximately 86-98% of children and 75% of adolescents and adults.

Since introduction, in the US, varicella cases, hospitalisations, and deaths have decreased by more than 90%. Other countries also experienced significant decreases in chickenpox cases following vaccine introduction. Initial concern that vaccine use might result in more shingles has not been borne out. Recent evidence suggests that those vaccinated are less likely to develop shingles than those following natural infection. Some who are vaccinated may still get very mild chickenpox with fewer or no blisters (they may have just red spots) and little or no fever.

Who should not get the varicella vaccine? 

Varicella vaccine, as a live vaccine, should not be given to pregnant women. Pregnancy should be avoided for one month after getting it. Immunocompromsed patients and those on medication affecting the immune system or with family members with immunodeficiencies should check with their doctor about whether they should receive it.

The current status of the varicella vaccine in Ireland

The varicella vaccine is licensed and marketed for use in Ireland. It is recommended for susceptible individuals in specific risk groups (www.immunisation.ie). It is not yet part of the National primary immunisation programme for all children.

Parents can request it from their GP, however the cost for the vaccine and its administration is borne by the parent. The feasibility of adding the chickenpox vaccine to the national programme is currently undergoing evaluation.

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General Practice (GP) is the first point of contact for most people who have health concerns or queries, nurses and doctors working in GP are particularly alert to the topic immunisation.

Vaccinations are administered in general practice on behalf of the HSE, as part of a national strategy to protect children and adults from serious infectious diseases and more recently from cervical and liver cancers. Vaccine schedules have evolved and changed over time and are responsive to vaccine safety, development and population needs. Whilst general practice is central to the delivery of annual influenza and pneumococcal vaccines to vulnerable groups, and to women during pregnancy, it is also important to consider infant immunisations and the role of the general practice nurse.

Trust in the science of vaccines

The science supporting the positive impact of vaccinations is well established, vaccines are some of the safest and most effective medicines we have, saving millions of lives annually. It is important to understand that the benefits of vaccinations far outweigh the possible side effects. We are confident of this because of rigorous vaccine testing, research and post-licensure surveillance, which is carefully scrutinised internationally, and in Ireland, by independent regulatory agencies.

Unfortunately, vaccine suppression of infectious disease has reduced people’s awareness of the suffering associated with these illnesses; ‘out of sight, out of mind’ has led to complacency and denial by some in contemporary society. However, the recent outbreak of COVID-19 pandemic and the universal quest to find a vaccine has been a stark reminder of the crucial role vaccines play in saving lives.

‘Out of sight, out of mind’ has led to complacency and denial by some in contemporary society.

Protecting our children

Within general practice, we recognise the ‘push and pull’ factors surrounding infant vaccination and the dilemmas parents or guardians can face when deciding to vaccinate. The powerful and often mixed messages that surround vaccines can cause confusion and misinformation which leads to loss of confidence, mistrust and vaccine hesitancy. We worry that the message of the lifesaving and enduring protection which vaccinations provide gets lost in the ‘noise’ of inaccurate, emotional media and online debate.

General practice nurse expertise

Nurses in general practice seek to work in partnership with families, fostering lasting, trusting relationships. As experts in infant immunisation we want to discuss  concerns and would encourage anyone who has questions to contact us. We are there to help, listen and clarify, we understand parents’ fears, we are not there to judge or criticise. If vaccines have previously been declined, appointments missed or delayed due to pandemic restrictions, we would ask that you speak with your general practice nurse who will ensure your decision is informed and tailored to individual circumstances, it may not be too late to vaccinate.

Relationships built on trust

Happily most parents choose to vaccinate their children. Through high uptake of vaccines, the benefits of immunity can extend beyond the level of the individual to the entire population, the benefits both from a health and economic perspective is incalculable. In response to the pandemic, we want to reassure parents and guardians of infants that we have made our surgeries safe places to attend for vaccination. By spacing out appointments, we ensure safe distancing, hygiene measures and use of protective equipment are strictly implemented to reduce infection risk. Vaccination appointments are always prioritised as essential. Phone first to plan an appointment with your general practice nurse and don’t forget to wear a mask.

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In 2012, Mags Cregan-Smart lost a baby to meningitis. Now she’s urging mothers to ensure their children are vaccinated. Sadly, globally, progress against meningitis lags behind other vaccine-preventable diseases.

What is meningitis?

Meningitis is a serious illness. Life-threatening bacteria can enter the body and cause meningitis (inflammation of the lining around the brain) and sepsis (an infection that overwhelms the body). These bacteria may live at the back of the throat or nose, often unnoticed, and can spread to others through coughing or close personal contact. The risk of infection is highest in winter.

In recent years, up to 200 annual cases of bacterial meningitis and associated sepsis have been reported to the Irish Health Protection Surveillance Centre, although experts estimate that the total number of cases may be considerably higher. These cases most commonly occur in children under five, but any age can be affected.

Of the people who do get bacterial meningitis, around one in 10 will die, and more than two in 10 of those who survive will have significant impairment, such as deafness, brain damage or loss of limbs (amputations may be required due to associated sepsis). 

Meningitis can strike quickly, killing a child in less than 24 hours. As it requires such rapid medical attention, preventing meningitis is better than relying on treating it in time.

Preventing meningitis 

A range of different bacteria can cause meningitis. However, there are safe and effective vaccines available that protect against common causes of life-threatening bacterial meningitis. Babies from two to 13 months are given these vaccines in Ireland, as part of their routine immunisations. From September 2019, when a child is in first year of secondary school, they now also get the MenACWY vaccine. This vaccine protects a child against infection from four types of bacteria known as meningococcal group A, C, W and Y.

Meningitis can strike quickly, killing a child in less than 24 hours. As it requires such rapid medical attention, preventing meningitis is better than relying on treating it in time.

While most people ensure they have their vaccines, some people still miss out.

This can be for three main reasons:  

• Complacency: because vaccines are so effective and diseases are now less visible, some people question whether they are still necessary, even though diseases would resurge without them.
• Convenience: it may be difficult for some people to attend vaccine appointments.
• Confidence: some people require additional reassurance from a health professional before being vaccinated. 

At Meningitis Research Foundation, we work with families affected by meningitis to help address these issues and encourage everyone to get these vital vaccines. 

A mother’s plea

Mags Cregan-Smart, from Wexford, has been raising funds and awareness to defeat meningitis, following the heart-breaking death of her baby Ruairí Smart, in 2012, at just six months old. She is encouraging everyone to get the vaccines available to them.

Mags says: “Ruairí brought us great joy and his death was very sudden. Meningitis strikes without warning, and there is so little time to get the rapid medical care needed. That’s why vaccination is so important: to stop meningitis before it happens. Vaccines can’t prevent all meningitis, but there are several vaccines available which save lives. Ruairí, like his brother Micheál, shared his name with a king of Ireland, and he will always be king of our hearts.”

The call from parents like Mags has led to Meningitis Research Foundation, a charity that supports families in the UK and Ireland, to drive forward a global plan to defeat meningitis. The global plan is due to be launched by the World Health Organization this year. It aims to dramatically reduce preventable deaths for meningitis, while ensuring there is more support available for anyone affected. 

More information is available at www.meningitis.org

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As the COVID-19 pandemic continues and we head into flu season, we must recognise collective responsibility to provide immunity against flu to protect others.

This year marks the tenth season in which Irish community pharmacists have been involved in the HSE’s flu vaccination campaign, and the first year that pharmacies can offer flu vaccination to children as young as two years of age.

Allowing pharmacists to administer the flu vaccine has been hugely successful: increased awareness of the vaccine through the promotion of the service by pharmacies has led to an overall increase of 60%, with 1.1 million vaccines distributed last year.

COVID-19 and the flu vaccine

In the midst of the current coronavirus pandemic, it is more important than ever that all at-risk patients receive a flu vaccination. As the world waits with hope for a vaccine against COVID-19, it should be seen as everyone’s responsibility to build collective immunity against flu. The best way to do this is through widespread vaccination.

Ireland performs well by EU comparisons but we still fall short of the target of 75% of people over the age of 65 availing of the vaccine. Making the vaccine free for everyone and improving its accessibility would send a powerful message about its importance to public health.

Increased awareness of the vaccine through the promotion of the service by pharmacies has led to an overall increase of 60%, with 1.1 million vaccines distributed last year.

Barriers to uptake of vaccines need to be addressed

The Irish Pharmacy Union (IPU) has strongly asserted that, for a universal vaccination programme to be successful, barriers to uptake must be identified and eliminated. For example, access to the vaccine must be made as simple as possible and it should be universally State-funded. The IPU has written to the Minister for Health, calling on Government to make Ireland the first country in Europe to provide free flu vaccination for everyone over the age of six months. While we welcomed the recent Government decision to make the flu vaccine available for free to all children aged 2-12 and all at risk groups, we will continue to advocate to extend further.

Offering flu vaccine in community setting

We can increase vaccination levels by offering it to wider groups of people in a community setting.

Offering the vaccine at residential services and workplaces would significantly increase uptake and help build a herd immunity.

Reducing the strain on the health system

The flu vaccine is the best defence against flu and Government needs to aim for seasonal flu prevention for the entire population. If we can prevent flu from overwhelming the health system during the winter, the savings will far exceed the cost of a properly funded universal vaccination policy.

Community pharmacists have been at the forefront in the fight against the coronavirus pandemic and will help in the battle against flu and coronavirus this winter. At present, we can’t stop coronavirus but, given the resources, we can try to stop the flu.

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