Epidemiological features, national burden of several HPV-related diseases and estimation of cost-effectiveness of HPV vaccines in Vietnam

该项目旨在收集支持将癌症预防疫苗HPV(人乳头瘤病毒)引入越南国家免疫计划所需的证据。HPV是已开发的第二种可以预防癌症的疫苗(第一种是预防肝癌的乙肝疫苗)。HPV疫苗可以预防HPV感染，而HPV感染是导致几乎所有女性宫颈癌病例的原因。在西方国家，宫颈癌比发展中国家少得多，因为定期的宫颈筛查(巴氏涂片)可以识别和治疗非常早期的病例。HPV在越南等发展中国家非常常见，它导致的癌症通常发现得很晚，导致高死亡率。HPV也是影响男性和女性的其他多种癌症的罪魁祸首，包括阴茎癌、肛门癌和喉癌。大多数工业化国家都在使用这种疫苗，并给女孩接种，在一些国家也给男孩接种。由于其高昂的价格，以及缺乏关于这些国家HPV感染和疾病的证据，只有极少数发展中国家采用了这种方法。越南是一个快速现代化的国家，经济蓬勃发展，人口日益西化。HPV通过无保护措施的性行为传播，性工作者和男男性行为者的感染率非常高。该项目将研究越南北部、南部和中部年轻大学生的HPV感染率，以获得全国的视角。我们还将研究两个重要的高危群体，性工作者和南方和北方的男男性行为者。我们将利用越南癌症医院的记录来估计感染HPV相关癌症的人口比例，并更好地了解受影响的年龄以及病例的结局和治疗费用。这将使我们能够预测引入HPV疫苗对社区的影响，并计算如果这些癌症得到预防，卫生系统将节省多少钱。最后，我们将在越南发展研究HPV疾病所需的实验室技能，特别是在越南进行HPV疫苗试验。这项建议不包括这项试验，但我们希望在未来进行一项试验，帮助我们决定将HPV疫苗引入越南这样的发展中国家最简单、因此成本最低的方式。该项目将由五个机构联合承担。这三个越南机构(两个在北部，一个在南部)将能够分享他们在这一领域的专业知识，并在伦敦(伦敦卫生和热带医学院)和澳大利亚(默多克儿童研究所)专家小组的帮助下开发新技能。

This project is designed to collect the evidence that will be needed to support the introduction of the cancer-preventing vaccine HPV (Human Papillomavirus) into the national immunization program of Vietnam. HPV is the second vaccine that has been developed that can prevent cancer (the first being Hepatitis B vaccine which prevents liver cancer). HPV vaccine prevents HPV infection, which is responsible for almost all cases of cancer of the cervix in women. In Western countries cancer of the cervix is much less common than in developing countries, because the regular cervical screening (Pap smears) identifies and treats very early cases. HPV is very common in developing countries like Vietnam, and the cancers that it causes are usually detected late, leading to high mortality. HPV is also responsible for a variety of other cancers affecting both men and women, including penile cancer, anal cancer and throat cancer. The vaccine is used is most industrialized countries, and is given to girls, and in some countries to boys as well. It has been introduced into very few developing countries, because of its high price, and the lack of evidence about HPV infection and disease in those countries. Vietnam is a rapidly modernizing country, with a booming economy and a population that is becoming increasingly westernized. HPV is spread by unprotected sex, and rates of infection are very high among sex workers and men who have sex with men. This project will study the rate of HPV infection among young university students in north, south and central Vietnam to get a national perspective. We will also study two important high risk groups, sex workers and men who have sex with men in both the north and south. We will use the records of the cancer hospitals in Vietnam to estimate the proportion of the population who were affected by HPV associated cancer, and to understand better the ages affected and the outcome and treatment costs of cases. This will enable us to predict the effect of HPV vaccine introduction on the community and calculate the money that will be saved by the health system if those cancers are prevented. Finally we will develop, within Vietnam, the laboratory skills that are needed to study HPV disease, and especially to undertake a trial of HPV vaccines in Vietnam. The trial is not covered by this proposal, but we hope in future to do a trial that will help us to decide which is the simplest and therefore least expensive, way to introduce HPV vaccine into a developing country like Vietnam. The project will be undertaken jointly by five institutions. The three Vietnamese institutions (two in the north and one in the south) will be able to share their expertise in this area and also develop new skills with help from expert groups in London (London School of Hygiene and Tropical Medicine) and Australia (Murdoch Childrens Research Institute).