Translated article - HPV vaccine - Norway

[blondina1]

Netmeeting about cancer vaccination

From the autumn any girls in the seventh grade are offered the HPV vaccine against cervical cancer. Cancer vaccine for 12-year-olds is still controversial.

http://media.aftenposten.no/archive/01040/_D-listeingress-51_1040440c.jpg Hanne Nøkleby


Biotechnology Council wants to postpone the introduction of the vaccine by a year to increase understanding of the vaccine limitations and restrictions and about how cervical cancer can be prevented.
Folkehelseinstituttet reject the advice from Bioteknologimenda about the postponement, and claims the vaccine that exists today is as effective and well-documented vaccoine and that there is no reason to wait.

Executive Director Hanne Nøkleby by Folkehelseinstuttet answers questions to inform about the HPV vaccine.


Questions and answers

"vaccine is effective for approx.6 years". Statistically how many 18 year olds have cancer in pregnancy? Is not this a disease that develops later in life?
mother of 12 year old

When we say that the vaccine so far has shown an effect for six years, it means that is as long as we have followed up vaccinated women and seen that they didn't infection or pre-cancerous conditions. From the infection occurs, it takes 10 to 30 years before it may develop into cancer, but the infection is a prerequisite. The most common age to get the infection is around 20 years of age. Preventing that, it also prevents the development of cancer. It may well be that the vaccination is significantly longer lasting, but we can ike saying before we have a longer follow-up amongst the vaccinated.

hey, I live in France and will now vaccinate my 14-year-old daughter. In this country the vacsine programm consists of three injections: 2. injection 2mnd after 1. and 3. ineksjon for further 6 months. In this country the vaccine is covered by the public and it is recommended to be given before young people start with sexual activity. Why is that there is only 1 vaccine recommended for Norwegian girls?
nina

There is a misconception. It happens in exactly the same way in Norway as you describe in France

hey here is an excerpt from the FDA s.6 : The FDA news release of March 31, 2003 acknowledges that "most infections (by HPV) are short-lived and not associated with cervical cancer,"
Does this not mean that we vaccinate without reason? ref: http://www.fda.gov/ohrms/dockets/dockets/07p0210/07p-0210-ccp0001-01-vol1.pdf
thomas

/ 0% of us get HPV infection, 90% of them associate themselves with the virus in a short period of time. But some of the 10% who have a prolonged infection, will develop cancer. We have no way to know who this group is. For them it does not help much that this is harmless to others. Therefore, the vaccine offered to all

(Going to translate the rest - for you norwegians.. http://www.aftenposten.no/nettprat/article3096260.ece )

[blondina1]

Has the vaccine been given to so young girls before?
Sandy L

Yes, to girls from 9 years old. Countries like England, Denmark and the Netherlands, have introduced the vaccination program in which the vaccine is given at the same age.

If you have the virus, is there any reason to vaccinate then? How do you check if you have the virus? Thank you.
Raul de Sana

Preventive vaccines works. It will therefore have no effect on those who have the infection, but it is not dangerous to be vaccinated for it. It is also so that vaccine can give effect to the one virus, even if one is infected with the other. Unfortunately, there is no reliable way to tell if you have an infection so far.

Is it true that there is a requirement for approval from the FDA that the vaccine must be used in a study in Norway precisely?
Håkon Moslet

A study in Norway has been mentioned as one of several follow-up points in the FDA 's approval for any of the vaccines. But if it for some reason can not be done in Norway, the manufacturer must find another place to do a similar follow-up. FDA can not commit the Norwegian authorities, and what happens in Norway will not change the approval conditions in the United States.

[blondina1]

Hi! In the U.S., this vaccine is approved for sale under the assumption that the negative effects/side effects, etc. are tested in Norway. What happened to this clause? Are they goign to eksperiment ona generation of girls? Does that mean it will have to be withdrawn in the U.S.?
terje karstensen

When a vaccine is approved, pharmaceutical authorities always claim that it has made thorough follow ups after the vaccine has been in use. It also applies to this. It is correct that in the follow-up, Norway is mentioned as one of the many follow-up points in the approva. But it is not in any context, talk about experimentation - it is done before the vaccine was approved. If the studies that is mentioned for some reason can not be done in Norway, the produceers will have to do the follow-up studies in another country. What is happening in Norway will not affect the vaccine licenses in the United States or anywhere else.

Is it possible to vaccinate boys against HPV this vaccine? Work with such a vaccine? Can HPV cause cancer in boys?
Erik

Yes, HPV can also cause cancer in boys. Vaccine can also be given to them. We know that it makes antibodies in the same way that it does for girl, and the studies examining the effect against cancer among males is in progress, but is not finished yet. Therefore, it is a little early to go out with strong recommendations to the gutter, but it is likely that it will come.


1. Has the vaccine has been tested on the young girls before? If the answer is no then this is a vaccine experiment! 2. Will it come up with clear written and oral information to each of the girls and their parents: the vaccination is voluntary? 3. Are there systematic medical follow-ups? We have not forgotten the poor follow-up related to the vaccination experiment against contagious hjernehinnebetennelse, also about how it was not given adequate information for example that vaccination was voluntary.
Sandy Luno

Yes, the vaccine has been tested in girls from 9 years of age
Yes, there is information to girls and parents. Obviously, the vaccine is voluntarily, as all vaccines in the Norwegian vaksinasjonsprogrammet are, and it will appear from the information
Yes, there is systematic follow-up. But since this is not a clinical trial, but the routine use of a medically approved vaccine, there will be no detailed follow-up of each person.


Would you give this vaccine to your daughters, nieces, grandchildren, etc.? Will those in the beginning getting this vaccine be regarded as "gunie pigs" or be seen as a safe vaccine ? PS! Incidentally supper well done by the ''Manager'' (the perosn who edits the afteposten newspaper) to use a picture of someone with a tattoo who i about to get a vaccine to illustrate a vaccine given to 12-year-olds!
Eva

Yes, I would recommended this vaccine to my closest. Eksperimets concerning the vaccine has been conducted for several years -Medically authorities in the U.S. og Europa have gone through all the data from the experiments and evaluate the vaccine as safe and effective vaccine


I have followed some of the discussion around this vaccine in the United States, and must say I am shocked over the argument. Many believe that it should not be given at all, because sex should be kept within the marriage - and it is no danger! Another controversial idea is that it be given to children before the "sexual age", but it goes without the saying that to avoid getting a potentially fatal disease that you have to get cervical cancer vaccine before you get the disease ... The arguments used against the vaccine in Norway?
Bjørn Danielsen

In Norway we say that this is a vaccine against an infection. There are two special things with this infection. One is that it can lead to cancer. The second is that it is transmitted sexually, but it is so common that 70 5 of all adults with what we perceive as a normal sex life becomes infected during their lifetime. Thus, this vaccine against an infection which all people have significant risks to get, and that can lead to very serious consequences (if we were to avoid HPV infection by changes in seksualhabits, it would require 100% monogamy for both women and men. Realistic?)


Which side effects can you expect in connection with the vaccine and what can you expect in the longer term? In other words: What side effects are regarded as common and / or are commonly associated with the vaccine?
Turid Crustal Lannem

This vaccine provides a pain in the upper arm. This most will experience. There are some who feel sick, get geadaches or get fever for a day or two, as with all vaccines. It is also seen someone faint, especially after people started to vaccinate school classes - usually when you vaccinate many young people in the aged. Allergic reactions have been reported, but it is rare. It is not rapportertmer serious reactions where thorough review of medical reports by independent pharmaceutical authorities suggest that the vaccine is the cause


Hello, 1) Why is the vaccine controversial? 2) How many girls get cervical cancer, and how many avoid getting it by using this vaccine? 3) The sideeffects? 4) Is the international requirements fulfilled in relation to the testing of the vaccine before this is done in Norway?
Øyvind

It is difficult to say. I think there have been few who have known that there is an infection that is transmitted sexually and can cause cancer, and the knowledge in itself makes people insecure. It is about 300 cases of cervical cancer in Norway each year. Through vaccination program we expect to be half this.


In the article "does not hold with the vaccine" published 26/5/09, argues Dr Moi "....... but it can cause the cervix to be so weak that it fails to hold a fetus, with premature birth as a result. " I ask that this statement will be explained further. Thank you in advance for your reply.
nina Linaae Fougner

To remove cell changes / pre-cancerous conditions one must have an operation where some of the cervix is removed. It is shown in large studies that women who have undergone such operations have a higher risk for abortions and for premature birth than others.


How many women die of cervical cancer, and how great a reduction in such deaths are expected because of the vaccine? So I would like to know how much HPV vaccination cost the state per year. Have also understood that Norway should stop to immunize against all tuberkolose. Tuberkolose is still a huge problem in large parts of the world, and we travel a lot more than before. Was not the vaccine we had longer effective? And how much cost tuberculosis vaccination in total per year?
Kirsti

About 300 women get the diagnosis cervical cancer each year and 80 women die of the disease. Through vaccination program, we can estimate that the number could be halved. If all the girls say yes to the HPV vaccine, the vaccine cost the country approximately 50 million annually. Norway will cease to vaccinate against all tuberculosis because there are so few who become infected with tuberculosis in the normal population today. Therefore, it is much better utilization of the resources we use in the fight against tuberculosis to target them toward those groups who have increased risk for infection, and ensure that they are vaccines, examined, and not least processed properly if they are infected, so they can not infect others.


Why is it that you recommend a product that has not undergone any foolowup studies and they do not know long-term effect of, see thalodomid m.m., to be used by all the girls? How can one allow the female population will be on gunie pigs in this way for the pharmaseutisk industry. It is quite natural that this industry wants the public to go for mass vaccination that they will earn much money, especially since the vaccination must be repeated at regular intervals ..
Janicke

This vaccine has been through all the testing stages. Data from testing is considered by the pharmaceutical authorities in the U.S. and Europe. They have reviewed the vaccine as safe and effective. All that is an absolute prerequisite for that we should consider using a vaccine in Norway. Now, we have information from use in other countries in three years after approval, so knowledge about the vaccine is great.


Have a daughter who is 12 years and must say I have some qualms about this vaccine. HAve read opposing articles and find it a difficult choice. When was the vaccine first tested and how do we know that this does not show up in a few years that this was the wrong choice? Do you think there will be a better vaccine in a short time? Is it enought to be vaccinated once or does one have to have repeated jabs?
Eli

I understand that you're struggling. The initial testing of vaccine began around 2000. Subsequently, the vaccination has been given to over 50 000 women in clinical studies, and in the past three years is more than 40 million vaccine doses given in different countries in the world. There are still some uncertainties related to the vaccine, but in our opinion, they can only turn out that it shows that the vaccine is somewhat less efektiv than we believe today, not in that it is harmful in any way. I think it will get vaccines with even better effect, but that it will take several years yet. Currently, we know that the effect lasts more than 6 years, but there could be a repeater jab later. That we can not answer for when we have followed vaccinated girls / women through even several years


How much is the vaccine for those who are not so lucky to go in 7. class in the fall?
Nina Moholt

Vaccine costs about 1200 kroners per dose, ie 3600 kr.for three doses.


Hi! My cousine lives in Sweden where they have for several years had this vaccine on a reimbursement not to be so expensive for those who want to buy it themselves. Why do not we have this system in Norway?
Anne Larsen

I know that they have the system in Sweden and agree that it is a good system. How this is done in Norway is an economic issue that we have no impact on.


Vaccine should be very effective. Why are there not more that will be offered free HPV vaccine? The recommendations provide Public Health in terms of vaccine to other age groups?
Kenneth Inghelm

The question of who can be offered the free vaccine is not at least an economic question. It's health care ministry, or in practice the government through their budgets, which takes the decisions. Folkehelseinstituttet recommend general vaccination of all girls under 16 - 17 years, and girls to women up to 26 years (it is the vaccine is approved for the time being) in consultation with their own physician. We also recommend the vaccination of boys / men in the same age, in consultation with your own doctor, but there may be relevant to discuss the probability to be infected already, and thus the effect we can expect. There is much less evidence about the effect on boys than girls, therefore, we must currently be a little more reserved with the recommendations there. But it is made of research suggests that it works almost as well.


Opponents have argued that the process has been too quick in Norway. Can you elaborate on why you think otherwise?
Jan Høvids

OK GOT TIRED OF TRANSLATING SO DID THE REST AS A GOOGLE TRANSLATE - SORRY


Of experts began assessing the vaccine and the documentation that was about it in the beginning of 2006. I can well admit that many of the participants in the group were skeptical initially, but was convinced by the work - there are actually very good documentarist Jone on this vaccine effect. The group submitted its recommendations to the Ministry of Health in spring 2007. Ettyer the vaccine has been up to an open hearing in the Health and then reviewed by the Council for the quality and priority of healthcare winter 2008. In connection with this, there were also several public discussions. This is thus a long process, and assessment in several organser than what is normal before the vaccines are in use. In the meantime, is also the cure adopted and used in many million doses in a number of ander land, so we have increased knowledge about vaccine safety in general and in particular, which selvflgelig is a force in denen context.


Why is not more informed about HPV, infection and prevention in schools? I was totally amazed when a friend me that the condom does not protect good enough HPV and that is something almost everyone is infected with. Amazingly dumb that it almost kept secret.
Lena Mo

I do not think it has been intended to keep it a secret, but it seems as if no one has thought of talking about it before the vaccine was likely. even health professionals have poor knowledge about this. Completely agree with you that it is stupid. We do what we can to get the information!


How many years has this vaccine been available? And it is check that it has no dangerous side effects?
Margrethe Solvang

Vaccine has been on the market for three years in the U.S. and Australia, 2.5 years in Europe. It is not seen dangerous side effects or events where you think the cure was the cause.


Will the HPV vaccine to have a beneficial effect on the boys, or will the boys are vaccinated more easily prevent the spread of girls? In that case, why can not guys this offer?
Nils Skanding

It is made much less examine OR of vaccine effect among boys. We know that they have antibodies, but it is not shown that the vaccine prevents cancer. Such studies in progress. Vaccination of boys could be relevant when there is more documentation on the site.


Makes it not false confidence? Vaccine does not protect against all types of HPV. Girls drop may survey? Is not screening safer? Easy to operate v cell change? Vaccine does not protect against other diseases / cancer types in the life? Do we NOK of side effects of the cure to such "precautionary" now? What server pharmaceutical manufacturer for this? What do independent research? How much vaccine versus screening? Is health ready for these three vaccines in addition to the current vaksineprogram?
Hilde

You are correct that the vaccine does not protect against all forms of cancer. Information about the screening and the need to continue is important. But screening can not prevent all cancer, we are here talking about the two offers as the aggregate is much better than one - OR the other. Behandlign of pre is no joke, including because it increases the risk of abortions and early birth, so it is also desirable to avoid. After that it is given 40 million doses, we believe that knowledge about vaccine safety are adequate. Of course, pharmaceutical manufacturers will make money on the vaccine, but we should not not use a medically useful because any money on it?


Have read that the risk of cervical cancer increases by a high number of partners. And this also has increased the incidence of Chlamydia and the risk of sterility. Why is it that no one takes the view to warn young girls against the "one night stands" and for many partners instead?
Helene

Completely agree with it in the information and warnings here is important. But about 70% of all sexually active people in our country get HPV infection during their lifetime. That to avoid many partners are therefore not sufficient to prevent infection and risk of cancer. Therefore, a vaccine suppøement to the type of information and warnings as you pull forward.


It seems as if the Biotechnology Council due to put their skepticism based on a small academic thesis by a student. According to posts in Aftenposten from Folkehelseinstituttet may appear on Biotechnology Council does not have sufficient knowledge of the HPV field. What is the motive to flag this skespsisen so strongly?
Monica I

We have also wondered. Jaeger has no answer for you there.


I remember a comment from helsemin. that HPV has been in the U.S. a long time, and that almost all girls who are vaccinated also have taken this vaccine. This is simply a lie. I'm even in the USA, and her works vaccination program so that parents themselves take their child to the doctor for vaccination. I sit with the form here now to see what vaskiner that is required here, and it says nothing about HPV. So when it is not mandatory here, how in all the world can it be defended, and do it in Norway?
Sigrid

No vaccines are required in Norway. All vaccines in vaksinasjonsprogrammet is an offer, also HPV vaccine. It is the same as that in the United States is one of the recommended vaccines. The biggest difference is how the offer is given - in Norway through health and skolehelsetjeneste, in the U.S. primarily by for seeking their own physician.


Will this vaccine also offered to older girls than 12-year-olds?
Hans Peter

Girls over 12 years will not blil offered the vaccine free. But to seek their own doctor and pay for the vaccine itself, will all be able to get it.


How can you claim that the HPV vaccine is as effective and well when we do not have any long-term studies that underpin this? Any evidence will not show up until about 20-30 years of vaccine will really lead to fewer cervical cancer. And why is it only those who are positive to the vaccine that gets the most space? Screnning with cytologiske samples from the life has proved very effective for detecting cancer cases. I'm even in health care, but I do not want my daughters to have this vaccine as long as we do not know anything particular about the side effects. There have also been deaths in countries where the vaccine has already been introduced, but this information will not be until they actually going to take a decision in relation to whether the child should vaccinate or not. I therefore request a little more "sobriety" in relation to what's coming out to consumers. One should not love too much of a product before it is proven that what you say is true. Perhaps the requirement from the Biotechnology Committee to postpone the introduction of vaccination of 12-year-olds are not so stupid?
Tanja Mehrnia

We know that both vaccines prevent HPV infections that the cellular changes that constitute their own pre-cancerous conditions. Infection is a necessary precondition for cancer, and cancer FOREGOING always of cell changes. Therefore, we believe there is reason to believe that when the pre prevented, also prevented the cancer. You are certainly right that we can not say it before for many years, and that it is important to føleg up. But when the question is where the most serious failure: is it bad to vaccinate and find that the effect is slightly worse than expected, or to leave and discover that a large number of women getting cancer even kunen they released it? we think the latter would be the worst. Screening is important, but not sufficient to prevent all cases, even among those who meet up at each summons. Vaccine is intended as a supplement to the screening. If we skulel wait until we really know that the vaccine prevents cancer, we had to wait for at least 10 years, we do not know anything more about it about a year or two. If the vaccine has the effect that today we think, would in the long term mean that around 1500 women get cancer and 500 of them die unnecessarily.


Would you abandoned your daughter take the vaccine? (let's say you have a daughter in 12 da ..:))
Siri

Yes, without doubt.


I think it is fantastic that vaccine is available. What I mean however is that 12-year-old should get thorough information about what this means, but also about other diseases that infected sexually (HIV). Will this be available for this age group? It would be a shame if they are vaccinated in the wake and think they are imune to the ALT.
Gunnvor

Norwegian youths get a lot of information about sexually overførete diseases, and it will be given in the same way forward. I agree with you that it is important to communicate that this is a vaccine against a particular sexually transmitted infection, which has the special property that it can lead to cancer. It is very important that it not be represented as a vaccine against venereal diseases, and we discuss a lot of health and others responsible for such information to youth.


How long has this Working vaccine? (ie how many years are you protected?) Can a revaksineres? Is this really vaksninen to protect those who do not regularly go and taking cell samples, or also those who take cell samples of the cervix have given increased protection of the vaccine?
Heidi

We know that the vaccine protects for 5 - 6 years. There is no sign of declining power in the course of the time, but we have ikek data that can say how much longer the protection lasts. Therefore we do not yet know if or when it will be applicable with revaksinasjon, but we know that revaksinasjon raise antibodies, as it will be relevant if it turns out that the protection is declining, for example. after 10 years. Vaccine is most important for those who do not go to regular samples, but ca. third of all cancer cases occur in women who have met the test. Vaccine gives an increased suite also for them.


Is the mercury in this vaccine, too??? why it is so enormously important that we must vaccinate???
stein arne south

No, there is no mercury in the vaccine. Vaccine is an opportunity, because we believe it will be important for protection against cancer. But no need to vaccinate, it is voluntary


I have a daughter aged 11. She will be offered this vaccine about 1 1 / 2 years. I have even had the cell changes on the cervix and is committed to protect my daughters against cervical cancer. But how can I be sure that this vaccine does not give them the risk of other side effects? And how safe is it with regards to preventing cancer?
Hanne Marte

It is given more than 40 million doses of this vaccine, unless they have seen serious incidents caused by vaccine. We see it as good security. Based on the documentation available about the vaccine, we expect that the risk of cancer vilreduseres by about 70%. But it is not zero, so it will be important to follow up with cell samples also, when the time comes