Что нужно знать о вирусе папилломы человека?

Сегодня один из самых распространённых вирусов, передающихся половым путём — вирус папилломы человека (ВПЧ). И он сильно отличается от многих ЗППП. Особенность ВПЧ в том, что он не вызывает никаких неприятных ощущений, но при этом может привести к развитию очень серьезных заболеваний.

Известно более 100 типов вируса папилломы человека, 14 из них входят в группу высокого онкогенного риска. При этом, согласно последним исследованиям, около трети женщин заражаются ВПЧ уже в течение 24 месяцев после начала половой жизни.

Есть и хорошие новости: риск передачи ВПЧ относительно низок во время беременности, а кроме того, зафиксированы случаи, когда иммунная система самостоятельно справлялась с вирусом в течении пары лет.

Тем не менее, пока не существует лечения, способного уничтожить вирус папилломы в организме человека. Но существуют вакцины, способные предотвратить заражение.

В интернете можно найти много противоречивых мнений о том, нужна ли вакцинация от ВПЧ. Мы обратились за ответом к практикующему израильскому врачу Виктору Леви, который рассказал про отношение к вакцинации от ВПЧ с точки зрения израильской медицины, и к заведующей онкологическим отделением ФНКЦ ФМБА России, д.м.н., профессору Кедровой Анне Генриховне.

 

doctor-levi1Виктор Леви, врач высшей категории и главный врач Израильской клиники LevIsrael:

Вирусом человеческой папилломы называют группу вирусов Human Papillomavirus Virus, в которую входят около 100 штаммов. Статистически, речь идет об одном из самых распространенных вирусов, являющихся одной из основных причин рака шейки матки. Вирус папилломы также известен как причина возникновения многих других видов рака, причем не только у женщин, но и у мужчин. Например, ВПЧ ответственен за 90% случаев рака ануса, 70% случаев онкологии рта и глотки, 65% случаев рака влагалища и вульвы и около половины случаев рака пениса. Кроме того, ВПЧ вызывает появление генитальных и накожных бородавок, а также бородавок на голосовых связках.

Соответственно, если есть реальная возможность предотвратить развитие столь малоприятных заболеваний, то отказываться от этого — в высшей степени неразумно. Тем более, что вакцина доказала себя как эффективное средство от вирусов, вызывающих рак. Причем ее действие эффективно на протяжении пятнадцати лет.

В Израиле используются два вида прививок от ВПЧ, рекомендованных Минздравом: Cervarix (производства компании GlaxoSmithKline) и Gardasil (производства компании Мерк).

Побочные эффекты от вакцинации обычно отсутствуют, либо являются весьма незначительными. В худшем случае речь идет о легких аллергических реакциях, головокружении либо о незначительном покраснении в месте укола. Данная информация основывается на статистике, полученной после 175 миллионов вакцинаций, произведенных по всему миру.

Подводя итог, хочу сказать, что для меня, как врача, выбор однозначен — в данном случае польза от вакцинации многократно превышает риск и я не вижу причин отказываться от ее проведения. Того же мнения придерживается и израильское Министерство Здравоохранения, повсеместно рекомендующее вакцинацию.

 

Кедрова онкология

Кедрова Анна Генриховна,  д.м.н., профессор. заведующая онкологическим отделением ФНКЦ ФМБА России:

В настоящее время на рынке имеются две профилактические вакцины против ВПЧ: Гардасил и Церварикс. Вакцины воздействуют на два ключевых штамма вируса – ВПЧ-16 и ВПЧ-18. В совокупности два эти штамма вызывают приблизительно 70% рака шейки матки во всём мире и некоторые другие раковые заболевания половых органов. Гардасил защищает от двух типов ВПЧ (ВПЧ-6 и ВПЧ-11), которые вызывают 90% случаев генитальных бородавок.

В Великобритании Объединенный комитет по вакцинации и иммунизации рекомендует вакцинацию девочек с 11 до 12 лет с возможностью последующей ревакцинации до 16 лет. Аналогичные рекомендации по вакцинации молодых женщин против ВПЧ для предотвращения рака шейки матки дали работники здравоохранения в Австралии, Канаде, Европе и Соединенных Штатах. Предполагается, что вакцинация девочек-подростков поможет спасти сотни жизней в год.

В 2009 году Управление по санитарному надзору за качеством пищевых продуктов и медикаментов США лицензировало вакцину Гардасил для применения у мужчин в возрасте от 9 до 26 лет для профилактики остроконечных кондилом, вызванных штаммами ВПЧ-6 и -11. Эти штаммы вызывают примерно 90% генитальных бородавок и, в большинстве случаев, рецидивирующий респираторный папилломатоз. Математическое моделирование показало, что включение мужчин в программу вакцинации может стать экономически эффективной стратегией только при условии, если охват вакцинируемых женщин будет выше 80%. Поскольку бремя заболеваемости выше у женщин, чем у  мужчин, увеличение охвата женщин в возрасте 11-12 лет является потенциально более эффективной стратегией, чем включение в программу мужчин.

В настоящее время лабораторные исследования и клинические испытания сосредоточены на разработке терапевтических вакцин против онкогенов ВПЧ, например, Е6 и Е7. Есть надежда, что иммунный ответ против двух онкогенов будет способствовать предотвращению развития опухолей.

Таким образом, вакцины против ВПЧ потенциально перспективны для предотвращения ВПЧ-положительного рака шейки матки у женщин.

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