Mencegah Infeksi HPV

dan kanker serviks

dengan Vaksinasi

dr. Sri Rahmawati

1 dari 10 wanita di Asia

berisiko mengalami infeksi
serviks HPV dalam masa
hidupnya

WHO/ICO. Human Papillomavirus and Related Cancers in Asia. Summary Report 2010. [Accessed September
2011 Available at www.who.int/hpvcentre

Ranking of cervical cancer to other cancers

among all women according to incidence
rates in Asia

Central Asia
Eastern Asia

Cervical
cancer is
the 2nd
most
frequent
cancer
among
women in
Asia,

Western Asia
Southern Asia

South-Eastern Asia

WHO/ICO. Human Papillomavirus and Related Cancers in Asia. Summary Report 2010. [Accessed September
2011 Available at www.who.int/hpvcentre

Ranking of cervical cancer to other cancers among

women ages 15-44 years,
years according to incidence rates in Asia

Central Asia
Eastern Asia

2nd most
frequent
cancer
among
women
between
15 and 44
years of
age.

Western Asia
Southern Asia

South-Eastern Asia

WHO/ICO. Human Papillomavirus and Related Cancers in Asia. Summary Report 2010. [Accessed September
2011 Available at www.who.int/hpvcentre

WHO/ICO: Indonesia

Datapoint year 2010.

Data sources:
World population prospects: the 2008 revision. New York, Population Division, Department of Economic and Social
Affairs, United Nations Secretariat, 2009.

Indonesia

Setiap hari, 37 wanita

didiagnosis
kanker serviks
Setiap jam, 1 wanita
meninggal karena kanker
serviks
http://globocan.iarc.fr/ (accessed on 7th Mar 2011)

The Human Papilloma

Virus
The causal role of HPV in
cervical cancer has been
firmly established
biologically and
epidemiologically.

Nubia Munoz et al Vaccine 2006

99.7 % of women with

cervical cancer are positive
for HPV.
Wallboomers JM et al, J Pathol 1999; 189:12-

Major burden of disease

caused by HPV is cervical
cancer
Overall incidence in HPV-related cancer : 561,100 cases worldwide/year
Overall incidence in HPV-16/18-related cancer: 402,900 cases
worldwide/year
10,500 8,200
(6,600) (7,800)
16,000
(12,800)
27,300
(25,100)

6,200
(5,500)

492,800
(344,900)

cervix
vulva/ vagina
anus
oral (mouth)
oropharynx
penis

The number of WW HPV-related cancers

is given in bold for each cancer type.
The number of HPV-16/18-related cases
for each cancer types is given in
parentheses.
WW = Worldwide
Adapted from 1. Parkin DM, Bray F. Vaccine.2006; 24 Suppl 3:S1125; 2. Parkin DM. Int J Cancer 2006; 118:30303044;
3. Parkin DM, et al. CA Cancer J Clin. 2005; 55:74-108.

Mekanisme Canggih HPV dalam

Menghindari Sistem Imun Tubuh1-4

Tidak terjadi inflamasi, tidak ada pemanggilan

Imunosupresi Lokal1-4

Tidak terjadi Viremi

1.Stanley M. Vaccine 2006; 24: S106-13, 2.Tindle, Nat

Rev Cancer 2002; 2, 59, 3.Stanley M. Vaccine 2006;
24: S16-22, 4. Stanley M. HPV Today 2007; 11: 1-16

Antibodi Respon Setelah Infeksi

Alamiah

1. Viscidi R, et al. Cancer Epidemiol Biomarkers Prev 2004; 13:324327; 2. Carter J, et al. J Infect Dis 2000; 181:19111919.

Women continue to
acquire new HPV
infections
Age at
baseline (years)

Cumulative risk of HPV

infection, %

50

1519

40

2024
2529

30

3044

20

45+

10
0

Years

Cohort study, Bogota, Colombia, N = 1,610

Bosch FX, et al. Vaccine 2008; 26S:K1K16.

Every woman who has a sexual

relationship
is at risk of acquiring an HPV infection
Up to 80% of women will
be infected with at least
one HPV type in their
lifetimes13
~75% will be oncogenic HPV
types1

Anyone who is
sexually active is
at risk4
Women are most
likely to be infected in
their late teens and
early 20s4

Any genital contact

may spread
infection4

Hand-to-genital
contact may
cause some
infections4

1. Brown DR et al. J Infect Dis 2005;191:182192; 2. Koutsky L et al. Am J Med 1997;102:38. 3. Bosch FX et al. J Natl Cancer Inst Monogr
2003;31:313.
4. UK Department of Health. The national HPV vaccination programme. www.immunisation.nhs.uk/publications/HPV_revised_23July2008.ppt
(accessed July 2010)..

Penelitian PKBI-UNPFBKKBN

www.bkkbn.go.id/Webs/index.php/rubrik/cetak/517 (accessed

PKBI: Perkumpulan Keluarga Berencana

Indonesia
UNPF: United Nations Population Fund
BKKBN: Badan Koordinasi Keluarga Berencana

51 % remaja di Jakarta
sudah tidak perawan

It means that from 100 adolescents, 51 are not virgin anymore, said
Sugiri Syarif
Head of BKKBN after giving a speech at Grand Final Rap Contest to
commemorate AIDS day at parking lot Monas IRTI, Sunday (28/11/2010).
http://monitorindonesia.com/2011/01/51-persen-remaja-jakarta-tidak-perawan/ (accessed on 26/05/11)

Jakarta
seks bebas juga meningkat di kota
besar lain :
Surabaya hampir 54%,
Medan 52%,
Bandung 47%.

http://monitorindonesia.com/2011/01/51-persen-remaja-jakarta-tidak-perawan/ (accessed on 26/05/11)

Memberikan vaksin HPV

TIDAK berarti
melegalkan seks bebas di luar nikah

Memberikan vaksin HPV

berarti
Melindungi serviks dari
infeksi HPV tipe onkogenik

Composition of available
HPV vaccines
Bivalent HPV vaccine
(Cervarix) AS04 adjuvant
Antigens

+
HPV 16 VLP

Aluminium
salt
(Al(OH)3)

MPL
+ Immunostimulan

HPV 18 VLP

Quadrivalent HPV vaccine (Gardasil)

AAHS Adjuvant

Antigens

+
HPV 16 VLP

HPV 18 VLP HPV 6 VLP HPV 11 VLP

MPL = monophosphoryl lipid A.

Aluminium salt
(amorphous
aluminium
hydroxyphosphat
e sulphate
[AAHS])

High antibody levels and

transudation
HPV

Neutralizing
antibody

Cervical canal

Cervical
epithelium

Epithelial tear
Blood vessel
Basement membrane

1. Parr EL, et al. J Virol 1997; 71:81098115; 2. Nardelli-Haefliger D, et al. J Natl Cancer Inst 2003; 95:11281137;
3. Schiller JT, et al. Nat Rev Microbiol 2004; 2:343347; 4. Kemp TJ, et al. Clin Vaccine Immunol 2008; 15:6064;
5. Schwarz TF, et al. Hum Vaccin 2010; 6:10541061; 6. Fraser C, et al. Vaccine 2007; 25:43244333;
7. Stanley M, et al. Vaccine 2006; 24(suppl 3):S106S113; 8. Einstein M. Cancer Immunol Immunother 2008; 57:443451.

Role of antibodies:
systemic and local Infection

HBV

Hepatitis B virus
(HBV) is
transported from
the site of infection
via the blood
stream to the liver1
By this route, the
virus is detected
by the immune
system1
Upon future
re-exposure to
HBV:1
Activation of
memory cells
Booster of
antibody
levels

HPV infects the

cervical mucosa
epithelium (local
infection)2,3
No systemic
infection!

HPV

Following infection
of cells, the virus is
hidden from a
systemic immune
response3
Transudating
neutralizing
antibodies in the
CVS are important
for protection2,4,5

1. Stanley M. HPV Today 2007; 11:116; 2. Stanley M, et al. Vaccine 2006; 24(suppl 3):S106S113; 3. Stanley M. Vaccine 2006; 24(suppl 1): S1622;
4. Einstein M. Cancer Immunol Immunother 2008; 57:443451; 5. Schwarz TF & Oberdan TF. Gynecol Oncol 2008; 110:S1S10.

Dampak menunda Pencegahan

Ingat, kanker serviks

membunuh
1 wanita setiap jam di
Indonesia 6.

1. Baseman JG et al. J Clin Virol 2005; 32 Suppl 1; S1624; 2. Ho GY et al. N Engl J Med 1998; 338: 4238; 3. Brown DR et al. J Infect Dis 2005; 191: 18292;
4. Bosch FX et al. J Natl Cancer Inst Monogr 2003; 313;. 5. Sawaya GF et al. N Eng J Med 2007: 356; 1991-3. 6. http://globocan.iarc.fr/; accessed on 15 July

Cervical Cancer Primary

Prevention

1. IDAI: Buku Pedoman Imunisasi di Indonesia. Edisi III. Jakarta. Page 7. 2. Paavonen J et al. Lancet 2007: 369: 2161-70 3. Andrijono. Kanker
Serviks Edisi I. Divisi Onkolologi, Dept. Obstetri-Ginekologi FKUI, Jakarta. Balai Penerbit FKUI: 2007: 67. 4. Ikatan Dokter Anak Indonesia
(IDAI): Buku Pedoman munisasi Di Indonesia, Edisi III, Jakarta; 2008. 5.PAPDI, Buku Konsesus Imunisasi Dewasa 2008.

Korelasi kuat antara HPV dan

CaCX

Young Girls Need

Vaccination
Its important to vaccinate young women as
early as possible to reduce their risk of
getting infected by the virus that causes
cervical cancer.

Dunne EF, Unger, ER, et al. Prevalence of HPV Infection Among Females in the United States. Journal American Medical Association 2007;

KESIMPULAN
Infeksi HPV berisiko sangat tinggi
untuk menjadi kanker serviks
Sebagian besar wanita yang pernah
berhubungan seksual berisiko
Infeksi HPV dapat dicegah dengan
vaksinasi
Vaksinasi pada usia 9-13 tahun
memberi perlindungan terbaik

Terima
kasih