Prof. Kovachev before FACTS: There is ignorance of the human papilloma virus and the malignant diseases it causes

This year saw a 30% increase in the number of girls vaccinated against human papillomavirus (HPV) compared to last year. This was reported by Dr. Kremena Parmakova from the "Infectious Disease Control" department. in the Ministry of Health, which presented data on the implementation of the National Program for the Primary Prevention of Cervical Cancer 2021-2024. If for the entire year 2023, 2,892 girls were vaccinated against HPV with the first dose of the vaccine, then for the eight months of 2024 are 3661. What else do we need to know… Prof. Stefan Kovachev, head of the General and Oncological Gynecology Clinic at the Academy of Medical Sciences spoke to FAKTI.

- Prof. Kovachev, how big a problem is it that people do not have enough good information about the HPV vaccine…
- A problem arises with the lack of information among parents, among children regarding this vaccine. And this deepens the subsequent problems already caused by those infected with this viral infection, in which many cancers can develop, both of the genital and other systems in the human body. It is these subsequent malignancies that are the big problem. Otherwise, the problem, in general, can be justified as ignorance of the relationship between the infection with the human papilloma virus and the malignant diseases that it caused. There is also the problem of not knowing the frequency of this disease, as it does not have any initial symptoms. A person can be infected with this infection but without having any symptoms. And because it is the most common sexually transmitted disease, every 3-4 people in the world – no matter male or female carries this infection. When you are infected and you don't have the symptom, you don't know that you are infected with this virus, but it is sitting inside you. The virus may not have any external and symptomatic manifestations, but at the same time work in the body of each of us and lead to the development of precancerous and cancerous diseases. So not knowing this mechanism, not knowing this connection between infection and malignancy, is actually the big problem for people. And we are already going to the fact that people do not know the vaccines, they do not know the importance of these vaccines in preventing this infection.

- And there is a vaccine…
- There is a vaccine, and it is not against cancer, as is often heard, but against this virus, which leads to a very large extent to malignant diseases in humans. And to insert something that is good to know. The scientist who established the link between human papilloma virus infection and cervical cancer in the 1980s and 1990s received the Nobel Prize for his discovery.

- Why is the most suitable age limit for vaccination 10-14 years?
- It's simple. The idea is that then most children have not yet started to have sex, during which this infection can actually be transmitted.

- Let's explain what the vaccine itself is?
- There is no DNA material in it. The vaccine creates immunogenicity, it supports the formation of antibodies in the body of the person to whom it is administered, and thus facilitates the immune system in the next encounter with this virus. Then the body reacts very quickly and produces antibodies to block the development of the infection.

- As an example of vaccine effectiveness, Australia is always pointed to, where vaccination coverage is very high. How did they decide to mass-vaccinate there?
- In Australia, vaccination coverage for women is currently over 78-80%. And for men it is about 68-69%. For a vaccine to be of serious importance to society, the country must have vaccination coverage of it above 70%. With them, this thing has already been reached. And what the facts show. If in 2006 they had an infection rate of about 22% of the affected population, now it is about 1%. This already, you understand, leads to a significant reduction in cervical cancer. I do not have statistics for other HPV related cancers such as penile cancer, anal cancer, vulvar cancer, vaginal cancer, laryngeal cancer, oral cavity cancer. I haven't read statistics about them because I was mainly interested in cervical cancer data. But you see that vaccination has resulted in a tremendous reduction in the incidence of cervical cancer. When vaccination coverage is raised, the spread of infection is reduced and this leads to a reduction in cervical cancer. When vaccination coverage above 70% is achieved, it does not mean that we will immediately see a reduction in cervical cancer, vulvar cancer, penile cancer, etc. No, this goes on for months, for years. First of all, they reduce warts because they respond the fastest to the vaccine, then they begin to reduce cancers.

- Even in our country, the main focus is on girls, but in many countries the vaccine is also applied to boys?
- When we talk about boys, let's say we have 53 per 100,000 cases of penile cancer for this year. Among men in Bulgaria, we have a serious death rate from this disease, we also register an increasing number of anus cancer. As for the vaccine and why boys should be vaccinated, it's also simple – if boys are not vaccinated, there is no way to reduce the frequency of transmission of the virus, which is mainly sexually transmitted. If we take care of 50% of the participants in a sexual act, what do we do… That is why boys should also be vaccinated to stop the spread of the virus. For men, we still don't have research and tests developed that can be used on a large scale. There are tests mainly for women. And this prevents us from extracting statistics on human papilloma virus-related diseases in men. For women in Bulgaria, we have roughly determined the frequency and say that it is about 28-29% in the age group from 15 to 54 years. This was shown by a survey we conducted some time ago in the largest cities in Bulgaria.