Apakah beban penyakit infeksi HPV?

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VACC-1250597-0000
Human Papilloma Virus (HPV) Penyebab Berbagai Macam
Kanker, termasuk 100% kanker serviks dan kutil kelamin

40 tipe menyerang
Kelamin dan Anus

Tipe kanker High risk

group-16,18,31,33,45,52,58 Tipe non-kanker grup
Percentages represent cases attributable to HPV infection low risk – 6,11.
1.Braaten KP et al. Rev Obstet Gynecol. 2008;1:2–10.
2.Hoots BE et al. Int J Cancer. 2009;124:2375–2383.
2
3.IARC. IARC monographs on the evaluation of carcinogenic risks to humans. Human papillomaviruses. Vol 90. Lyon,
France: IARC, 2007.
 * GLOBOCAN (Global Cancer Statistics) http://gco.iarc.fr

Globocan 2008 Globocan 2012 Globocan 2018

No. Negara
Incidence Mortality Incidence Mortality Incidence Mortality

1. Indonesia 13.762 7.493 20.928 ↑ 9.498 ↑ 32.469 18.279

2. Thailand 9.999 5.216 8.181 ↓ 4.513 ↓ 8.622 5.051 ↓

3. Phillipines 4.544 1.856 6.670 ↑ 2.832 ↑ 7.190 ↑ 4.088 ↑

4. Myanmar 6.434 3.536 5.286 ↓ 2.998 ↓ 6.472 ↑ 3.856 ↑

5. Vietnam 5.174 2.472 5.146 ↓ 2.423 ↓ 4.177 ↓ 2.420

6. Malaysia 2.126 631 2.145 ↑ 621 ↓ 1.682 ↓ 944

7. Cambodia 1.578 867 1.512 ↓ 795 ↓ 993 ↓ 708 ↓

8. Singapore 228 123 300 ↑ 106 ↓ 429 ↑ 208 ↑

9. Lao People’s D.R 491 270 314 ↓ 168 ↓ 320 ↑ 182 ↑

10. Brunei 15 9 35 ↑ 11 ↑ 52 ↑ 24 ↑

11. Timor Leste 3 50 14

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BEBAN KANKER SERVIKS DI INDONESIA

Sebanyak 88 kasus baru kanker

serviks terjadi setiap harinya.1

50 wanita Indonesia meninggal setiap

hari karena kanker serviks1

Tingkat Kematian, Insidensi, Prevalensi 5

Tahun Tertinggi diantara Negara-negara di
Asia Tenggara1 !!!!!

Globocan data 20181

WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre). Human
4 Summary Report 2018. Available at www.
Papillomavirus and Related Cancers in Indonesia.
Hpvcentre.net
 *Human Papilloma Virus
Non enveloped double-
stranded DNA virus1
• A virus that infects
human skin and mucosal
surfaces
• Transmitted easily by
touching
• Classified as a
carcinogen
1. Howley PM, Lowy DR. In: Knipe DM, Howley PM, eds. Philadelphia, Pa: Lippincott-Raven; 2001:2197–2229.
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2. Schiffman M, Castle PE. Arch Pathol Lab Med. 2003;127:930–934. 3. Wiley DJ, Douglas J, Beutner K, et al. Clin
Infect Dis. 2002;35(suppl 2):S210–S224. 4. Muñoz N, Bosch FX, Castellsagué X, et al. Int J Cancer. 2004;111:278–285.
 * HPV Types Differ in Their Disease
Associations

Mucosal Cutaneous
Cutaneous
~40 Types Sites ~ 80 Types
Sites of infection Sites of
of infection
infection

High risk (oncogenic) Low risk (non-

HPV 16, 18, 31, 33, 45, oncogenic)
52, 58 HPV 6, 11

Cervical Cancer
Anogenital Cancers Genital Warts “Common”
“Common”
Oropharyngeal Cancer Laryngeal Papillomas Hand
Hand and
and Foot
Foot
Cancer Precursors Low Grade Cervical Disease Warts
Warts
Low Grade Cervical Disease

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 *Infeksi HPV bisa terjadi pada semua
kelompok usia
*Namun Infeksi HPV Tertinggi Pada Remaja dan Dewasa Awal
*Risiko infeksi terus berlanjut pada usia dewasa dan tua

Age specific incidence of infections with oncogenic HPV types after an average interval of
14 months* - Ontario (Canada) 7
*. Average interval between annual periodic health examinations. Sellors JW, et al. CMAJ 2003; 168: 421-425
FAKTANYA: Human Papilloma Virus (HPV) dapat menular
rute non-seksual

Rute seksual Rute Non Seksual

Kontak Genital : Extragenital : Vertikal Horizontal

• Hubungan - pakaian ibu • Genital-finger
senggama - handuk • Finger tips
• Genital-genital - surgical gloves Neonatus • Ujung jari kuku
• Manual-Genital - fomite Saat lahir • Finger -
• Oral-genital - biopsi forceps conjungtival

Respiratory
papilomatosis
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1. F.Xavier Bosch et al. International Journal of Gynecology and Obstetrics (2006) 94 (Supplement 1), S8-S21; 2. Sonnex X et al. Sexually
Transmitted Infections 1999 Oct;75(5):317-9
9 07/07/2021
FAKTANYA: Kanker Serviks adalah kanker paling banyak
ke-2 yang mengancam perempuan Indonesia

• Lebih dari 70% didiagnosa dengan stadium

lanjut (> stage IIB)2
• Cakupan skrining hanya mencapai < 5%
(ideal ~ 80%)3

1).IARC.GLOBOCAN 2018
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2). Mochtarom M. Data registrasi Kanker Ginekologik. Bagian Obstetri dan Ginekologi.RSUPN /FKUI, Jakarta 1992
3). Indonesian National Cancer Control Committee Data, presented in Oct 2017.
Infeksi HPV dapat menyebabkan Neoplasia pada jaringan
serviks

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Ref:Woodman C, et al. The Natural History of Cervical HPV Infection: Unresolved issue. Nature (review cancer). 2007: vol 7
Perjalanan penyakit Kanker Serviks

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Ref: Video Animasi tentang kanker serviks
https://youtu.be/HVLG3PwDDLg
SETIAP DETIK AKAN TERJADI
KASUS KUTIL KELAMIN PADA
PRIA DAN WANITA

1. World Health Organization (WHO). Executive summary: the state of world health. http://www.who.int/whr/1995/media_centre/executive_ summary1/en/print. html. Accessed 2 Aug 2017.

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Insidensi kutil kelamin meningkat dari tahun ke tahun

Data Courtesy of Dr. Wresti Indriatmi, SpKK, Sexual Transmitted Disease Task force of PERDOSKI.
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90% Kutil kelamin (Kondiloma Akuminata) disebabkan
oleh HPV tipe 6 dan 111
• 32 juta kasus kutil kelamin
terjadi setiap tahun di Dunia1

• Dapat mengenai genital, anus

dan perineum pada LAKI-LAKI
& PEREMPUAN

• Saat ini insidens kutil kelamin

terus meningkat dan menempati
penyakit IMS 3 teratas. (Baik
pada perempuan atau laki-laki)3

Images top left and top right: Reprinted with permission from IMS: Infeksi Menular Seksual
NZ DermNet (www.dermnetnz.org)
Ref:
1. 15
World Health Organization (WHO). Executive summary: the state of world health. http://www.who.int/whr/1995/media_centre/executive_ summary1/en/print. html. Accessed 2 Aug 2017.
2. Yanofsky, et al. Genital Warts, a comprehensive review. The Journal of Clinical and Aesthetic Dermatology. June 2012, Vol 6, no 5
3. Daily, SF. Majalah Kesehatan Masyarakat Indonesia, 2001;28:729-32
Vaksinasi Dibutuhkan Karena Kadar Respon
Antibodi Rendah Sesudah Infeksi Alamiah
HPV
WW
VVaac hhyy H
ccciin HPPVV
naatti
~ 50% wanita memberikan respon imun yang ioonn?
?
tidak terukur sesudah infeksi HPV alamiah1,2

Sesudah Infeksi Alamiah : kadar serum RENDAH1

Kadar antibodi rendah tidak memberikan

jaminan proteksi terhadap re-infeksi1

Beberapa wanita dengan infeksi persisten gagal

untuk serokonversi3

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1. Viscidi R, et al. Cancer Epidemiol Biomarkers Prev 2004; 13:324–327;
2. Carter J, et al. J Infect Dis 2000; 181:1911–1919.
Virus HPV dapat menghindar dari sistim imun tubuh1-3

Uses the natural life cycle of epithelial cells to release new viruses 1-4
tidak
Does not cause cellada
deathpenarikan
1-4 sel radang

Enters basal epithelial cell, integrates DNA in host cell1-41-3

Imunosupresi
Replicates in the cells Lokal 1-4
and remains entirely intraepithelial

Local infection,1-4 HPV infects the epithelium

TIDAK ADA VIREMIA
through micro abrasions1-3

17 1.Stanley M. Vaccine 2006; 24: S106-13, 2.Tindle, Nat Rev Cancer 2002; 2, 59,
3.Stanley M. Vaccine 2006; 24: S16-22
Mekanisme Proteksi Vaksin HPV

3. Decrease viral load

1. New infection
after shedding
prevented

2. Infection prevented from

reaching another site

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Adapted from Schwarz TF & Leo O. Gynecol Oncol 2008; 110: S1–S10
REKOMENDASI WHO : VAKSINASI HPV
Sebagai pencegahan utama penyakit terkait HPV

Secondary
prevention:
Screening
and treatment
of precancers1,2
Primary prevention:
Vaccination 1,2

Vaksinasi membantu memberikan perlindungan 3

Vaksinasi direkomendasikan tanpa melihat aktivitas seksual seseorang atau paparan
sebelumnya terhadap HPV. Vaksinasi direkomendasikan bahkan bila pasien tersebut
positif pada tes HPV DNA4

World Health Organization, United Nations Population Fund. Preparing for the Introduction of HPV Vaccines: Policy and Programme Guidance for Countries. World Health Organization; 2006.
World Health Organization. Weekly Epidemiological Record. 2009;15(84):117–132.

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US FDA. FDA Licenses New Vaccine for Prevention of Cervical Cancer and Other Diseases in Females Caused by Human Papillomavirus. Available at
http://www.fda.gov/bbs/topics/NEWS/2006/NEW01385.html.2006. Accessed October, 2007.
The American College of Obstetricians and Gynecologists. Human Papillomavirus Vaccination. ACOG Committee Opinion No. 704 Juni 2017
 Vaksinasi HPV diprioritaskan untuk individu yang naïve terhadap
HPV yaitu target usia 9-14 tahun. (WHO position paper 2017)

Masih bisa
menerima
manfaat dari
vaksinasi HPV

*VAKSINASI HPV
Human papillomavirus vaccines: WHO position paper, May 2017. Weekly epidemiological record.12 MAY 2017, 92th year. No 19, 2017, 92, 241–268. http://www.who.int/wer.

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 Profil keamanan vaksin HPV Safety Profile

WHO - GACVS 2017

* Review sistemik 2017 dari WHO terhadap SAE (Serious Adverse Event) setelah
vaksinasi HPV (data terhadap 73,697 individu dari randomized controlled
trials) menunjukan tidak adanya perbedaan pada tingkat kejadian SAE
antara kelompok yang divaksin dan kelompok yang tidak divaksin.
* Yang GACVS khawatirkan bahwa tuduhan yang tidak berdasar (tanpa dasar
penyelidikan biologis dan epidemiologi yang kuat) akan memiliki dampak
negatif terhadap cakupan vaksin di sejumlah negara, dan ini akan
mengakibatkan kerugian nyata
* Walaupun tidak ada vaksin atau obat yang sepenuhnya tanpa resiko, organisasi
kesehatan internasional di dunia, termasuk World Health Organization (WHO),
the US Centers for Disease Control and Prevention (CDC), Health Canada, the
European Medicines Agency (EMA), the Australia Therapeutic Goods
Administration (TGA), dan lainnya, terus merekomendasikan penggunaan
Vaksin HPV.
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http://www.who.int/vaccine_safety/committee/reports/June_2017/en/
IDAI :
Vaksinasi HPV sejak usia anak 10 tahun

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Rekomendasi
Perempuan: Vaksinasi HPV hingga usia 55 tahun
Laki-laki : Vaksinasi HPV hingga usia 26 tahun

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 * Publically Funded / Reimbursed HPV Immunization Programs: 85 (does not include GAVI Demos)
Female only program: 68 Countries; Gender-neutral: 17 countries
− Color represents current state. Future changes noted in parentheses if color will change
3 − G9 specific programs detailed on next slide. 29 Europe
Austria**
North America GAVI Demo Projects-Global Belgium
Canada** (30) Bulgaria
Mexico Armenia, Bangladesh, Croatia**
USA** Benin, Burkina Faso, Cyprus
Burundi, Cambodia Czech Republic**
Cameroon, Cote d’Ivoire, Denmark
14 Ethiopia, Gambia, Georgia, Estonia
Ghana, Indonesia, Kenya, Finland
Caribbean & Laos, Liberia, Madagascar, France
Central America Malawi, Mali, Moldova, Germany
Antigua** (2017) Mozambique, Nepal, Niger, Greece
Aruba Sao Tome, Senegal, Sierra Hungary* (G9 JN ’18)
Belize Leone, Solomon Islands, Iceland
Bahamas Tanzania, Togo, Zimbabwe Ireland*
Barbados
Italy (80% G9)**
Bermuda**
Latvia
Cayman Islands
Liechtenstein**
Dominican Republic
Lithuania
Guatemala
Honduras (GAVI grad)
12 Luxemburg
Macedonia
Panama** Middle East & Africa
Netherlands
Puerto Rico** Botswana
Norway
Trinidad & Tobago** Israel**
Portugal*
St Martin (COM – part of EU) Kazakhstan
Kuwait 15 Slovenia

12 Lesotho
Asia Pacific
Spain
Sweden
Libya
South America Australia** Switzerland**
Argentina** Guyana (GAVI grad) Rwanda (GAVI) Bhutan United Kingdom
Brazil** Paraguay Seychelles Brunei
Bolivia (GAVI grad) Peru South Africa Hong Kong^ Philippines
Chile Surinam UAE Punjab, India^ South Korea
Colombia Uruguay Uganda (GAVI) Indonesia^ Sri Lanka (GAVI)
Ecuador
French Guiana
Uzbekistan (GAVI) Japan Taiwan^
24 Macau
Malaysia
Thailand
FUNDING: New Zealand** Last update: Dec 14, 2017
*Male Recommendation **Male Reco & Funding ^sub-national (<50%)
It’s our responsibility
to protect our patients.

THANK YOU
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