In this issue:

• Brief STIEF update
• Update on HPV vaccine supplies
• Key points from the Global HPV Stand Alone Scientific Symposium in Vienna
• Useful online resources:
  • Te Aitanga a Tiki: Māori dimensions of sexuality
  • The Light Project
  • Aotearoa Transgender Health Guideline
• Radio NZ interview - new research on healthcare-seeking behaviour of people with STI symptoms in NZ
   

STIEF Update

It has been another busy year for STIEF with:

• The launch of our redesigned and updated HPV website in March 
• 800+ STIEF and NZSHS STI Summary of Guidelines distributed 
• 170+ Helpline calls received
• 15,900+ patient information pamphlets distributed
• 2,000,000+ website page views
• 1,100,000+ website visitors

If you are in Otago Southland, you might spot this colourful sticker applied to condom vending machines about town. We were delighted to collaborate with Southern District Health Board on this initiative. 

Many thanks to those of you who completed the STIEF Guidelines survey. Responses (n=94) confirmed that the Guidelines continue to be used regularly and are considered to be ‘very helpful’ or ‘extremely helpful’ by the vast majority: 

• Herpes/HPV Full Guidelines 
  • 40% extremely helpful
  • 46% very helpful
• STI Summary of Guidelines (STIEF and NZSHS)
  • 51% extremely helpful
  • 46% very helpful

HPV Vaccine Supplies

Good news! Supplies of the HPV vaccine have resumed. The Ministry of Health sent out the following notification on the 11^th October:

Limited supplies of HPV vaccine have now resumed to New Zealand, and were initially distributed to school-based immunisation programmes (SBIPs) to enable them to begin vaccination with dose 2 of this year’s programme. From 15 October 2018, general practices and other vaccinators will be able to order 1 box of the vaccine per fortnightly order cycle. HPV vaccine is expected to be available without restriction from mid-November 2018 as additional stock arrives. Please do not book patients in unless you have vaccine onsite.

Patients who have turned 27 years of age since 1 April 2018 and who receive their first dose of HPV vaccine by 1 April 2019 will still be eligible to complete their free vaccination course. Please submit a manual claim for doses given to these patients.

Likewise international students who turn 18 years of age during this period and who receive their first dose of HPV vaccine by 1 April 2019 will still be eligible to complete their free vaccination course. Please submit a manual claim for these patients.

Patients who turn 15 years of age during this period and have not yet begun HPV vaccination or completed their course will need three doses to be fully protected.  

Global HPV Stand Alone Scientific Symposium 

The Global HPV Stand Alone Scientific Symposium, hosted by MSD (Merck Sharp & Dohme Corp), was held in Vienna on the 18 – 20^thJuly 2018. Approximately 100 delegates attended from 41 countries. New Zealand was represented by STIEF Professional Advisory Board Member, Dr Julian White (Clinical Director of the Department of Otolaryngology, Head and Neck Surgery at Waikato Hospital) and Dr Ai Ling Tan (Gynaecology Oncologist at Auckland City Hospital and Ascot Hospital). Many thanks to Drs White and Tan for sharing their notes with us. Some key points follow below.
 

Symposium overview

The symposium itself was divided into half-day sessions. The first afternoon was devoted to an update on the scientific data further confirming that the HPV vaccine continues to be a very effective and safe vaccine. There was some emphasis on the desirability of gender-neutral vaccination, for which New Zealand was one of the forerunners in launching. 
 

Highlights of HPV in the past year

Safety update

• Reports to VAERS (a US spontaneous reporting system - anyone can report, including consumers) were characterised.¹
• Findings:
  • >60 million HPV4 doses distributed during this study period
  • 19,760 reports to VAERS
  • 60.2% in females
  • 17.2% in males
  • 22.6% sex was missing
    • Overall 94.2% of reports were non-serious 
    • 29 deaths – no association to HPV4
• Interpretation:
  • Safety profile of HPV4 is consistent with data from pre-licensure trials and post marketing safety data.
• Similar work done, with same data, on 9-valent vaccine over the last 3 years; not yet published. 
   

Disease burden and the importance of gender neutral vaccination

• 20% of all cancers globally are caused by viruses
• 5% of all cancers are caused by HPV
• Seroconversion after natural HPV infection:
  • Females 60%
  • Males 10%
     

HPV vaccination of boys and extended catch up of women

Vaccination strategies based on catch-up vaccination of females and males are effective for accelerating HPV prevalence reduction. Inclusion of routine male vaccination improves the resilience of vaccination programmes.²

Addressing HPV in adults

Research indicates that the biggest barrier for adults to have the vaccine was thought by health professionals to be the cost but for patients the biggest barrier was identified as lack of information.

Real world setting – country experience

Over the last decade, the impact of HPV vaccination in real-world settings has become increasingly evident, especially among girls vaccinated before HPV exposure in countries with high vaccine uptake. Reported maximal reductions of approximately³:

• 90% for HPV 6/11/16/18 infection
• 90% for genital warts
• 45% for low-grade cytological cervical abnormalities
• 85% for high-grade histologically proven cervical abnormalities
  • Earlier the immunisation confers best population level results
  • Vaccine induced herd protection is substantial
  • HPV-associated malignancies is now a disease of the past

Key messages to consumers

• A reminder to keep messages to the public simple:
  • Is it effective?
  • Is it safe?
  • Do you (health professional) recommend it? 

Promoting gender neutral vaccination

• HPV does not discriminate between men and women, why should we?
• HPV infection rates in males are consistently high – prevalence is consistently high.
  • Women 18 – 59 years – 30%
  • Men aged 19 – 70 years – 60+%
• The HIM Study⁴ shows that few males make antibodies after infection so they remain susceptible to recurrent infections. 
• Increasing number of oropharyngeal cancers in males – HPV-related in non-smokers
• Screening in women but not in males
• Physical and economic burden
• Nearly all HPV-related cancers and diseases are caused by 9 types of HPV (in Gardasil vaccine) 
   

References

[1] Arana et al. Post-licensure safety monitoring of quadrivalent human papillomavirus vaccine in the Vaccine Adverse Event Reporting System (VAERS), 2009-201.Vaccine, 2018;36:1781-1788 

[2] Elfström et al. Human Papillomavirus Vaccination of Boys and Extended Catch-up Vaccination: Effects on the Resilience of Programs. J Infect Dis, 2016;213:199-205

[3] Garland S et al. Impact and Effectiveness of the Quadrivalent Human Papillomavirus Vaccine: A Systematic Review of 10 Years of Real-world Experience. Clin Infect Dis, 2016;63(4):519-527

[4] Giuliano A et al. Seroconversion following anal and genital HPV infection in men: The HIM study. Papillomavirus Res; 2015;1:109-115

Useful Online Resources

Te Aitanga a Tiki: Māori dimensions of sexuality

Te Aitanga a Tiki: Māori dimensions of sexuality - a collection of reo Māori and English language resources that draw on Māori knowledge, such as pūrākau (stories) and mōteatea (traditional chants), to relate Māori understandings of sexual and reproductive health to young Māori in schools, kura and communities.

The Light Project

The Light Project - a website to start the conversation and help equip NZ youth, their whānau and communities to navigate the new porn landscape. The site is based on the resource needs identified in our Porn and Young People – What Do We Know? NZ Youth Stakeholder Survey.  

Aotearoa Transgender Health Guideline

Aotearoa Transgender Health Guideline - hosted by the transgender research group at Waikato University, who are also looking to host a one day - Aotearoa NZ Trans Health Symposium at Waikato University on Saturday 4 May 2019.  

Local STI Research Update

Dr Hayley Denison (STIEF Director) is the lead author of new research by Massey University exploring Healthcare-seeking behaviour of people with sexually transmitted infection symptoms attending a Sexual Health Clinic in New Zealand. Listen to Hayley’s Radio NZ interview discussing the results of this research with Jesse Mulligan here.