US researchers have used mathematical models to show how worries over vaccine risks affect vaccine uptake within the community. The study shows how to predict ways in which population vaccinating behaviour might unfold during a vaccine scare, testing the model against real data from two infamous vaccine scares in England and Wales: the 1970s pertussis outbreak and the measles-mumps-rubella vaccine scare in the 1990s. 

Feel free to use these quotes in your stories.  If you would like a copy of the research or to speak to an expert, please don’t hesitate to contact us on (08) 7120 8666 or by email.

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Dr Julie Leask is a senior research fellow and manager of social research at the National Centre for Immunisation Research & Surveillance at the Children’s Hospital Westmead. She is also a senior lecturer at the Sydney Medical School at the University of Sydney

“The study confirms that parents’ immunisation decisions are influenced by what is going on around them. The authors point out a well described evolution in vaccination programs – where good disease control lessens the visibility of diseases motivating people to be vaccinated. When they are scared off that vaccine, as with the MMR-autism controversy, large groups may start to stop or delay vaccination. However, as the study shows, it took some years for immunisation rates to bottom out after the scares. Also, there have been vaccine scares that did not result in lowered vaccination coverage. What this says to me is that it is actually quite hard to put people off vaccination. Why? It’s still valued, we still have some exposure to the effects of the diseases (eg, whooping cough), and vaccination is strongly reinforced within our healthcare system.

The MMR and pertussis vaccine scares in the UK were the result of charismatic doctors laying their theories Galileo like at the door of the scientific church, positioning themselves as brave whistle-blowers willing to break ranks. That’s a very appealing approach. The great tragedy with the MMR controversy is that the science was saying all along that the vaccine is safe and worthwhile but it was often dismissed or ignored in place of heart-wrenching stories from parents whose lives were overturned by autism. Once the measles epidemics returned, people regained an appreciation of vaccination because we then had stories of the impact of measles to counterbalance things. It’s unfortunate that it took epidemics for the scares to go away. Generally, I think we need to have constant reminders of why we vaccinate. If that’s not possible because the diseases are not around as much, then we need to have grandparents, doctors and nurses telling us their stories – of their impact. The research is showing us increasingly that the cold hard facts about the success of immunisation needs to be augmented with stories about the impacts of the diseases.”

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*Bauch CT, Bhattacharyya S (2012) Evolutionary Game Theory and Social Learning Can Determine How Vaccine Scares Unfold. PLoS Comput Biol 8(4): e1002452. doi:10.1371/journal.pcbi.1002452. PLEASE ADD THIS LINK TO THE FREELY AVAILABLE ARTICLE IN ONLINE VERSIONS OF YOUR REPORT (the link will go live when the embargo ends): http://www.ploscompbiol.org/article/info:doi/10.1371/journal.pcbi.1002452

EMBARGO LIFTED AT 8 am AEDT, Thursday March 29, 2012

Two studies to publish in PLoS One suggest that a sudden increase in narcolepsy in Finnish children at the beginning of 2010 was likely to be related to the Pandemrix vaccine used in response to the H1N1 (swine flu) pandemic in 2009. As mentioned below by an expert in the field, this vaccine has never been used in Australia.

Feel free to use these quotes in your stories. If you would like to speak to an expert, please don’t hesitate to contact us on (08) 7120 8666 or by email.

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Dr Alan Hampson is Chairman of the Influenza Specialist Group in Melbourne

“These papers are interesting but simply give detail and substance to reports that were reviewed by the World Health Organisation twelve months ago (and which resulted in the report at: http://www.who.int/vaccine_safety/topics/influenza/pandemic/h1n1_safety_assessing/narcolepsy_statement/en/)

It is important to stress that the vaccine was NEVER used in Australia. It is interesting that paediatric narcolepsy associated with this vaccine appears to be only a Scandinavian experience as it wasn’t seen in other countries using the same vaccine.”

Dr Hampson is available for interviews

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Professor Nikolai Petrovsky is an Adelaide based clinician and Research Director at Vaxine Pty Ltd

“Two scientific papers have just been published establishing a link between administration in 2009 of a particular swine flu vaccine

(Pandemrix) manufactured by GSK and a large rise in cases of narcolepsy in Finnish children. The flu vaccine used in Finland was different to the swine flu vaccine used in Australia and had not been previously satisfactorily tested in children, raising concerns about the adequacy of the regulatory processes around the release of this particular vaccine for use in European children. Pandemrix is different to most other swine flu vaccines in that it also included squalene oil.

Use of squalene oil in vaccines has a troubled history with a published study claiming a link between squalene induced antibodies and chronic fatique symptoms in Gulf War veterans (the Gulf War syndrome). Although the conclusions of this single study were subsequently disputed, the recent demonstration that a vaccine containing squalene causes narcolepsy is likely toreopen debate regarding vaccine safety . What is needed is funding of independent research into vaccines to try and explain why these problems might be occurring. Unfortunately at present almost all such research is largely left to the companies producing and selling vaccines.

Although the Pandemrix vaccine was fortunately not given to any Australian children, Australia has had its own share of problems with childhood influenza vaccine programs. In 2010 CSL’s Fluvax influenza vaccine was indefinitely removed from use in young children after it caused an unacceptable rate of side effects. The message from these adverse events is not that we should stop using vaccines, given their overwhelming benefits in preventing serious infectious diseases, but rather that governments including the Australian government need to invest much more into research into how to develop safer and more effective next generation vaccines.”

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*AS03 Adjuvanted AH1N1 Vaccine Associated with an Abrupt Increase in the Incidence of Childhood Narcolepsy in Finland, Nohynek et al., PLoS ONE, Volume 7, Issue 3, e33536, 2012

and

Increased Incidence and Clinical Picture of Childhood Narcolepsy following the 2009 H1N1 Pandemic Vaccination Campaign in Finland, Partinen et al., PLoS ONE, Volume 7, Issue 3, e33723, 2012

An Australian study of Victorian data is the first to show a reduction of high-grade cervical abnormalities (HGAs – the precursors to cervical cancer) in a population of women following introduction of human papillomavirus (HPV) vaccination programs. However, the authors say more work is needed to confirm a link between this lower incidence and vaccination status.

Feel free to use these quotes in your stories.  Any further comments will be posted here. If you would like to speak to an expert, please don’t hesitate to contact us on (08) 7120 8666 or by email.

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Dr Julia Brotherton is an Epidemiologist with the Victorian Cytology Service Registries and lead author of the paper

“We are very excited about this data from the Victorian Cervical Cytology Registry (the Pap Test Register) which shows a reduction in the number of very young woman with high grade cervical lesions diagnosed since the vaccine program started. In conjunction with the data from our colleagues in the sexual health field, who have already demonstrated a significant reduction in the occurrence of genital warts since the vaccine program started, we are optimistic that this is an indication that the vaccine program is already beginning to have an impact.

Australian women were very fortunate in having access to the vaccine in the first nationally funded program in the world (which remains the world leading program in terms of the wide age range (12 to 26 years) vaccinated in the catch up delivered between 2007 and 2009). In clinical trials the vaccine was very effective at preventing HPV infection with the types covered by the vaccine (types 6,11,16 and 18) and it appears that it may already be reducing disease due to these types in Australia. The next step is to link vaccination records from the National HPV Vaccination Program Register with screening results from the Pap Test Registers to show that the reduction is indeed due to vaccination. The vaccine register was established by Commonwealth legislation with this purpose in mind.”

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Assoc Prof Karen Canfell is an Epidemiologist with the Cancer Council NSW. (She is acknowledged in the paper for providing the team with methodological advice.)

“HPV vaccination in young women in Australia commenced in 2007, and between 2007 and 2009 a catch-up program for young females up to the age of 26 years was conducted.

Because vaccination was conducted in women up to the age of 26 years, and cervical screening in Australia is recommended to start in women aged 18-20 years, an active interplay between vaccination and cervical screening outcomes is expected earlier in Australia than in most other countries.

The new study used data from the state of Victoria. The investigators analysed whether there was any change in the rate of new high-grade cervical abnormalities (which can be precursors to cervical cancer) in young women after HPV vaccination started. They found no reductions in the abnormality rates in women over the age of 18 years, but they did identify a reduction in girls younger than 18 years.

This study is the first anywhere in the world to assess the potential impact of the HPV vaccine on cervical abnormalities within a real-world environment, outside the context of clinical trials.

The study looked at overall trends, and we cannot be absolutely certain that the drop in cervical abnormalities in the youngest age group was due to HPV vaccination. The group in which the effects were observed were younger than the age group in whom screening is normally recommended, so although the results are suggestive, there are some issues in interpreting the findings.

Ultimately the results will need to be confirmed in studies that look at the effects in individual women whose vaccination status is known. Going forward, analysis of data from other states in Australia will also be important.

Also, as time goes on, the impact of the HPV vaccination program will become more and more evident and we will start to see effects in older age groups. HPV vaccination is most effective when it is given to younger girls before they are exposed to HPV, so we expect to see a more pronounced impact once the youngest vaccinated groups reach the age where they would have been at risk of having a cervical abnormality.

This study reinforces how important it is that parents of 12-13 year old girls have their daughters vaccinated.

The study is also a timely reminder that even if women have been vaccinated, they will still need to have regular cervical screening, because the vaccine does not protect against all types of HPV that are implicated in cervical cancer. Cervical screening, combined with vaccination, is still the best way to prevent cervical cancer.”

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Dr Edith Weisberg is the Director of Research at the Sydney Centre for Reproductive Health at Family Planning NSW

“The authors have carried out a very thorough examination and analysis of the data available to them. Although the results are encouraging, I believe it is premature to take too much from this study and that further research is required over a longer period for the following reasons:

-The number of Pap smears in young women < 18 years is low as the recommended starting age is 18 years

-The comparative time interval for Pap smear rates before HPV vaccination and after are different – over four years versus less than two years, leading to a reduction of 41 per cent in pap smears taken in young women <18 years after HPV vaccination introduction

-The authors show a percentage reduction in high-grade cervical abnormality (HGA) rates after vaccination introduction but this may be affected by the decreased numbers of smears taken

-It would be interesting to compare four-year intervals before and after introduction of the vaccine

-Prior to vaccination, young sexually active women may have been more likely to have Pap smears than those who have been vaccinated, who, despite publicity about the continuing need for Pap smears, were less likely to have them

-One would expect a similar decrease in HGA in women aged 18-20 years as the take up of catch-up vaccination was also high. But this is not demonstrated

I believe that this is important research and needs to be continued progressively over time but needs to link Pap smear results with the vaccination history of the women. I believe over time we should be able to show how effective the vaccine is.”

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Kate Broun is Cancer Council Victoria’s Cancer Screening Manager

“This is encouraging data and a good first indication that the Human Papilloma Virus (HPV) vaccine is effective at preventing cervical cell abnormalities. However this is only suggestive evidence and we really need to see the link with Pap test registers to confirm this.

The National Human Papilloma Virus Vaccination Program Register (NHVPR) was established with the intent of monitoring the effectiveness of the HPV vaccine in preventing cervical cancer by allowing for cross referencing of data against Pap test registries. This data linkage is yet to happen and the Cancer Council calls on the Australian Government to allow for this data linkage to occur.

Australia is already leading the way in Cervical Cancer prevention and linking the data will help inform cervical cancer prevention policy and programs in Australia and beyond. This data further emphasises the importance of HPV vaccination. Cancer Council Victoria encourages girls aged 12-13 to have the vaccine as part of the school-based National Immunisation Program.

The Cancer Council Australia website www.cervicalcancervaccine.org.au explains to teens and parents that this vaccine is extremely safe and effective in protecting against cervical cancer. We also encourage all women aged 18-69 to get regular Pap tests every two years. For those who have been vaccinated – it’s still vitally important to continue having two-yearly Pap tests (between the ages of 18 and 69).”

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Prof Michael Quinn is a Professor of Gynaecology and Gynaecologic Oncology at the University of Melbourne

“The study is the first anywhere to show falling rates of high grade change in very young women and although this is likely to be due to the effects of the vaccination programme, further analysis of information linking women’s smear history to their vaccination history will be needed to prove that the fall is entirely due to vaccination rather than other factors. The suggestion that a change in Pap smear guidelines in relation to age of first screen should be undertaken on the basis of this study is perhaps a little premature.”

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** Early effect of the HPV vaccination programme on cervical abnormalities in Victoria, Australia: an ecological study, Brotherton et al., The Lancet, 377: 2085-92, 2011.

The most recent statistics show the rates of chlamydia, a sexually transmitted infection, have tripled during the past decade and it’s the 15 to 24-year-olds at the highest risk. This year alone Queensland is experiencing the highest number of notified chlamydia cases in Australia with over 15,000 new cases already diagnosed in 2010. As schoolies celebrate around the country, experts are gathering in Queensland to look at why we are seeing such a surge in cases, how far away we are from a vaccine, and what is being done to try and stem the tide.

The briefing coincides with the Australian Chlamydia Conference which begins in Brisbane on Wednesday.

BRIEFING DETAILS:
DATE: Wed 24 November
START TIME: 11.30am AEDT (10.30am QLD time)
DURATION: 25 min
VENUE: Online.

SPEAKERS:

• Professor Ken Beagley – Institute of Health and Biomedical Innovation, Queensland University of Technology | Listen (mp3)
• Dr Jane Hocking – Centre for Women’s Health, Gender and Society in the Melbourne School of Population Health, University of Melbourne | Listen (mp3)
• Dr Frank Beard – Acting Senior Director, Communicable Diseases Branch, Queensland Health | Listen (mp3)
• Listen to the Q and A session here (mp3)

The annual incidence of genital warts is about one per cent in young sexually active people. Human papillomavirus (HPV) types 6 and 11 cause up to 90 per cent of cases and are two of the four types of virus targeted by the HPV vaccine used in Australia.

Feel free to use these quotes in your stories.  Any further comments will be posted here. If you would like to speak to an expert, please don’t hesitate to contact us on (08) 7120 8666 or by email.

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Professor Ian Frazer is from the Centre for Immunology and Cancer Research at University of Queensland, and the developer of the world’s first cervical cancer vaccine.

“Published data on HPV vaccination to date relates to the controlled circumstances of monitored randomised placebo controlled trials. This paper adds to our knowledge of the effectiveness of the HPV vaccines by providing direct evidence of field effectiveness of HPV vaccination for prevention of warts. It therefore allows inference of the effectiveness of vaccination for prevention of other HPV related disease including cervical cancer in an unselected general population.”

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Dr Edith Weisberg is the Director of Research at the Sydney Centre for Reproductive Health at Family Planning NSW.

“The dramatic rapid reduction in genital wart diagnosis in Australian young women following HPV vaccination will result in considerable reduction in health costs related to treatment and in personal distress caused by genital wart infections. It points to the likelihood of a possible equal reduction in high grade cervical lesions and ultimately cancer of the cervix in this cohort of vaccinated young women.”

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Dr Kirsten McCaffery is a Senior Research Fellow of the Screening Test and Evaluation Program, School of Public Health, University of Sydney.

“This is a very encouraging finding. Research shows that genital warts can cause serious anxiety, distress and depression, and can significantly reduce psycho-sexual wellbeing and quality of life. Any intervention which can reduce the negative effects of genital warts is welcome and will make an important contribution to the sexual health of the nation.”

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