In the National Program for the Primary Prevention of Cervical Cancer (2012-2016), 13-year-old girls were also included among the 12-year-old girls subject to immunization. Meanwhile, on January 28, the European Week for the Prevention of Cervical Cancer (CRC) started in the building of the National Assembly. The Speaker of the Parliament Tsetska Tsacheva and leading infectious diseases doctors took part in the ceremony. We sought a comment on the problem of vaccinating girls against the human papilloma virus, which is the main cause of cervical cancer, from Dr. Lubomir Kirov - chairman of the Association of General Practitioners.
Dr. Kirov, what is the coverage of vaccinated 12-year-old girls in 2014?
- Nearly 20% of girls of this age were vaccinated last year, and 24% in 2013.
Why is there so little interest?
- And in this case we have a manifestation of purely Bulgarian psychology. In our country, something must be mandatory and a sanction must follow from it in order to be implemented. Even if something is very good and effective, and even if it is provided free of charge, as in this case, if you try to convince of its advantages, every Bulgarian will think that there is a scam in this work. Well, no scam. And if you're going to ask me if I've vaccinated my own daughter against HPV, yes, I have - although she's over the age for the program where we've been vaccinating 12-year-old girls since last year.
In Brazil, for example, from March to the end of June last year, 80% of girls subject to immunization received their first vaccination. And we are talking about millions of 12-year-old girls in this country. Placed before the start of sexual life, the vaccine protects practically 100% of the girl from infection with the oncogenic papilloma virus.
Where on the body is the application of this vaccine made?
- Muscular, in the shoulder. Like any immunization, the muscle is pricked with a small needle. Yes, there may be redness in this area, there may be soreness for a few days. This happens with many of the vaccines we administer. But these are not side effects.
How long does the vaccine protect against HPV?
- Provides protection for 20-25 years. At this early age it is best to do and build immunity because these girls are supposed to have had no contact with the virus which
mostly sexually transmitted
The age most attacked by the human papilloma virus is women around 30-40 years old. It does not interfere, and in some countries it has been introduced, in others it is being discussed to introduce catch-up immunizations for those who missed the vaccine at the most appropriate age. A booster is also made, i.e. in addition to the normal doses, after a certain period of time, another dose is given to increase immunity, which decreases with age. The logic is as follows: the immunity that begins to wane 20 years after the first application should be revived and thus provide protection throughout the critical period of a woman's life, during which she could develop cervical cancer.
Explain what is the mechanism for parents to give the human papillomavirus vaccine to their daughters?
- The program for 12-year-old girls has now been extended to 13-year-old girls, as a two-dose immunization regimen in six months has been introduced instead of three doses of vaccines in six months, thus saving funds. Parents should contact their family doctor and the colleague will do the relevant vaccination completely free of charge because it is funded by the National Program for the Primary Prevention of Cervical Cancer. But the decision is up to the parents. Here the state is responsible for the information campaign. At the beginning of the program we did as much as possible a campaign in schools, in the media and among fellow GPs. But this requires a hell of a lot of funds, which, unfortunately, are not allocated.
Now I see again that there are cries to drop the mandatory immunization calendar in Bulgaria. This is a mistake. In countries where there is no such obligation,
immunizations are again pushed as mandatory
but through administrative requirements for various services. For example, you enroll your child in school, they require the relevant immunizations. But otherwise it is said that immunizations are not mandatory.
How will you comment on the petition of parents and patient organizations against the hexavalent vaccine? Their concern is that there is not enough evidence for the safety of this vaccine
- The requirements for vaccines are much, much higher than for medicines. The mark on the packaging - a black inverted triangle - is not only placed on this vaccine, but also on other medicines. Yes, there is a period of observation, but this vaccine has been rigorously clinically tested and observation does not mean that it is unsafe. By the way, there is an article on the Association of General Practitioners website that explains exactly what this is all about.
An average of 60,000 children are born in Bulgaria annually. Assuming that's just the entire contingent of children who should be vaccinated, I think the 3,000 people who signed the anti-vaccine petition shouldn't stop the rest of us from vaccinating their children. Anyone can say anything, but when something bad happens, these people have to take responsibility for their own children. If their child becomes infected and becomes dangerous to others, such people should be held accountable.
If the vaccine has a side effect, then who will pay?
- No one can guarantee that a side effect will not occur in single cases. And nowadays, you may still get side effects from a polio vaccine somewhere, even though a live vaccine is no longer used. It's cruel for the child it will happen to. But if it happens to one child in a million, should immunization be stopped and thus 150,000-200,000 children die from polio every year, as in the USA at the beginning of the last century. We have to think not only about ourselves but also about everyone else.
• Every day in Bulgaria a woman dies of cervical cancer (CRC)
• Every year in Bulgaria, more than 1000 women get sick with PMS
• In 99.7% of cases, HCM is caused by the human papilloma virus (HPV)
• Vaccination is the only method for effective and long-lasting primary prevention of cervical cancer
• Vaccination and regular gynecological examinations reduce the incidence of cervical cancer by 94%