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WHO: 一個全球健康問題 - 宮頸癌

(2019-02-07 15:39:13) 下一個

重要事實

  • 人乳頭瘤病毒是世界範圍內一組極為常見的病毒。
  • 人乳頭瘤病毒有100多種類型,其中至少有14種可引起癌症(又稱高風險類型)。
  • 人乳頭瘤病毒主要通過性接觸傳播,大多數人都會在性活動開始後不久感染人乳頭瘤病毒。
  • 宮頸癌由通過性行為感染的某些特定類型的人乳頭瘤病毒引起。
  • 兩種類型的人乳頭瘤病毒(16型和18型)引起70%的宮頸癌和宮頸癌前病變。
  • 也有證據表明,人乳頭瘤病毒與肛門癌、外陰癌、陰道癌、陰莖癌和口咽癌有關。
  • 宮頸癌是生活在較不發達地區的婦女的第二常見癌症,估計2018年有57萬例新發病例(1)(占全球新發病例的84%)。
  • 2018年,約有31.1萬名婦女死於宮頸癌,其中85%以上發生在低收入和中等收入國家。
  • 宮頸癌綜合控製包括一級預防(人乳頭瘤病毒疫苗接種)、二級預防(篩查和治療癌前病變)、三級預防(診斷和治療浸潤性宮頸癌)和姑息治療。
  • 世衛組織推薦使用對16型和18型人乳頭瘤病毒有保護作用的疫苗,這些疫苗已在許多國家獲準使用。
  • 對30歲及以上女性的癌前病變進行篩查和治療,是預防宮頸癌的一種符合成本效益的方法。
  • 如果得到早期診斷,宮頸癌可以治愈。
何謂人乳頭瘤病毒?
人乳頭瘤病毒是最常見的生殖道病毒感染。大部分性活躍婦女和男性均會在人生某個階段感染該病毒,有的還會反複感染。
女性和男性獲得感染的高峰均為性活躍期開始後不久。人乳頭瘤病毒通過性行為傳播,但不一定需要插入式性交。生殖器皮膚接觸被普遍認為是一種傳播模式。
存在許多種人乳頭瘤病毒,且很多並不會帶來健康問題。通常情況下,人乳頭瘤病毒在感染之後幾個月內就會消失,而無需進行任何幹預,約90%會在2年之內消退。少數幾種特定類型的人乳頭瘤病毒感染則會持續存在並發展到宮頸癌。
宮頸癌是迄今為止與人乳頭瘤病毒有關的最為常見的疾病。幾乎所有宮頸癌病例都是由人乳頭瘤病毒感染導致。
某些類型的人乳頭瘤病毒感染也可導致一定的肛門、外陰、陰道、陰莖和口咽癌。可以采用與宮頸癌類似的一級預防策略加以預防。
不會導致癌症的人乳頭瘤病毒(特別是6型和11型)會引起生殖器疣和呼吸道乳頭狀瘤病(一種腫瘤在從鼻子和嘴到肺的空氣通道中生長的疾病)。雖然這些病症很少導致死亡,但會造成大量發病。生殖器疣很常見,具有高度傳染性,且會影響性生活。
人乳頭瘤病毒如何導致宮頸癌
雖然大部分人乳頭瘤病毒感染會自行消退,大部分癌前病變也會自行消失,但所有婦女都麵臨人乳頭瘤病毒感染轉為慢性的風險,以及癌前病變發展為浸潤性宮頸癌的風險。
對於免疫係統正常的婦女,發展到宮頸癌需要15到20年時間。對於免疫係統薄弱的婦女,例如感染艾滋病毒但未得到治療者,則隻需要5至10年時間。
人乳頭瘤病毒持續存在並發展到宮頸癌的危險因素
  • 人乳頭瘤病毒類型——其致癌性或致癌力;
  • 免疫狀態——艾滋病毒感染者等免疫功能低下的人員,更有可能持續感染人乳頭瘤病毒並更快發展到癌症前期和癌症;
  • 合並感染其他性傳播病原體,如導致單純皰疹、衣原體和淋病的病原體;
  • 產次(出生嬰兒數)和初生年齡; 
  • 吸煙。
全球宮頸癌負擔
宮頸癌是全世界婦女第四常見癌症。估計2018年有57萬例新發病例,占所有癌症死亡婦女的7.5%。在每年逾31.1萬宮頸癌死亡中,85%以上發生在欠發達地區。
在發達國家,已經建立相關規劃,使得女孩能夠獲得人乳頭瘤病毒疫苗接種,婦女可得到定期篩查。後者可使癌前病變在較易治療的階段被發現。早期治療可使這些國家80%的宮頸癌得到預防。
在發展中國家,隻能有限獲得這些預防性措施。宮頸癌隻有發展到晚期並出現症狀之後才被發現。此外,要使這種晚期疾病得到治療(如癌症手術、放療和化療)可能存在很大限製,因而這些國家的宮頸癌死亡率較高。
通過有效幹預,就可在全球使宮頸癌的高死亡率(年齡標化率:2018年為6.9/10萬)得到降低。
宮頸癌控製:一種綜合方法
世衛組織建議采用一套綜合方法來防控宮頸癌。建議的行動包括一整套涉及生命全程的幹預措施。行動應該是多學科、跨領域的,包括社區教育、社會動員、疫苗接種、篩查、治療和姑息治療。
一級預 二級預防
 
三級預防
 
9-14歲女孩
  • 人乳頭瘤病毒疫苗接種 
30歲以上婦女
 
有需要時所有婦女
 
女孩和男孩,視情況而定
    
  • 與煙草使用有關的健康信息和警告  
  • 與年齡和文化相符合的性教育 
  • 推廣安全套並向有性活動者提供安全套  
  • 男性包皮環切術
“篩查和治療”: “一站式”方法
  
  • 在衛生服務點針對高風險類型人乳頭瘤病毒開展快速檢 
  • 隨即開始治療  
  • 現場治療

  •  

 
任何年齡人群的浸潤性癌症治療和姑息治療  
  • 手術
  • 放療 
  • 化療 
  • 姑息治療

  •  

 

一級預防始於9-14歲女孩在有性生活之前接種人乳頭瘤病毒疫苗。

建議男孩和女孩酌情采用的其他預防幹預措施有:
  • 安全性行為教育,包括延遲開始性活動
  • 向已經有性活動者推廣及提供安全套;
  • 就煙草使用發出警告。煙草使用通常始於青春期,也是宮頸癌和其他癌症的重要危險因素;
  • 男性包皮環切。

從30歲開始,應對處於性活躍期的婦女進行異常宮頸細胞和癌前病變篩查。

如果需要對癌症前期的情況作出處理,切除異常細胞或病變,建議采取冷凍療法(通過冷凍來破壞宮頸上的異常組織)。

如果存在宮頸癌體征,治療浸潤性癌的選用方案包括手術、放療和化療。

接種人乳頭瘤病毒疫苗

目前有三種疫苗可以提供針對人乳頭瘤病毒16型和18型的保護,這兩種類型的人乳頭瘤病毒可引起至少70%的宮頸癌。第三種疫苗可以對另外三種類型的致癌性人乳頭瘤病毒帶來保護,這些類型會導致另外20%的宮頸癌。鑒於隻對16型和18型人乳頭瘤病毒帶來保護的疫苗也可能對其它可引起宮頸癌的不常見人乳頭瘤病毒類型提供一定的交叉保護,因此世衛組織認為三種疫苗對於宮頸癌具有同等保護作用。其中兩種疫苗還可對引起肛門生殖器疣的6型和8型人乳頭瘤病毒形成保護。

臨床試驗和上市後監測情況表明,人乳頭瘤病毒疫苗非常安全,而且在預防人乳頭瘤病毒感染方麵非常有效。

人乳頭瘤病毒疫苗如在接觸到該病毒之前接種會效果最佳。因此,世衛組織建議對大都還沒有開始性活動的9-14歲女孩實施疫苗接種。

疫苗不能治療人乳頭瘤病毒感染或宮頸癌等與人乳頭瘤病毒有關的疾病。

一些國家已開始為男孩接種疫苗,理由是該疫苗可以預防男性和女性生殖器癌症,且有兩種可用疫苗還可以預防男性和女性生殖器疣。由於疫苗接種是預防宮頸癌最為有效的公共衛生措施,因此世衛組織建議年齡在9-14歲的女孩接種疫苗。

接種人乳頭瘤病毒疫苗不能代替宮頸癌篩查。在已經采用人乳頭瘤病毒疫苗的國家,可能仍然需要建立或加強篩查規劃。

癌前病變的篩查和治療

宮頸癌篩查包括在沒有症狀且可能感覺十分健康的女性中檢查癌前不正常現象和癌症。通過篩查發現的癌前病變,可能很容易施治,並可避免癌症的發生。通過篩查還可在早期發現癌症,這時開展治療就有較高的治愈可能。

由於癌前病變發展到癌症需要很多年,建議自30歲起對每位女性進行篩查並在此後定期篩查(頻次取決於所使用的篩查檢測法)。對於攜帶艾滋病毒的性活躍女性而言,一旦她們了解到自身的艾滋病毒感染狀況,就應及早進行篩查。

篩查必須與獲得治療和陽性篩查結果的管理機製建立起聯係。沒有適當管理的篩查不符合道德規範。

世界衛生組織目前推薦使用3種不同類型的篩查檢測法:

  • 人乳頭瘤病毒檢測,以發現高危類型的人乳頭瘤病毒。 
  • 用乙酸進行目視檢查(VIA)。 
  • 常規(Pap塗片)檢查和液基細胞學(LBC)。

關於癌前病變的治療,世衛組織建議使用冷凍療法或高頻電波刀(LEEP)。對於出現晚期病變的婦女,應進行轉診,以進一步開展調查並作出適當處理。

浸潤性宮頸癌的管理

當婦女出現宮頸癌疑似症狀時,必須將其轉到適當機構作進一步評估、診斷和治療。

宮頸癌的早期症狀可能包括:

  • 育齡婦女在月經間期出現不規則點滴出血或輕微出血;
  • 絕經後點滴出血或出血; 
  • 性交後出血;
  • 陰道分泌物增多,有時帶有惡臭。

隨著宮頸癌的發展,可能出現更嚴重的症狀,其中包括:

  • 持續性背部、腿部和/或骨盆疼痛;
  • 體重減輕、疲勞、食欲不振;
  • 分泌物有惡臭和陰道不適;
  • 單腿腫脹或雙側下肢腫脹。

視癌症殃及的器官狀況,在疾病晚期可能出現其他嚴重症狀。

要根據組織病理學檢查來作出宮頸癌診斷。癌症的分期根據腫瘤大小以及疾病在骨盆和遠位器官的擴散程度確定。治療則取決於疾病分期,可選方案包括手術、放療和化療。姑息治療也是癌症管理的一個重要內容,可以減輕因疾病引起的不必要疼痛和痛苦。

世衛組織的應對

世衛組織已製定如何通過接種疫苗、篩查和處置浸潤性癌來防控宮頸癌的指導文件。世衛組織與各國和夥伴一道製定並實施全麵規劃。

2018年5月,世界衛生組織總幹事發出了消除宮頸癌行動呼籲,要求與合作夥伴和國家攜起手來,擴大以預防宮頸癌為目標的3種基本幹預措施的獲得性和覆蓋麵:即人乳頭瘤病毒疫苗接種、篩查和治療癌前病變,以及處理宮頸癌。

英文鏈接:

https://www.who.int/cancer/cervical-cancer

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閱讀 ()評論 (36)
評論
白水之魚 回複 悄悄話 回複 'fish_fish' 的評論 : 祝你好運。
fish_fish 回複 悄悄話 前麵已經有過判決了:見U.S. court pays $6 million to Gardasil victims By Peter Lind - - Wednesday, December 31, 2014
WASHINGTON, April 10, 2013 - Gardasil, the vaccine for HPV (human papillomavirus), may not be as safe as backers claim.

Judicial Watch announced it has received documents from the Department of Health and Human Services (HHS) revealing that its National Vaccine Injury Compensation Program (VICP) has awarded $5,877,710 dollars to 49 victims in claims made against the highly controversial HPV (human papillomavirus) vaccines. To date 200 claims have been filed with VICP, with barely half adjudicated.
“This new information from the government shows that the serious safety concerns about the use of Gardasil have been well-founded. Public health officials should stop pushing Gardasil on children.” said Judicial Watch President Tom Fitton.

現在是新的訴訟。Jennifer Robi,24歲的前運動員和學者,16歲接種HPV疫苗後被困在輪椅上,表現持續不受控製的神經/肌肉收縮(抽搐)和PTOS和許多其他症狀的自身免疫疾病。

疫苗2006年開始使用,周期太短難以判定最終效果,尤其是宮頸癌發生率10-30年後明顯下降才能令人信服。而且,在這期間還要繼續觀察有無嚴重不良反應。
fish_fish 回複 悄悄話 回顧一下Thiomersal(含汞)的故事吧。1930年引入疫苗製作,50、60、70年代出現區域性汞中毒後引起公眾注意,之後的研究發現重金屬包括汞對人體尤其神經係統有害。FDA和CDC在1999年的聲明中聲稱沒有找到確切的Thiomersal對人體有害的證據。但是,由於很多注射疫苗後的自閉症等患者提出訴訟,2001年夏天Thiomersal從疫苗中去除。2006年的訴訟結果使幾家大藥廠激活關門。

請注意該周期有多少年。難道在其中反對的人就是偏鋒嗎?
白水之魚 回複 悄悄話 回複 'fish_fish' 的評論 : 感覺你有點走偏鋒了,難道,FDA,WHO,都都無視這些結果?
fish_fish 回複 悄悄話 糾正一下,NCI認為從HPV感染到腫瘤開始形成要10-30年(https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-fact-sheet):
Researchers believe that it can take between 10 and 30 years from the time of an initial HPV infection until a tumor forms. However, even when severely abnormal cells are seen on the cervix (a condition called cervical intraepithelial neoplasia 3, or CIN3), these do not always lead to cancer. The percentage of CIN3 lesions that progress to invasive cervical cancer has been estimated to be 50% or less (20).
fish_fish 回複 悄悄話 這裏是訴訟案的資料(https://childrenshealthdefense.org/news/court-hears-gardasil-science-and-moves-forward/):
In fact, the rate for girls during the clinical trials (85/100,000) was 37 times the death rate from cervical cancer! Birth defects among children conceived during the study period were 5x those of the control group and miscarriages were doubled over background rates. Reproductive problems among vaccinated girls were 10x background rates. Finally, Merck’s own data showed that administering the Gardasil vaccine to girls who had previous exposure to HPV actually raised their risk of developing precancerous lesions (or worse) by almost 45%.
fish_fish 回複 悄悄話 回複 '白水之魚' 的評論 :
全貌是,天花、麻疹和百白破是空氣傳染,傳染性高,致病率和病死率高,一旦傳染是公共安全問題。
關於宮頸癌,2015年美國宮頸癌發病率為7.9/100,000,僅有5% HPV感染進展為原位癌(一般感染大約30年後),由於pap smear篩查,其中的91%的原位癌在36個月內診治,70%的CIN一期和54%的CIN二期在12個月內診治。收益人群與不良反應之比與傳染病疫苗不可同日而語。HPV絕大多數人自愈,有的人甚至不知道已經患過病毒感染。
此外,HPV亞型超過百種,疫苗隻是選擇最可能的九種(新的GARDASIL?9),不能百分之百cover來預防HPV感染。
並且,Merck本身的臨床實驗還發現,如果已經有過HPV感染,疫苗接種後患宮頸癌的風險比對照組增加45%。該發現很可怕,因為30%以上的孩子10歲前就接觸過HPV病毒。
https://www.classaction.org/gardasil裏麵有26個留言觸目驚心(具體我的文章有提及http://bbs.wenxuecity.com/health/822865.html),其中的例子:
1) UGH? 4 years ago My daughter was given Gardisil at age
12, all 3 doses. She was one of the lucky ones who didnt suffer the terrible
side effects but I will say, 5-6 years after her last dose, she had an abnormal
pap and ended up having a leap procedure due to cervical dysplasia, which the
shot was supposed to protect against. Thank God we caught it before it became
full fledged cancer.
2)Marilyn Petty? a year ago My granddaughter got the shots when she was 11 or 12. She just turned 22.
She went to the Health Clinic and they found two different spots on her
cervical told her not to worry they would see her back in a year. Well I got
worried and looked up information on HVP didn't like anything I read so we took
her to another doctor. He checked her his self and ran some test. Guess what he
found. She has cervical cancer and he says it can't wait that it is at a very
serious stage and needs to be removed. Problem she is on Medicaid and they
don't want to cover this, but they covered the shots that was told that she
needed to protect herself from HVP. So now I am fixing to start an up hill
battle with Medicaid in order to get her the medical treatment she needs. Any
one that can help me with this one would be wonderful. I am not ready to lose
her. I have already lost my son. She is way to young to let die because of
government red tape. Wish me luck. I am so sorry to hear about everyone elses
problems with these shots. If I knew all this before, I never would have gotten
her those shots. They told me it was really needed and there should be no
problems. Catch phase there should be no problems.
3)Missouri_girl? 4 years ago Is it too late to sue the makers
of this awful vaccine? I tested positive for HPV 3 months after the last (of 3)
shots and then it progressed to me having LEEP surgery after that to remove
pre-cancerous cells on my cervix. Ive also dealt with 5years of severe
constipation, went threw a colonoscopy, endoscopy and im only 24! I never had
insurance, had to save up and pay all these bills off!
這裏的例子更為極端,20歲左右就得了宮頸癌(Cervical cancer tends to occur in midlife and is most frequently diagnosed in women between the ages of 35 and 44. It rarely develops in women younger than 20,來源於
Key Statistics for Cervical Cancer - American Cancer Society)。而且都是打過HPV疫苗之後。
綜上所述,HPV疫苗與其他疫苗相比並不安全,接種要慎重。
白水之魚 回複 悄悄話 回複 'fish_fish' 的評論 :

你提供的資料真實性,我一點都不懷疑,但你可能忽略了全貌。128:387=33%,三分之一訴訟成功,比例還是蠻高的。但你知道誰在左右這類訴訟和輿論,多少錢到了律師的口袋裏嗎?根據VICP資料:
僅2011年,每例成功訴訟平均獲得78萬美元賠償,但律師費和其它法律費用(包括不成功訴訟費)多達1億1千3百萬美元。

疫苗傷害現象肯定存在,受害者理應得到賠償,這都不是問題,問題是如我前麵所講,任何藥物,疫苗都不完美,猶如魚與熊掌,不能因為個案的存在而放棄重要的東西,進而承擔更嚴重的風險。更不要被相關的利益團體所左右並產生恐慌。

自人類第一個疫苗 - 牛痘苗誕生以來,各種擔憂,事故和爭論一直伴隨,但今天人們公認疫苗是人類最偉大的發明之一。天花,肺結核,小兒麻痹,百白破,麻疹等致命性傳染病,想當初何等猖獗,現在卻難覓蹤影,如果不是人們廣泛接種疫苗,今天又會怎樣?吐血而死(結核),滿大街的瘸子拐子(小兒麻痹),滿臉麻子(天花)。。。HPV也是如此,不能因噎廢食吧。我們的看法不一,可能因為我與你看問題的角度和高度不同。
fish_fish 回複 悄悄話 https://www.nvic.org/vaccines-and-diseases/hpv/vaccine-injury.aspx
這個網站比較客觀,有具體數字。
Even though the National Childhood Vaccine Injury Act of 1986 legally required pediatricians and other vaccine providers to report serious health problems following vaccination to the federal vaccine adverse event reporting system (VAERS), many doctors and other health care providers giving vaccines to children and adults fail to report vaccine-related health problem to VAERS. The evidence suggests that only one to 10 percent of serious health problems that occur after use of prescription drugs or vaccines in the U.S. are ever reported to federal health officials who are responsible for regulating the safety of drugs and vaccines and issue national vaccine policy recommendations.

As of July 1, 2018, 387 claims have been filed to the federal Vaccine Injury Compensation Program (VICP) for 14 deaths and 373 injuries that occurred after HPV vaccination. To date, the U.S. Court of Claims has compensated 128 of the 387 children and adults who filed claims for HPV vaccine injuries.
fish_fish 回複 悄悄話 我當然相信了,大家可以去查已經發表的病例。HPV疫苗發生嚴重不良反應明顯多於其他疫苗。
黑社會當然不是,因為隻是宣傳讓大家打疫苗,沒有強迫每個人必需去打。
利益驅動,任何政府部門都需要資金。美國已經還好了,沒有象某些國家唯金錢至上,生成假疫苗或問題疫苗。
白水之魚 回複 悄悄話 回複 'fish_fish' 的評論 : 你描述的情況,感覺美國比黑社會還黑暗,人人好像是待宰的羔羊,你真的相信嗎?
fish_fish 回複 悄悄話 我在健康養生中開了個帖子,關於HPV疫苗 http://bbs.wenxuecity.com/health/822865.html
訴訟律師的結案陳詞提到:Kennedy closed his powerful presentation by chronicling the parade of corrupt conflicts that caused HHS officials to turn a blind eye to the rife fraud that characterized the clinical trials. Merck loaded the two FDA and CDC panels that approved Gardasil, with paid toadies. He showed that the pharmaceutical industry actually pays 45% of FDA’s annual budget and that NIH and its officials own part of the patents to the Gardasil vaccine and collect royalties on every vaccine sold. NIH collects tens of millions of dollars annually from Gardasil sales. Finally, 45% of CDC’s budget goes to promoting and purchasing vaccines. Merck exerts control over the CDC with millions of dollars in contributions to the CDC foundation, which allows funding for pet projects. This level of support gives Merck the power to also punish the CDC by withholding funding if displeased by the agency.
鑒於FDA和CDC與藥廠有COI,有共同的經濟利益,我並不能完全相信他們的報告。

這裏有有關Gardasil 副作用的病例報告和研究:https://medscienceresearch.com/gardasil/ 強烈推薦該網站,有鏈接可以查到相關的發表文章。
白水之魚 回複 悄悄話 如果大家對疫苗的安全有問題,建議去美國疾病控製中心的相關網站看看,鏈接:
https://www.cdc.gov/vaccinesafety/vaccines/hpv-vaccine.html

HPV Vaccine Side Effects
The HPV vaccine is very safe, and it is effective at preventing HPV. Vaccines, like any medicine, can have side effects. Many people who get the HPV vaccine have no side effects at all. Some people report having very mild side effects, like a sore arm from the shot. The most common side effects are usually mild.

Common Side Effects of HPV Vaccine:
Pain, redness, or swelling in the arm where the shot was given
Fever
Headache or feeling tired
Nausea
Muscle or joint pain

我覺得大家應該對美國的藥品(包括疫苗)的審批和監管係統有信心。還不放心,問一問周圍打過疫苗的人,到底有沒有副作用,有什麽副作用,作用大不大?

白水之魚 回複 悄悄話 回複 'luck86' 的評論 : 如果孩子還小,不妨多觀察幾年。醫生,學校推動接種這種疫苗,說明了疫苗的意義,難道醫生,學校老師沒有孩子?他們的孩子不打疫苗,專門忽悠別人打?
白水之魚 回複 悄悄話 回複 'bjszh' 的評論 : 你的理解和比喻挺有道理。就像藥物一樣,沒有完美的東西,為了治病和防病,必須承擔一定風險。
luck86 回複 悄悄話 很不理解為什麽醫生和學校要advocate 9_14的女孩take這個shot, 這個年齡的女孩生理還沒發育成熟,有的period 都還不規律,打了shot,如果有副作用,更難分辨到底是什麽引起的。
bjszh 回複 悄悄話 看來不接受小於號。
隻要B遠遠小於A,綜合社會效益就是好的。你是願意冒10%還是1%的風險?
luck86 回複 悄悄話 其他兒童期的疫苗,我都支持,畢竟已經存在了很長時間,相對安全。而這個HPV的contradiction好像比較大,而醫生和媒體又大力推崇,其實讓人迷惑。謝謝fish_fish 提供的新的信息,也感謝樓主提供這個討論的平台。畢竟有時即使risk不大,但如果確實存在,而且發生了,那就是100%的risk了,
bjszh 回複 悄悄話 不知為什麽砍去了結尾。
隻要 B
luck86 回複 悄悄話 而且好像這個疫苗有效保護期隻有10年,那麽如果小孩在14歲接種這疫苗, 到24歲就失效了,而有的保守點的女孩說不定到那時還沒機會會 expose HPV病毒,那麽take這個疫苗比較大的副作用的風險就沒有意義了。不知我認為的10年保護期準不準確,希望更了解這疫苗的網友指正。
luck86 回複 悄悄話 謝謝fish_fish提供的信息,也很關注這個問題,主要是媒體,學校非常promote這個疫苗。我暫時選擇了不給小孩打這個疫苗, 因為她還太小。但小孩回來問我為什麽不給她打,不打會得cancer,她們同學都打。希望能多點信息供人們做出相對好的選擇。
bjszh 回複 悄悄話 謝謝這裏嚴肅的討論。我不是學醫的,講點外行話。無論哪種疫苗,如果假設不打的發病率為10%(A),而打了有嚴重副作用的為1%(B),那麽對這1%的人來說,本來好好的,打疫苗打出了毛病,當然會反對。但對那些因為疫苗而避免染病的10%來說,結論就不一樣了,隻要 B
fish_fish 回複 悄悄話 這裏是庭審律師的描述:
2.3 % of the girls receiving the vaccine complained of symptoms of autoimmune disease within 7 months. Since cervical cancer kills only 1.5 Americans in every 100,000, he noted, “Merck’s own data show that the chances of getting an autoimmune disease from this vaccine are 1000 times the risk of dying from cervical cancer.”
Not only did a heartbreaking 50% of the subjects in both the study group and the spiked placebo group experience a serious adverse event within the seven months of the trial, death rates among girls in the study were double background rates. In fact, the rate for girls during the clinical trials (85/100,000) was 37 times the death rate from cervical cancer!
fish_fish 回複 悄悄話 從 FDA’s Vaccine Adverse Event Reporting System (VAERS)報告來看,HPV的副作用不可謂不高。僅有5%的HPV感染與宮頸癌相關,smear早期篩查能顯著提高早期診斷和生存率。因此,要慎重考慮是否接種HPV疫苗。
https://childrenshealthdefense.org/news/court-hears-gardasil-science-and-moves-forward/ 這裏是有關2019年1月庭審記錄,披露由於免疫周期要長,因此默克公司用了更大劑量的AAHA無定形磷酸氫鋁佐劑,而他們的安慰劑對照組沒有用公認的惰性安慰劑,而是用同樣大劑量的AAHA,因此,掩蓋了疫苗產生的副作用(來源於大量佐劑導致的自身免疫損害)。該大劑量的AAHA在動物中能導致自身免疫反應。
此外,默克公司臨床實驗的人群選擇與臨床應用不符,從來沒有低於15歲年齡組的臨床研究。
fish_fish 回複 悄悄話
HPV Vaccine VAERS Reports

Description 12/14/2018 TOTAL
Disabled 2,856
Deaths 458
Did Not Recover 12,199
Abnormal Pap Smear 667
Cervical Dysplasia 324
Cervical Cancer 148
Life-threatening 962
Emergency Room 15,401
Hospitalized 6,047
Extended Hosp. Stay 291
Serious 8,873
Total Adverse Events 60,714

The cervical cancer diagnosis rate in the United States is 7.9/100,000. Given that only 5% of HPV infections progress to neoplasia (CIN) and that 91% of early stage cases resolve spontaneously within 36 months, with 70% of CIN 1 and 54% of CIN 2 cases doing the same within 12 months, using these pathologies as surrogate markers for cancer incidence represents a scientific shortcoming.

文學城上有關HPV副作用的帖子:
關於HPV疫苗 來源: 咪嗚 http://bbs.wenxuecity.com/health/294973.html
絕對要看:HPV子宮頸癌疫苗首席研發員說出的真相 醫者意也 http://www.wenxuecity.com/blog/201603/41693/737545.html
最新研究:美國默克公司HPV疫苗關聯美國25-29歲年齡組婦女生育率下降 ——來來來,討論一下這個問題
薛成 https://bbs.wenxuecity.com/health/797772.html

白水之魚 回複 悄悄話 回複 'fish_fish' 的評論 : 歡迎這種理性討論。我不是說要忽略這些副作用,但我認為它們屬於極端個案。打疫苗的副作用風險高不高?最直接可信的辦法是問一下周圍人群,有沒有發生過或聽過類似的案例。

研究發現,近一半的美國男性感染了致癌性人乳頭瘤病毒(HPV),但與女性不同的是,男性可能一生都處於帶毒感染狀態。

HPV是美國最常見的性傳播疾病。大約7900萬美國人感染了不同類型的HPV,約一半的新感染病例發生在24歲之前。

HPV屬於一種惡性感染。每年有超過9,000例與HPV相關的癌症發生在男性身上。HPV是導致63%的陰莖癌,91%的肛門癌和72%口腔和咽喉癌的原因。

此外,男性中的HPV是引起女性宮頸癌的間接原因。該病毒也是導致90%的生殖器疣的原因。 HPV還可導致呼吸道的腫瘤,稱為呼吸道乳頭狀瘤。

美國著名影星道格拉斯自己患的喉癌就是由HPV引起的,他多次在媒體上宣傳HPV,希望引起社會對HPV的關注,同時呼籲美國的年青人注射HPV疫苗。

雖然自2009年以來已經有HPV的疫苗,但覆蓋率仍然很低。隻有約11%的男性和33%的女性接種了這種疫苗。

根據美國CDC調查,大多數感染HPV的人不知道他們已經感染,因為感染者通常不會出現明顯的症狀。


詳情請參考鏈接:http://blog.wenxuecity.com/myblog/70732/201701/24234.html
fish_fish 回複 悄悄話 現在多個國家,包括法國、日本、印度和美國都有針對Gardasil的訴訟,希望早日得出結論。
下麵是一則以前的新聞:
U.S. court pays $6 million to Gardasil victims By Peter Lind - - Wednesday, December 31, 2014
WASHINGTON, April 10, 2013 - Gardasil, the vaccine for HPV (human papillomavirus), may not be as safe as backers claim.

Judicial Watch announced it has received documents from the Department of Health and Human Services (HHS) revealing that its National Vaccine Injury Compensation Program (VICP) has awarded $5,877,710 dollars to 49 victims in claims made against the highly controversial HPV (human papillomavirus) vaccines. To date 200 claims have been filed with VICP, with barely half adjudicated.
“This new information from the government shows that the serious safety concerns about the use of Gardasil have been well-founded. Public health officials should stop pushing Gardasil on children.” said Judicial Watch President Tom Fitton.



The CDC recommends the Gardasil vaccine, made by Merck Pharmaceuticals, for all females between 9 and 26 years to protect against HPV. Furthermore, the CDC says Gardasil is licensed, safe, and effective for males ages 9 through 26 years.

The facts appear to contradict the FDA’s safety statements. The adverse reaction reports detail 26 new deaths reported between September 1, 2010 and September 15, 2011 as well as incidents of seizures, paralysis, blindness, pancreatitis, speech problems, short term memory loss and Guillain-Barré Syndrome. The documents come from the FDA’s Vaccine Adverse Event Reporting System (VAERS) which is used by the FDA to monitor the safety of vaccines.

That’s 26 reported deaths of young, previously healthy, girls after Gardasil vaccination in just one year.
fish_fish 回複 悄悄話 5)Sondra Sierko January 17, 2019 at 7:57 AM
My daughter has had a continuing period for over a year since getting this vaccine. I felt guilted into getting it for her at age 15 and am angry that I went against my better judgment and complied. She is miserable and more depressed. When I went back to the dr they refused to believe it had anything to do with the HPV vaccine and that it was pure coincidence that it happened at that time. No show of concern or compassion, they couldn’t understand why I was so upset, then they offered to put her on birth control! What?!
抱歉在您的博客上發表這麽多信息,隻是希望大家更好的權衡利弊,做出對自己和孩子最好的決定。
謝謝您的文章!
fish_fish 回複 悄悄話 其他疫苗副作用沒有這麽大,有的認為與自閉症相關。
HPV疫苗的副作用很多認為與自身免疫有關,有的很嚴重。因為HPV不像天花、麻疹等空氣傳播、病死率高,因此是否接種要衡量其利弊。我的孩子其他疫苗都接種了,但我覺得我可能會拒絕HPV。

下麵是“The New Gardasil: Is It Right For Your Daughter?”一文中的評論:
1)Dee August 2, 2016 at 2:49 PM
My Son was diagnosed with POTS after receiving the Gardasil vaccine…he developed symptoms the day after his second shot! We were lucky. It only took us about six weeks to get get into the Mayo Clinic where we did, at the final hour, get a POTS diagnosis. It is almost one year later and he still struggles with symptoms each day. We were told that he should be able to manage his symptoms by simply drinking a Gatorade or two each day and exercising daily. He is 19 and had to defer enrolling in college for a semester due to his condition. He was able to attend college during the second semester and will return this fall. Brain fog, fatigue, dizziness, and stomach issues are his main complaints and we are just now beginning treatment with a POTS specialist. I’m so angry with myself for being sucked into the hype and allowing my son to get this vaccine. He says he has forgotten what it is like to feel good because he feels lousy all the time.
2) cathy friedman May 6, 2018 at 10:37 AM
My daughter fainted four days after receiving the guardasil 9 shot. She had to withdraw from graduate school and has recently been diagnosed with POTs by Dr. Brent Goodman at the Mayo Clinic in Scottsdale.
I would love to talk to you about what happened to our daughters. There are so many out there who have been injured. We need to do something. There must be a way to file a class action law suit against Merck. They know something and I am determined to hold them accountable. This has been a nightmare. Please email me at cfriedma@gmail.com. Thanks!
3) Machae July 26, 2017 at 11:25 PM
Hi, I want to thank ypu for giving the real facts behimd the terrible shot. I am almost certain I aquired POTS with RAS(seizures) through the shot. I wish people would listen.
4) Emily March 11, 2018 at 8:36 PM
Thank you for affirming what I know now about this vaccine. I made the mistake of having my daughter have this vaccine although it was never presented to me as an option. Ever since, the pain and depression and change in personality has haunted us. I tell every parent I know to make sure they speak out and not allow their child to have this vaccine. I wish daily I could turn back time and wonder what my, now teen’s, life would be like. I wish there was an antedote but every doctor here looks at me like I’m crazy when I mention it. Thanks again.


白水之魚 回複 悄悄話 回複 'Dlu2442' 的評論 : 世上有幾人不接觸?
Dlu2442 回複 悄悄話 疫苗的副作用不可不注意。這個要有直接接觸才會感染,因此覺得無需冒副作用的風險
白水之魚 回複 悄悄話 回複 'fish_fish' 的評論 : 任何疫苗都有副作用,隨意Google任一疫苗,都會發現很多負麵個案,但比起不打疫苗可能出現的風險小之又小,個人應該有個基本判斷。
fish_fish 回複 悄悄話 因為我的小孩再過5、6年就要考慮打疫苗的問題了,所以特地查了一些這方麵的內容,隻是想讓大家知道一下這些信息。
我是學醫出身,現在做研究。基於我查到的資料,打HPV疫苗要慎重考慮。
fish_fish 回複 悄悄話 我查了一下,副作用可能不是幾個極端例子,有興趣的人可以讀:
1)The New Gardasil: Is It Right For Your Daughter? by Kelly Brogan, MD
這裏的讀者留言就有好幾個例子。其中之一:cathy friedman May 6, 2018 at 10:37 AM
My daughter fainted four days after receiving the guardasil 9 shot. She had to withdraw from graduate school and has recently been diagnosed with POTs by Dr. Brent Goodman at the Mayo Clinic in Scottsdale. I would love to talk to you about what happened to our daughters. There are so many out there who have been injured. We need to do something. There must be a way to file a class action law suit against Merck. They know something and I am determined to hold them accountable. This has been a nightmare. Please email me at cfriedma@gmail.com  Thanks!
2)還有sanevax.org網站,上麵有一些例子。

白水之魚 回複 悄悄話 回複 'fish_fish' 的評論 : 疫苗的效果很好,新聞報道都是極端的例子。部分西方人反對注射疫苗,其實害人害己。最近華盛頓州麻疹流行,是很好的例子,因為全世界普種麻疹疫苗多年,麻疹在全球幾乎滅絕,但因為小部分人不以為然,決絕接種,結果疾病卷土重來。
fish_fish 回複 悄悄話 我以前是覺得接種疫苗是應該的,但最近有些新聞,使我不確定疫苗的副作用:
1) Court Hears Merck Gardasil Science and Moves Forward: google搜索即可
2) Addressing expected challenges after resumption of HPV vaccination:In Japan, an HPV vaccination program started in 2010, and the HPV vaccine became a nationally recommended routine immunization for girls aged 12–16 years in April 2013. However, because cases of young girls with widespread pain and movement disorders after vaccination were reported in the media in June 2013, Japan's Ministry of Health, Labour and Welfare (MHLW) announced the suspension of its recommendation for routine HPV immunization.
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