HPV virus safety
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Vaccines are safe and rarely result in adverse events, says US reviewhttp://www.bmj.com/content/343/bmj.d5538see also BMJ Articles, 10https://docs.google.com/document/d/1c4ajaawpUoom8ZmDEewqoAtuJSfKjJad8AMspvtrdIM/edit?hl=en_US
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Average price in Italy: around £48 per vaccine dose by the end of 2009, much lower than the original ex-factory prices negotiated by AIFA (Italian Agency for drugs) for Cervarix (€95) and Gardasil (€104). http://www.bmj.com/content/343/bmj.d6668?variant=fullsee also BMJ Articles, 14https://docs.google.com/document/d/1c4ajaawpUoom8ZmDEewqoAtuJSfKjJad8AMspvtrdIM/edit?hl=en_US
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The UK must shortly decide which vaccine to buy if it is to continue its vaccination programme against human papilloma virus. The programme has been a success [...]. Coverage is on target at around 80%, and the evidence on efficacy and safety is strong. http://www.bmj.com/content/343/bmj.d6239see also BMJ Articles, 26ahttps://docs.google.com/document/d/1c4ajaawpUoom8ZmDEewqoAtuJSfKjJad8AMspvtrdIM/edit?hl=en_US
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But which is the most cost effective vaccine? In 2008 the UK chose the bivalent vaccine Cervarix. Compared with the quadrivalent vaccine Gardasil, it provides greater protection against cervical cancer, but no protection against anogenital warts. As Mark Jit and colleagues reported in their modelling study in 2008 (BMJ 2008;337:a769) and again in an updated study this week (p677) the bivalent vaccine is only cost effective if it is substantially cheaper. However, as Verhiejen says, because the price of the vaccines is confidential we don’t know whether the right decision has been made. http://www.bmj.com/content/343/bmj.d6239see also BMJ Articles, 26ahttps://docs.google.com/document/d/1c4ajaawpUoom8ZmDEewqoAtuJSfKjJad8AMspvtrdIM/edit?hl=en_US
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Jit et al (2008) showed that if the bivalent vaccine, Cervarix, which protects against HPV types 16 and 18, cost £13 to £21 less per dose than the quadrivalent vaccine, Gardasil, both vaccines would be equally cost effective, although the bivalent vaccine would be less effective because it does not prevent anogenital warts.http://www.bmj.com/content/343/bmj.d5720see also BMJ Articles, 26bhttps://docs.google.com/document/d/1c4ajaawpUoom8ZmDEewqoAtuJSfKjJad8AMspvtrdIM/edit?hl=en_US
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UK coverage for all three doses ranges from 76.4% (England) to 86.9% (Scotland). [Dept. Health] This coverage compares well with other countries - in the Netherlands coverage was 51% at first call and is still only 56.4% after recall. [Oomen et al (2011)] http://www.bmj.com/content/343/bmj.d5720see also BMJ Articles, 26bhttps://docs.google.com/document/d/1c4ajaawpUoom8ZmDEewqoAtuJSfKjJad8AMspvtrdIM/edit?hl=en_US
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The safety of both the bivalent vaccine, which was used in the UK national programme, and hte quadrivalent vaccine were monitored weekly by the Medicines and Healthcare Product Regulatory Agency (MHRA) in more than four million doses distributed across the UK. [MHRA (2010)] Only recognised and listed side effects were reported, and other adverse findings could not be related to the vaccines.http://www.bmj.com/content/343/bmj.d5720see also BMJ Articles, 26bhttps://docs.google.com/document/d/1c4ajaawpUoom8ZmDEewqoAtuJSfKjJad8AMspvtrdIM/edit?hl=en_US
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Jit et al (2008). BMJ 2008;337:a769. http://www.bmj.com/content/337/bmj.a769.full
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Jit et al (2011). BMJ 2011;343:d5775.
http://www.bmj.com/content/343/bmj.d5775
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Dept. Health. Department of Health. Annual HPV vaccine coverage in England in 2009/2010.

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123795
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Oomen et al (2011). Opkomst HPV-vaccinaties per 15 juli 2011 Geboortecohorten 1997 …
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MHRA (2010).
http://www.mhra.gov.uk/home/groups/pl-p/documents/websiteresources/con028376.pdfhttp://www.mhra.gov.uk/home/groups/pl-p/documents/websiteresources/con028377.pdf
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#ERROR!
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32. CERVICAL SCREENING IN U25s
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Edition: 1 October 2011
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Page: 673
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Author: Margaret McCartney
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Article reference: BMJ 2011;343:d6167
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Article link: http://www.bmj.com/content/343/bmj.d6167
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Article Summary: Women under 25 should not be screened for cervical cancer as it does more harm than good.
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Detail: Current guidelines say women under 25 should not have smear tests to screen them for cervical cancer. However, some doctors are recommending them for screening anyway, only for their test results to be destroyed by the labs because the women fall outside the guideline age. Over 700 tests were not read by labs last year for this reason. This has provoked a controversy as to whether it is up to GPs or the labs to make the decision about who should be screened.
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Karen Denton from NHS screening programme: “The guidelines are quite clearly that women under 25 shouldn’t be screened. One in three of them will have an abnormal test result. This doesn’t mean they are at increased risk of cervical cancer... [but] it is incredibly anxiety provoking, very upsetting, and it’s likely to lead on to further investigation and treatment, and it’s the treatment which can have a future effect on pregnancy outcome. So actually, the women are not being harmed and are being benefited by not having their cervical cytology test reported.”
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Peter Sasieni, Wolfson Institute of Preventive Medicine: Evidence shows screening under 25 is ineffective. “Women screened in their early 20s are no less likely to get cervical cancer in their 20s than are those screened from age 25. Screening very young women will lead to the detection of cervical lesions that gynaecologists will want to treat, but the evidence is that in young women many of these lesions would have spontaneously disappeared even without treatment. There is also concern that such treatment can lead to premature deliveries in subsequent pregnancies. On balance, many experts believe that screening at age 20 does more harm than good - a position with which I would agree.”
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There is evidence of harm from treatment given after abnormal smear test results (Obstetrics and Gynecology 2009;114:504-10) and evidence that screening does not prevent under 25s dying from cervical cancer (BMJ 2009;339:b2968).
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Questions:
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How likely are women under 25 to get cervical cancer at all?
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Why so many false positives for women under 25? How does this compare to the number of false positives in other age groups? Women under 25 are probably less likely than older women to have full-blown cancer. Do women under 25 have relatively more lesions though, leading to a high number of false positives?
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To what extent are pregnancy outcomes affected by unnecessary treatment?
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1. MEN’S SHEDS, WOMEN’S VACCINES
Edition: 3 December 2011
Pages: 1118
Article reference: BMJ2011;343D7810
Article link: http://www.bmj.com/content/343/bmj.d7810
Author: Jane Smith, deputy editor
Article summary: Editor’s choice: there is a gender gap in modern healthcare. Men are less likely to consult doctors and die younger, however women’s higher use of healthcare leave them vulnerable to “iatrogenic harm” (harm caused by medical treatment) which is “cynically promoted by medical corporations”.

Detail:
“the gap between men and women varies widely (being worse in eastern Europe and among men in poorer social conditions)”
“The NHS is switching to Gardasil (which protects against both HPV types 16 and 18 and genital warts) from Cervarix (which doesn’t cover genital warts) (doi:10.1136/bmj.d7694).”
“Australia, which adopted Gardasil from the outset, has seen a dramatic fall in genital warts.”

To follow up:
Health gaps
M/F gaps
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HPV data 2011
Comments 2011
HPV data 2009
side effects 2009
comparative risks