This opinion was first published in Portuguese, which version can be found here:
https://www.jornaldeangola.ao/ao/noticias/aumentar-a-consciencializacao-sobre-o-hpv/
March 4th marks International HPV Awareness Day, also known as Human Papillomavirus. HPV comprises a group of more than 100 viruses that can infect the skin or mucous membranes, including genital, oral or anal, and can cause anogenital warts (in the anus and genital area) and, in more severe cases, even cancer depending on its type. Transmission occurs mainly through direct contact with infected skin or mucous membranes, with sexual contact being the main form of infection. It is important to note that infection can occur even in the absence of full sexual intercourse, as simple contact is sufficient for transmission.
We'll likely all come into contact with the HPV virus at least once during our lives, and for most people, this won't present any problems as our immune system is capable of eliminating it. However, in some cases, the immune system doesn't respond appropriately, which can develop various diseases, as mentioned above. The virus has a long latency period, i.e., a considerable interval between infection and the appearance of symptoms, and many people may not realise that they have been infected. This makes the virus even more dangerous because even without visible symptoms, the infected individual can transmit it to other people.
The infection is usually discovered when the body's resistance is reduced, such as during the severe flu or other illnesses that require an immune (defence) response. At that point, the HPV virus can multiply and cause manifestations such as lesions (like cauliflower-like warts) or cancer. The HPV strains (variant or a group of variants of the virus) 16 and 18 are directly related to cervical cancer. This disease causes approximately 300,000 deaths of women each year worldwide, with 90% of these deaths occurring in low- and middle-income countries.
In Angola, according to statistics available from the Angolan Cancer Control Institute for 2022, around 18.80% of all cases treated were of this type, which represents the second highest prevalence among all types of cancer treated. It's important to mention that HPV can also be transmitted vertically, i.e., from mother to child during childbirth. Although the virus is often associated with the aforementioned cervical cancer, the risk of infection is mistakenly considered to be only for women. However, since simple contact with the virus is enough for infection, it can affect both sexes.
Since HPV is so common and affects both men and women, what can we do to protect ourselves? Prevention is always the best approach. This includes the use of condoms during sexual intercourse, regular preventive examinations such as the Pap smear for women, and, for those within the recommended age range, vaccination. It's important to note that vaccination may not be as effective for people who have already started having sex and have probably already been exposed to the virus. It is, therefore, more suitable for younger people who have not yet had contact with HPV.
Many countries choose to vaccinate girls exclusively against HPV, to the detriment of boys. Here are some reasons for this choice:
• Efficient Prevention of Cervical Cancer: HPV (Human Papillomavirus) is directly associated with cervical cancer, which exclusively affects women. Vaccinating girls can significantly reduce the risk of developing this type of cancer.
• Reducing Population Group Transmission: Vaccinating girls can reduce the spread of the virus in population groups, which indirectly protects boys. As HPV is sexually transmitted, reducing the prevalence among women can reduce the likelihood of transmission to men.
• Cost-effectiveness: In many cases, vaccinating only girls may be more economically viable than vaccinating both sexes. As cervical cancer is the central public health concern associated with HPV, prioritising vaccination in girls may be considered more cost-effective.
However, it is essential to note that HPV vaccination in boys also has significant benefits, such as preventing genital warts and certain types of cancer, such as penile cancer and anal cancer. As more data and resources become available, some countries expand their vaccination programs to include both sexes.
Angola's Ministry of Health recognises the risk posed by the HPV virus as a relevant public health issue. As a result, vaccination has been included as a priority action in the National Development Plan 2023-2027. Among the various vaccines already licensed by the World Health Organization (WHO), the age group covered includes boys and girls between 9 and 14 years old. The implementation of the vaccination campaign in Angola is still in the development phase and will be announced soon.
Through testing, condom use or vaccination, we all have tools to protect ourselves from the consequences of HPV infection. Our lives and the lives of those we love are our greatest asset, so we must do all we can to protect ourselves and enjoy a long and healthy journey.
In addition to individual prevention measures, there must be a collective effort to raise awareness about HPV and the importance of prevention. This includes educational campaigns in schools, workplaces, and communities and facilitating access to health services that offer preventive examinations and vaccinations. Collaboration between governments, health organisations, and civil society is essential to combating HPV and its consequences effectively. Together, we can create a healthier and safer environment for everyone.
Prevent it! Tests, condoms and vaccines save lives! Don't stop protecting yourself.
Dra Maria Quaresma Gomes, Imunization Specialist WHO Angola.
Dra Leila Rafael da Silva, Public Health Specialist and UNV WHO Angola.