Immunisable cancers: Better safe than sorry

By Rebecca Sesny

Thousands of women in Uganda bleed to death every year from advanced stages of cervical cancer. Unaware of their affliction, they only seek medical treatment when it is too late.

Now, a shot in the arm is expected to save young girls from going the way of their mothers “We have gone far with vaccinations,” says Dr. Dr. Gerald Mutungi, the programme manager of the non-communicable disease programme. “We are about to start another number of vaccinations for young girls.”

Uganda, according to the Fred Hutchinson Cancer Research Centre, with a population of 34 million, has among the highest cancer rates in the world, many of which are fuelled by the HIV epidemic.

Through recent programmes sponsored by the Government and the Global Alliance for Vaccines and Immunisation, more vaccines are being offered to people in need.

What is a vaccine?
Vaccines are medicines that boost the immune system’s natural ability to protect the body against “foreign invaders,” which may cause disease.

When an infection invades the body, the immune system recognizes it as foreign, destroys it, and “remembers” it to prevent another infection in the future. Vaccines take advantage of this response by introducing the foreign Cancer vaccines

There are two types of cancer vaccines. Preventative vaccines that are intended to prevent cancer from developing and prevent infections from cancer causing viruses.

Preventive vaccines, which are commercially available for cervical cancer and liver cancer, block infection with the causative agents of human papilloma virus and Hepatitis B virus, respectively Therapeutic vaccines, on the other hand, are given to patients who already have cancer. The vaccine is used to aid in strengthening the body’s immune system.

Therapeutic vaccines are not yet available in Uganda. They are introduced into the body after cancer has already developed to help boost the body’s immune system.

Therapeutic vaccines can be combined with other cancer treatments, including surgery, chemotherapy and radiation therapy.

Studies have suggested that cancer treatment vaccines are more effective when given with other kinds of cancer therapy. Uganda does not yet have access to cancer treatment vaccines.

The preventative vaccines that are available can be used with other types of treatments such as those for HIV or Malaria. “We hope that they take the same precaution as being taken by those who do not have HIV,” said Dr. Orem.

Viruses
These small infections agents can lead to cancer by altering a body’s cells, causing a mutation. These mutated cells result in cancer.

The main viruses associated with cancers in Uganda are human papillomavirus and Hepatitis B, which have available vaccines for infection prevention. Others are the Epstein-Barr virus, and Human herpesvirus 8, which do not currently have vaccines.

Scientists are working to developing the drugs for these two viruses. “We are targeting people at risk; those who are in the tropics and children,” says Dr. Jackson Orem, the director of the Uganda Cancer Institute.

Human Papilomavirus (HPV)
This is the leading cause of cervical cancer. It is the most widespread cancer-causing virus in Uganda, causing at least 70% of cervical cancer cases. It is estimated that 2,500 women die from it very year in this country.

Many women who suffer from cervical cancer do not seek help until they are in advanced stages of the disease, making the mortality rate high. A new vaccination, recently given to girls between the ages of nine and 14, in two districts, was successful.

“You don’t want these girls to have cervical cancer as adults,” says Orem. “You have the opportunity to prevent that.” The programme has been expanded to add 10 more districts to the programme, but the vaccine is available in limited supply.

Mutungi says the high cost of the drugs stopped the medicine from being available nationwide, but they hope to expand giving vaccines in the near future, covering the whole country by 2015.

Hepatitis B
The most common risk factor for liver cancer is chronic infection with the Hepatitis B virus. The virus is highly contagious and is spread through the transmission of blood, semen and other bodily fluids from one person to another through unprotected sex, sharing of intravenous needles and from mother-to-child during childbirth.

Hepatitis B can cause chronic liver disease and puts people at high risk of death from cirrhosis of the liver and liver cancer.

Prevalence

According the World Health Organisation, more than 600,000 people die from Hepatitis B-related causes every year, including liver cancer.

The Hepatitis B vaccine was the first viral infection vaccine to be established for the prevention of cancer. According to the cancer institute, it can help reduce around 95% of liver cancer incidents. With the help of Global Alliance for Vaccines
and Immunization, the vaccine is now offered to children nationwide, along with routine vaccinations.

Without access to vaccinations, there are still ways to help prevent infections. Transmission “HPV is sexually transmitted so I would advise everyone to have protected sex and to avoid multiple partners,” says Mutungi, the programme manager of the noncommunicable diseases programme. “With Hepatitis B, the usual hygiene practices should be enough.”

Epstein-Barr and Human herpesvirus 8

The Epstein-Barr virus can also be linked to different types of cancer such as Burkitt’s Lymphoma, which is widespread in children across equatorial Africa.

In Uganda, Epstein-Barr virus is considered universal — meaning more than 95% of the population is infected by the time they are nine. However, not all people infected with the virus will develop cancer.

Human herpesvirus 8, the primary cause of Kaposi sarcoma, infects more than 80% of the Ugandan population. Currently there are no vaccines available to prevent the Epstein-Barr virus or Human herpesvirus 8. However, the development is underway.

“Some candidate vaccines are being tried,” says Orem. “We are hopeful that if the vaccines come up, we will be one of the first countries to have them.” According to the Uganda Health Communication Alliance, HIV-positive individuals are vulnerable and succumb to secondary diseases, such as cancer. “HIV provides the condition for viruses that cause cancer,” says Orem. “It weakens the immune system.”

Side effects of cancer vaccines
Very common side effects in cancer vaccines are also associated with other vaccinations. These include pain, redness and swelling at the injection site, which often occur along with muscle pain and rash or itchiness.

These side effects occur in around 15% of vaccine doses. People sometimes experience flu-like symptoms after receiving a cancer vaccine, including fever, chills, weakness, dizziness, nausea or vomiting, headache, and occasional breathing diffi culties.

One’s blood pressure may also be affected. Other, more serious health problems have been reported in smaller numbers of people after receiving a cancer vaccine.

The reported problems have included asthma, appendicitis, pelvic infl ammatory disease, and certain autoimmune diseases, including arthritis.

Common questions
Can one get a booster dose of the cancer vaccines to increase chances of immunity? You cannot get a booster for HPV to prevent against cervical cancer, and Hepatitis B is not given as a booster either; it is usually given once to children during their routine vaccinations around one year old. It is covered in cost by the Global Alliance for Vaccinations and Immunities.

However, with Hepatitis B, you can get another shot on your own (usually recommended for health workers who normally come in contact with Hepatitis B) at your own cost of less than $20 (about sh49,000). The vaccine lasts for about fi ve years.

Why it is not advisable to vaccinate girls who have been sexually active?
Dr. Jackson Orem says: “The only sure way to stop the spread is to get those who are not yet sexually active. This is the window that you have when she is still not infected.”

You can vaccinate girls who are already sexually active, but they now would have already been exposed to the virus. If they already have the cancer, the vaccine will not cure it. The programmes for vaccinations are aimed at girls before they are sexually active to cut down on the spread initially.

What is the cost of immunisable vaccines in Uganda? Are they readily available in private health centres?
You can get both privately at your own expense. HepB is given free once to children and thereafter it costs around $20 to get another one.

HPV is only offered in certain districts for free. Up to 12 districts are being added to the new programme to them make 14. Ibanda and Nakasongola districts were the original two where trial was done. The others to be added are Bududa, Busia, Lira, Isingiro, Kamwenge, Katakwi, Kayunga, Mityana, Nebbi, Oyam, Rukungiri, and Ntungamo.

However, you can get the vaccine on your own at more than $30 (about sh72,000). What are the symptoms HPV gives little symptoms, but in some rare cases, it causes genital warts. Cervical cancer symptoms include abnormal bleeding, unusual heavy discharge, pelvic pain and pain during urination.

Hepatitis B infections have symptoms such as itchy skin, fever, body aches, jaundice and chronic infl ammation of the liver.

Liver cancer has very few symptoms, similar to Hepatitis B infections such as yellowing of the skin and an inflamed and tender liver.