CDC encourages healthcare practitioners, partner organizations, and other state programs to create awareness in the community about HPV virus, different pathologies caused by the virus and its mode of transmission. CDC also promotes adolescent’s HPV vaccination programs and provides guidance on achieving high HPV vaccination rates.
Healthcare providers are often faced with the dilemmas about initiating the conversation with parents and adolescents about HPV vaccination. This short informative video offers simple and practical guidance to have a successful conversation with parents about the vaccine.
An Afghanistan war veteran receives a new penis and a scrotum without testicles and a partial abdominal wall from a deceased donor at the John Hopkins in Baltimore.
The soldier was wounded by an improvised explosive device while serving in Afghanistan. The patient’s name was not released to maintain his privacy, but he has already been discharged from the hospital. "When I first woke up [after the intervention], I felt finally more normal... [and with] a level of confidence as well. Confidence... like finally I'm okay now," he explains.
The transplant team included nine plastic surgeons and two urological surgeons, and it took them 14 hours to perform the complicated procedure. “We are optimistic he will regain near-normal urinary and sexual functions,” said W. P. Andrew Lee, director of plastic and reconstructive surgery at the Johns Hopkins University School of Medicine.
Lee described the loss of genitals as an “unspoken injury of war,” with devastating consequences for intimacy and happiness.
Urinary functions will be restored immediately while Sexual function, including sensation and the ability to get an erection, could be gained in about six months, said Richard Redett, a Johns Hopkins plastic and reconstructive surgeon and clinical director of the genitourinary transplant program.
This type of transplant, where a body part or tissue is transferred from one individual to another, is called vascularized composite allotransplantation. The surgery involves transplanting skin, muscles and tendons, nerves, bone and blood vessels. As with any transplant surgery, tissue rejection is a concern.
Two weeks after the penis surgery, the patient received bone marrow infusions from the donor. The procedure, pioneered by the same Johns Hopkins team, modulates the immune response that causes patients to reject transplanted organs, so the patient needs only one low-dose maintenance immunosuppression medication per day.
The team decided not to transplant the testicles after consulting the bioethics committee, as it would have contained sperm from the recently deceased donor.
The identity of the donor was also not disclosed, nor was his cause of death, but his family released a statement praising the sergeant’s service to his country and noting the donor family includes several military veterans.
The surgeons at John Hopkins have been planning for penile transplant since 2013. Dr. Rick Redett, the genitourinary program's clinical director, calls the procedure "the culmination of more than 5 years of research and collaboration across multiple disciplines."
A 2016 report found that from 2001 to 2013, 1,367 men in the United States military suffered injuries to their genitals or urinary tract in Iraq or Afghanistan, 94% were age 35 or younger.
This successful transplant opens new avenues for soldiers who have suffered blast injuries in war. Other men are now undergoing screening for the procedure, Andrew Lee said in a news conference.
In 2016, surgeons at Massachusetts General Hospital performed the first penis transplant in the U.S. on a man who had his penis amputated due to penile cancer, but he did not receive a scrotum during the transplant.
This video animation illustrates the transplantation process of Total Penile and Scrotum Transplant.
American Society of Clinical Oncology is the leading
professional body committed to decrease the burden of cancer and hence promote
any underutilized intervention that have potential to save millions of lives by
preventing cancer incidences.
An extremely
important policy statement from the American Society of Clinical Oncology
(ASCO), published ahead of print on April 11, 2016 regarding the HPV
Vaccination
ASCO states
that more than 10% of cancers worldwide (more than million cases per year) are
caused by viruses with HPV contributing about 600,000 to the pool.
In addition
to cervical cancer, HPV is also responsible for causing anal cancer, vaginal
cancer, and vulvar cancers, and increasingly of oropharyngeal cancer. It is
estimated that HPV is responsible for 60% of all oropharyngeal cancer, 90% of
which are caused by HPV 16.
HPV is the
cause of nearly all cervical cancers with 70% cases caused by genotype 16 and
18.
HPV
additionally causes of 91% of anal cancers, 75% of vaginal cancers, 69% of
vulvar cancers, and 63% of penile cancers, with HPV 16 being the predominant
oncogenic genotype.
Thus HPV
causes cancers in both sexes and oropharyngeal cancer is 3-5 times more common
in men.
“With safe
and effective vaccines readily available, no young person today should have to
face the devastating diagnosis of a preventable cancer like cervical cancer.
But unless we rapidly increase vaccination rates for boys and girls, many of
them will,” said ASCO President Julie
M. Vose, MD, MBA, FASCO.
Vaccination
against the HPV virus is incredible preventive strategy, because once the HPV
virus becomes incorporated into cells lining the cervix, anus or oropharynx it
is impossible to eradicate it and it will remain there for life.
A 2011
National immunization survey reported that only 36% of girls 14% of boys have
received the full schedule of immunization needed to protect against the virus.
A study in the same year also showed
that some of the states with highest rates of HPV related cancers have the
lowest rate of immunization.
Therefore, The
ASCO recommendations for increasing vaccination awareness and use are
summarized here.
Education
and raising the awareness among health care providers, public health
professionals, policy makers and patients about HPV vaccine and the cancers it
causes.
Increasing
the vaccination rates in society by combining it with other vaccines like eg,
Tdap and meningococcal virus) for young adolescents. Distribution of
educational pamplets, reminders by e-messaging or mailing should also be
considered to bring on increase contacts among Drs and patients.
ASCO
strongly urges the policy makers and insurance company to increase the
vaccination coverage, thereby decreasing out of pocket expenses because
vaccination rates are strongly related to these factors.
Addressing
critical knowledge gaps through research and development, making vaccinations
safe and effective.
ASCO strongly
believed that oncologists can play a very important role in increasing patients
compliance for vaccination. They should keep abreast the recent advances by CDC
and WHO regarding vaccination and interact with internists, gynecologists and
primary care physicians to raise their awareness and interaction. Play a role
in policy making in the society so that leaders can understand the critical role
played by vaccines in avoiding cancers.
Bivalent (Cervarix), quadrivalent (Gardasil),
and, more recently, nonavalent (nine-valent) vaccines against HPV genotypes
(targeting those most commonly causing cancer globally) are approved in the
United States and other countries for primary prevention of HPV infections
Usual Adult Dose for Human Papillomavirus
Prophylaxis
Gardasil
- women and men: Cervical, vulvar, vaginal, and anal cancer caused by HPV and genital warts
(condyloma acuminata) caused by HPV:
9 years through 26 years: one dose (0.5 mL) intramuscularly once. Repeat dose
in 2 months and 6 months for a total of 3 doses. Cervarix - women:
9 years through 25 years: one dose (0.5 mL) intramuscularly at 0, 1, and 6
months.
Usual
Pediatric Dose for Human Papillomavirus Prophylaxis
Gardasil
- girls and boys:
9 years or older: one dose (0.5 mL) intramuscularly once. Repeat dose in 2
months and 6 months for a total of 3 doses. Cervarix - girls:
9 years or older: one dose (0.5 mL) intramuscularly at 0, 1, and 6 months.
Vaccine is usually initiated at 11 to 12 years old; optimally, vaccination
should be completed prior to onset of sexual activity.
