兩性要愛不要癌 校園職場預防 新生活運動 衛教師: 狄勤育 HPV 1 04-2012-GRD-2011-TW-9947-SS

子宮頸癌對全球女性的威脅 全世界每年有將近50萬位婦女被診斷為 子宮頸癌 全世界每兩分鐘有一位婦女死於子宮頸癌 亞太地區每四分鐘有一位婦女死於子宮頸癌 Age standardised rate (ASR) per 100,000 population (All ages) WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre). Human Papillomavirus and Related Cancers in Asia. Summary Report 2010. [Accessed on 5th July, 2010]. Available at www. who. int/ hpvcentre

認識子宮頸癌 子宮頸腺癌三大特色”2不1快”(註4) 發現不易- 通常發生於子宮頸較內口的部位 治療不易- 抗藥性較高 子宮頸腺癌： 位於柱狀細胞 子宮頸癌： 位於鱗狀上皮細胞 子宮頸腺癌三大特色”2不1快”(註4) 發現不易- 通常發生於子宮頸較內口的部位 治療不易- 抗藥性較高 擴散快- 發現時通常已非初期 3 (註4) 資料來源: 臺北醫學大學及萬芳醫院癌症中心副主任　賴基銘醫師

子宮頸鱗狀上皮因人類乳突病毒感染而產生之系列變化 正常子宮頸 人類乳突病毒感染／ CIN* 1 CIN 2／CIN 3／ 子宮頸癌 Goodman/p. 1559/Figure 2 1/Gallo/p. 534/col 1 /¶1 Key Point Integration of HPV into the DNA of the infected host cell is commonly associated with high-risk oncogenic HPV types1 and is linked to the activity of E6 and E7 proteins.2 Background HPV infects its host by penetrating through mucosal tears in the basal membrane.3 In benign HPV-associated skin lesions, the HPV virus maintains its genome as episomes at low copy numbers (10–200 copies/cell) in the basal cells of the epithelium separate from the host cell DNA. To maintain its viral DNA as an episome, viral E1 and E2 proteins are expressed. Failure to express E1 leads to the integration of the HPV genome into the host cell chromosome.3 Integration of HPV into the DNA of the infected host cell is commonly associated with high-risk oncogenic HPV types1 and is considered an important step in tumor progression.2 In malignant HPV-associated skin lesions, HPV DNA integration into the host cell’s chromosome regularly occurs through a break in the viral genome around the E1/E2 region. Integration-mediated disruption of E2 may trigger uncontrolled expression of E6 and E7, resulting in cellular transformation.2 The E6 protein associates with the tumor suppressor protein p53 and promotes proteolytic destruction of the protein. This leads to malignant transformation and loss of regulated cell growth. The E7 protein associates with the pRB, which inactivates the cell cycle restriction function of this protein.2 References 1. Gallo G, Bibbo M, Bagella L, et al. Study of viral integration of HPV-16 in young patients with LSIL. J Clin Pathol. 2003;56:532–536. 2. Syrjänen KJ, Syrjänen SM. Molecular biology of papillomaviruses. In: Papillomavirus Infections in Human Pathology. Chichester, United Kingdom: John Wiley & Sons, Inc.; 2000:11–51. 3. Doorbar J. The papillomavirus life cycle. J Clin Virol. 2005;32(suppl):S7–S15. 2/Syrjanen/p. 32/col 2/¶2; p 33/col 1/¶2 3/Doorbar/p. S8/col 2/¶3 *CIN = 子宮頸上皮內贅生(cervical intraepithelial neoplasia) 摘錄自：Goodman A, Wilbur DC. N Engl J Med. 2003;349:1555–1564. © 2003 美國麻州醫學會，保留所有權利。本圖經許可後摘錄。 3/Doorbar/p. S9/col 1/¶2; col 2/¶1 4 4 1/Gallo/p. 534/col 1 /¶1 2/Syrjanen/p. 32/col 2/¶2; p 33/col 1/¶1,2 2/Syrjanen/p. 12/Table 2.1; p. 18/col 2/¶2,3; p. 39/col 1/¶2,3; col 2/¶4; p. 40/col 1/¶1; col 2/¶3 4

人類乳突病毒(HPV) HPV 16 與 HPV 18 為全世界子宮頸癌的主要型別。4 已知種類 >100 種2 約有40種可以感染黏膜細胞2,3 約有15 – 20種為致癌性2,3 HPV 16 與 HPV 18 為全世界子宮頸癌的主要型別。4 非致癌性型別** HPV 6 及 HPV 11型為常見與外生殖器疣相關的型別。3 研究證實，99.7%的子宮頸癌，都和人類乳突病毒感染有關，並造成子宮頸細胞變異，進而惡化成子宮頸癌。 無套膜的雙鏈DNA病毒1 重點 全球有許多種類的HPV 存在，在總數約15 – 20種的致癌性類型中，超過10% 的子宮頸癌是由HPV 16與HPV 18所造成的。 背景知識 像HPV之類的乳突病毒(Papillomaviruses)都是無套膜的雙鏈DNA病毒。1 已知的HPV類型超過百種 2，其中80種以上已被定序與分類。3 約有30 – 40種的HPV是屬於肛門生殖器類型，其中約有15 – 20種具有致癌性。2,3 在一項國際性的綜合分析中，發現HPV 16 與 18 都具有致癌性，且所有子宮頸癌當中有70%是由它們而起，其次最常見的5種類型(31, 33, 45, 52, 58)則佔另外的17%病例。4 其它的致癌性HPV類型還包括35, 39, 51與56。4 HPV 6 與 11 都不具致癌性，而與外肛門生殖器疣有關。3 References 1. Howley PM, Lowy DR. Papillomaviruses and their replication. In: Knipe DM, Howley PM, eds. Fields Virology. 4th ed. Philadelphia, Pa: Lippincott-Raven; 2001:2197–2229. 2. Schiffman M, Castle PE. Human papillomavirus: Epidemiology and public health. Arch Pathol Lab Med. 2003;127:930–934. 3. Wiley DJ, Douglas J, Beutner K, et al. External genital warts: Diagnosis, treatment, and prevention. Clin Infect Dis. 2002;35(suppl 2):S210–S224. 4. Muñoz N, Bosch FX, de Sanjosé S, et al. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med. 2003;348:518–527. 1. Howley PM, Lowy DR. In: Knipe DM, Howley PM, eds. Philadelphia, Pa: Lippincott-Raven; 2001:2197–2229. 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. 5 5

Central/South America 全球導致子宮頸癌的HPV型別發生率 69.7 14.6 HPV Type 16 52.5 25.7 18 45 67.6 17 31 North America/ Europe 33 57 12.6 52 South Asia 58 Others Key Point Most cases of invasive cervical cancer are associated with HPV 16 or 18, but approximately one quarter to one third of all cases are associated with other HPV types, the distribution of which varies by region. Background In a pooled analysis from an international survey of HPV types in cervical cancer and from a multicenter, case-control study (N = 3607), both co-coordinated by the International Agency for Research on Cancer (IARC) and with HPV DNA detection and PCR done centrally, Muñoz and colleagues investigated geographic variations in the contribution made by different HPV types to invasive cervical cancer.1 HPV DNA was detected in 96% of specimens from women with incident, histologically confirmed cervical cancer. Thirty different HPV types were identified. The 15 most common types (in descending order of frequency) were 16, 18, 45, 31, 33, 52, 58, 35, 59, 56, 39, 51, 73, 68, and 66.1 Reference 1. Muñoz N, Bosch FX, Castellsagué X, et al. Against which human papillomavirus types shall we vaccinate and screen? The international perspective. Int J Cancer. 2004;111:278–285. Northern Africa Central/South America *A pooled analysis and multicenter case control study (N = 3607) 1. Muñoz N, Bosch FX, Castellsagué X, et al. Int J Cancer. 2004;111:278–285. 6 6

HPV可能引起許多癌症 2002 總癌症個案數 總癌症個案數 HPV相關個案 100% 3% 12% 40% 90% 40% 7 Key Point HPV has been identified in several different types of malignancies. Background Cervical cancer is not the only cancer which is attributable to HPV. HPV is also associated with several other types of malignancies. This slide shows the proportion of cancers of the oropharnyx, anus, oral cavity, vulva, and penis that are attributable to HPV. Estimates are based on the global burden of disease and the "attributable fraction" of a given cancer type that is due to HPV (eg, what proportion of a given cancer is caused by HPV). Because cervical cancer is both the most common of the cancers and because the attributable fraction due to HPV is 100%, cervical cancer accounts for about 75% of HPV-attributable cancers globally. However there are a number of other cancers which have a considerable proportion attributable to HPV. Oncogenic HPV is associated with approximately 40% of vaginal, vulvar, and penile carcinomas; 90% of anal carcinomas; 12% of oropharynx cancers; and 3% of oral cavity-related cancers. Reference 1. Parkin DM. The global health burden of infection-associated cancers in the year 2002. Int J Cancer. 2006;118:3030–3044. 12% 40% 90% 40% 2002 HPV疫苗目前尚未核准用於肛門癌,口腔癌,口咽癌,陰莖癌 1. Parkin DM. Int J Cancer. 2006;118:3030–3044. 7 7 7

男性在人類乳突病毒傳播中所扮演的角色 男性感染並傳播人類乳突病毒1 男性感染及／或傳播人類乳突病毒的危險因子包括： 1/Castellsagué/ p. S346/col 1/¶1. 男性感染並傳播人類乳突病毒1 男性感染及／或傳播人類乳突病毒的危險因子包括： 年輕（好發年齡組：25–29 歲）2,3 近期有多名性伴侶2,4 性伴侶中有人罹患子宮頸上皮內贅生5 未進行包皮割除手術2,6 2/Svare/p. 216/Table 1. 3/ Insinga/ p. 1397/abstract; 4/Chin-Hong/p. 2070/abstract. 5/Bleeker/p. 36/abstract. 6/Castellsague/p 1105/abstract. Key Point Men acquire and transmit HPV, including high-risk HPV types, although HPV infection in men is associated with few visible signs of the disease. Background As with any other sexually transmitted disease, men are involved in the epidemiologic chain of HPV infection.1 Acting as both “carriers” and “vectors” of oncogenic HPV, male partners may be important contributors to the risk of cervical cancer in their female partners.1 Factors that increase the risk of HPV acquisition in men resemble those that increase the risk of HPV infection in women.2 For example, younger men (peak age group 25–29 years of age)2,3 are more likely to be HPV positive.3 Men with more sex partners (both in the past 6–12 months and over a lifetime) are also more likely to exhibit HPV DNA.2,4 Recent studies have shown that the risk of acquiring HPV is also increased among men with female sexual partners who have CIN,5 or men who are not circumcised.2,6 Interestingly, one study conducted in several countries demonstrated that the circumcision status of men affects the likelihood of HPV transmission: circumcision appears to reduce the transmission of HPV to women and reduces the consequent risk of cervical cancer.6 References 1. Castellsagué X, Bosch FX, Muñoz N. The male role in cervical cancer. Salud Publica Mex. 2003;45(suppl 3):S345–S353. 2. Svare EI, Kjaer SK, Worm AM, Østerlind A, Meijer CJLM, van den Brule AJC. Risk factors for genital HPV DNA in men resemble those found in women: A study of male attendees at a Danish STD clinic. Sex Transm Infect. 2002;78:215–218. 3. Insinga RP, Dasbach EF, Myers ER. The health and economic burden of genital warts in a set of private health plans in the United States. Clin Infect Dis. 2003;36:1397–1403. 4. Chin-Hong PV, Vittinghoff E, Cranston RD, et al. Age-specific prevalence of anal human papillomavirus infection in HIV-negative sexually active men who have sex with men: The EXPLORE study. J Infect Dis. 2004;190:2070–2076. 5. Bleeker MCG, Hogewoning CJA, Voorhorst FJ, et al. HPV-associated flat penile lesions in men of a non-STD hospital population: Less frequent and smaller in size than in male sexual partners of women with CIN. Int J Cancer. 2005;113:36–41. 6. Castellsagué X, Bosch FX, Muñoz N, et al. Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. N Engl J Med. 2002;346:1105–1112. 1/Castellsagué/ p. S346/col 1/¶1 abstract. 2/Svare/p.215/ abstract; p. 216/Table 1. 8 3/Insinga/ p. 1397/abstract. 10 2/Svare/p.215/ abstract; p. 216/Table 1. 4/Chin-Hong/p. 2070/abstract. 5/Bleeker/p. 36/abstract. 2/Svare/p. 215/ abstract; p. 216/Table 1. 6/Castellsagué/p. 1105/ abstract; p. 1105/col1/¶1. 8

HPV的傳播路徑 主要傳播途徑 次要傳播途徑 生殖器接觸 • 性交 • 生殖器–生殖器 • 手–生殖器 • 口–生殖器 生殖器之外 • 汙染物 (?) • 內衣 • 外科手套 • 組織切片用鑷子 垂直感染 母親 新生兒 (出生時) 呼吸道 乳突瘤 9

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2008/04/11 蘋果日報

25歲正妹電玩美少女辛咩咩 自爆罹患子宮頸癌 2013/04/29 新聞網 25歲正妹電玩美少女辛咩咩　自爆罹患子宮頸癌 2013/04/29 新聞網 擁有傲人F罩杯身材的電玩美少女辛咩咩，深受不少宅男的喜愛，但她日前在臉書自爆，自己罹患的子宮頸癌。25歲的她不菸不酒，卻傳出罹患子宮頸癌，所幸檢查後只是0期症狀，切除後可以百分百成功，她也呼籲女性朋友要定期進行子宮頸抹片檢查。 近來在電玩界以傲人身材闖出名的辛咩咩，她在接棒「宅男女神」郭書瑤主持電玩節目。27日她在臉書自爆，自己罹患的子宮頸癌。 她提到「我25歲，不菸不酒，昨天發現子宮頸癌0期，細胞異常，醫生説切除一部份，就會百分百成功。我知道有無數的年輕女性和我一樣，以為青春等於健康。若不是月經異常去看醫生他建議我做抹片，我也不會知道。早期發現，早期治療！所以各位朋友，請趕快告訴身邊的女生朋友們：快去做抹片！」

子宮頸癌與人類乳突病毒感染密切相關 正常子宮頸 1年內 2–5年 4–5年 超過2年 9–15年 約80%的HPV感染會在一年內痊癒 侵襲癌 持 續 性 感 染 暫 時 性 感 染 癌前病變 第一級 CIN 1 超過2年 9–15年 人類乳突病毒感 染 第二，三級 CIN 2/3 正常子宮頸 約80%的HPV感染會在一年內痊癒 但若HPV造成持續性的感染，則可能引發子宮頸癌前病變，甚至癌症 14

HPV相關癌症是由於持續感染所造成 HPV的感染途徑主要是接觸傳染 由於HPV沒有發生血液內感染1，因此即使感染過HPV也不一定產生抗體 15 Tindle RW. Nat Rev Cancer. 2002;2:1–7. 2. Scott M, Nakagawa M, Moscicki A-B. Clin Diagn Lab Immunol. 2001;8:209–220. 3. Frazer IH. Nature Rev Immunol. 2004;4:46–54. 15

子宮頸癌的病徵 子宮頸的癌前病變和早期癌症通常沒有徵狀 (不引起疼痛或其他徵狀) 陰道異常出血 陰道分泌物增加 盆骨疼痛 性交時疼痛 16

有效預防子宮頸癌三部曲 1.做好健康安全性行為 （1）避免過早發生性行為 （2）減少性伴侶人數 （3）安全性行為，全程使用保險套。 （1）避免過早發生性行為 （2）減少性伴侶人數 （3）安全性行為，全程使用保險套。 2.定期做子宮頸抹片檢查 六分鐘護一生，抹片檢查很容易 3.依醫囑接種HPV疫苗 17

世界防癌組織建議 最有效預防子宮頸癌的方法 施打子宮頸癌(HPV)疫苗 + 定期子宮頸抹片檢查 18

HPV疫苗 6 11 16 18 16 18 可保護人類乳突病毒的型別 疫苗抗體製作方式 酵母菌 (Saccharomyces cerevisiae) +DNA重組載體 ( recombinant plasmid) 被感染DNA重組昆蟲病毒的昆蟲細胞 (Insect cells infected with recombinant baculovirus) 適應症 1.子宮頸癌 2.子宮頸腺癌 3.外陰癌前病變 4.陰道癌前病變 5.肛門癌 6.生殖器疣(菜花) 施打時程 0 / 2 / 6 個月(男、女皆可施打) 0 / 1 / 6 個月(限女性) 6 11 16 18 16 18 Key Point GARDASIL™ and GSK bivalent vaccine do not contain the same components/ Background GARDASIL is a quadrivalent vaccine of four recombinant HPV type-specific VLPs (Merck Research Laboratories, West Point, PA, USA) consisting of the L1 major capsid proteins of HPV 6, 11, 16, and 18 synthesized in Saccharomyces cerevisiae.1 Of note, yeast technology has been used safely for many years; for example, yeast-derived hepatitis B vaccine has been safely administered to more than 20 million people worldwide.2 The four VLPs are purified and adsorbed onto a Merck-patented amorphous aluminium hydroxyphosphate sulfate adjuvant.1 Aluminium salts are the only adjuvant currently licensed for use in the United States.3 The safety of aluminium has been established by experience during the past 70 years, with hundreds of millions of people inoculated with aluminium-containing vaccines.2 GSK bivalent vaccine is a bivalent vaccine containing a mixture of HPV 16 and 18 VLPs (GlaxoSmithKline Biologicals, Rixensart, Belgium). Each type of VLP is produced on Spodoptera frugiperda Sf-9 and Trichoplusia ni Hi-5 cell substrate with AS04 adjuvant containing 500 μg aluminium hydroxide and 50 μg 3-deacylated monophosphoryl lipid A (MPL, Corixa, Montana, USA).4 MPL is derived from Lipid A, a lipid domain found in a lipopolysaccharide of Salmonella minnesota, that is modified to change its natural biological properties (e.g. lethal toxicity, pyrogenicity, complement activation, adjuvanticity and B lymphocyte mitogenicity) while maintaining its immunostimulatory activity. The adjuvant AS04 has recently been developed; the population exposed to AS04 to date is largely limited to the one in clinical trials. AS04 has recently been licensed in Europe for the first time as a component of a hepatitis B vaccine indicated exclusively for renally impaired patients, and has not yet been licensed for use in children under age 15 years.5 GARDASIL is a trademark of Merck & Co., Inc., Whitehouse Station, NJ, USA. References 1. Villa LL, Costa RLR, Petta CA, et al. Prophylactic quadrivalent human papillomavirus (types 6, 11, 16, and 18) L1 virus-like particle vaccine in young women: A randomised double-blind placebo-controlled multicentre phase II efficacy trial. Lancet Oncol. 2005;6:271–278. 2. Centers for Disease Control. Hepatitis B and the Vaccine. Available at: www.cdc.gov/nip/vacsafe/concerns/hepb/q&a/htm. Accessed January 13, 2005. 3. Offit PA, Jew RK. Pediatrics. 2003;112:1394–1397. 4. Harper DM, Franco EL, Wheeler C, et al. Efficacy of a bivalent L1 virus-like particle vaccine in prevention of infection with human papillomavirus types 16 and 18 in young women: a randomized controlled trial. Lancet. 2004;364:1757–1765. 5. EMEA. Committee for Medicinal Products for Human Use Summary of Opinion for FENDRIX. European Medicines Agency [web site]. Available at: www.emea.eu.int/pdfs/human/opinion/11826004en.pdf. Accessed January 19, 2005. 2/CDC. p.4 * 建議半年內依醫囑完成三針注射，以達最佳保護功效。 * 參考資料：四價HPV，二價HPV疫苗產品仿單。 19 3/Offit. p.1396 2/EMEA. p.1 19

雖然長的很像HPV病毒，其實是空包彈，只有一層外殼…. 20 30

HPV疫苗簡介 以基因工程技術於酵母菌體內大量合成人類乳突病毒L1蛋白，重組形成類病毒顆粒，純化後製成疫苗。 可充分激發人體免疫系統，產生抗人類乳突病毒的中和抗體。 不帶任何病毒基因，無致病危險性。 人類乳突病毒顆粒 類病毒顆粒 VLP 21 *以四價HPV疫苗為例

Ref: MSD internal data, 2008 Jun 國外施打人類乳突病毒(HPV)疫苗的狀況 Last Updated June 18, 2008 3 8 26 14 39 16 North America: USA Canada Mexico Europe: Germany Cyprus Ireland France Czech Republic Latvia UK Denmark Lithuania Spain Estonia Luxembourg Italy Finland Malta Austria Greece Netherlands Belgium Hungary Norway Bulgaria Iceland Poland Portugal Romania Slovakia Slovenia Sweden Serbia Montenegro Switzerland Liechtenstein Turkey Crotia Bosnia Russia Macedonia Belarus Caribbean & Central America: Costa Rica Trinidad Puerto Rico El Salvador Guatemala Honduras Curaçao Nicaragua Bermuda Panama Bahamas Cayman Islands Barbados Aruba Jamaica Dominican Republic Asia Pacific: Australia Indonesia Korea Taiwan Hong Kong Singapore New Zealand Macau Malaysia Philippines Thailand India Vietnam Georgia South America: Brazil Bolivia Argentina, Uruguay, Peru, Ecuador, Colombia, Chile Middle East & Africa: Gabon Congo Kinshasa Israel C.A.R. Morocco Mauritius Kenya Kuwait Mauritania UAE Guinea Eq. Ethiopia Uganda Togo Malawi Congo Brazzaville Jordan Egypt Cote d’Ivoire Burkina Faso Chad Bahrain Saudi Arabia Botswana South Africa Cameroon 全球127國核准, 39國公費給付 全球接種超過1億6,600萬劑 四價HPV疫苗GARDASIL是 WHO及最多國家的選擇: - 也是唯一獲得美國FDA核准上市的HPV疫苗 - 核准上市國家高達106國 - 其中公費給付的國家當中, 幾乎全部都是選擇嘉喜做為常規接種疫苗 22 Ref: MSD internal data, 2008 Jun 22

全球最多政府公費採購的HPV常規接種疫苗 歐洲地區 (22國) 英國 (2012年9月起指定採購四價疫苗) 法國 愛爾蘭 丹麥 挪威 瑞士 馬其頓 羅馬尼亞 斯洛維尼亞 比利時 德國 希臘 盧森堡 西班牙 瑞典 葡萄牙 義大利 捷克共和國 保加利亞 冰島 荷蘭 拉脫維亞 北美地區 (3國) 加拿大 美國 墨西哥 四價疫苗 80% 1億6仟6佰萬劑* 二價疫苗 20% 4,400萬 加勒比海 & 中美洲地區 (2國) 波多黎各 巴拿馬 南美洲 (5國) 蓋亞納 哥倫比亞 千里達及托貝哥 阿根廷 祕魯 開曼群島 亞太平洋地區(4國) 澳洲 紐西蘭 馬來西亞 台灣 日本 中東 & 非洲地區 (3國) 科威特 阿拉伯聯合大公國 賴索托 公費狀況 使用四價疫苗(Gardasil) 使用二價疫苗(Cervarix) 同時使用二價及四價疫苗 1. http://www.hse.ie/eng/services/hpv/get/ 2. http://www.bethesdamagazine.com/Bethesda-Magazine/May-June-2012/The-Shots-Felt-Around-the-World/index.php?cparticle=4&siarticle=3 101年11月更新

各縣市公費HPV疫苗現況 四價疫苗◎ 四價疫苗 2007 ◎ 2008-2010 二價疫苗 2012※ (常規接種/校園接種) (一次性採購/限特殊對象) 四價疫苗 2010- 迄今 (常規接種/校園接種) 四價疫苗 2014 (常規接種/校園接種) 四價疫苗 2010- 迄今 (常規接種/校園接種) 四價疫苗◎ 2008- 迄今 (常規接種/校園接種) 四價疫苗 2013 (常規接種/校園接種) 四價疫苗◎ 2009 (一次性採購/限特殊對象) 二價疫苗※ 2010-2012 (常規接種/校園接種) 【圖例說明】 實線：常規接種/校園接種 虛線：一次性採購/限特殊對象 藍色：四價疫苗 粉色：二價疫苗 ◎ ：指定採購四價疫苗 ※ ：四價疫苗廠商未投標

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人類乳突病毒(HPV)疫苗預防效果 臨床試驗顯示: 人類乳突病毒第 16、18型所造成的子宮頸癌效果:~98.2% 人類乳突病毒第 6、11型生殖器疣:~99% 第16及18型 人類乳突病毒 第6及11型 人類乳突病毒 子宮頸癌 (98.3%) 子宮頸 陰道癌 外陰癌 癌前病變* 生殖器疣 (~99%) * 25%-70%由第6,11,16,18型引起 HPV = Human Papillomavirus 28 參考資料: 四價人類乳突病毒(第6、11、16、18型)基因重組疫苗產品說明書, 2011.

20071107 A13 蘋果日報 29

四價HPV疫苗疾病預防效果研究 證實對較年長女性保護力也相當好 Nubia Munoz et al., Lancet 2009; 373: 1949-57

有性經驗後打疫苗效果不好? Day 1 Parameter Total (N=20887) Asia Pacific (N=748) Europe (N=9181) Latin America (N = 5666) North America (N=5292) Percent of total 100% 4% 44% 27% 25% Mean Age (years) 20 21 Non-virgin 94% 96% 92% 99% 93% 目前已經發表的臨床研究資料，20,887人中94%女性都是有過性經驗，保護效果都是一樣98%。絕大多數女性都可以得到疫苗提供的完整保護。 31

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常見問題 現在沒感染是否可以不用接種疫苗? 施打前需不需要先做抹片檢查? 沒有性行為需不需要做抹片檢查? 施打完疫苗是否需做抹片? 超過26歲是否可以接種疫苗? 男性是否可接種? 準備懷孕可接種嗎?產後多久可接種? 我可以去哪裡施打疫苗？ 35

健康新觀念 Prevention is Better than Cure ! 預防勝於治療 !

有獎徵答

有獎徵答 Q1:造成子宮頸癌的元兇是什麼? A1:人類乳突病毒(HPV)傳染 38

有獎徵答 Q2:人類乳突病毒是怎麼傳染的? A2:接觸傳染 39

Q3:子宮頸癌常見的HPV病毒型別為？菜花 常見的病毒型別為？ A3:子宮頸癌常見型別為16、18型，菜花 常見型別為6、11型 有獎徵答 Q3:子宮頸癌常見的HPV病毒型別為？菜花 常見的病毒型別為？ A3:子宮頸癌常見型別為16、18型，菜花 常見型別為6、11型 40

Q4:國際抗癌聯盟（UICC）建議最有效預防子宮頸癌的方法是? A4:施打HPV疫苗 + 定期子宮頸抹片檢查 有獎徵答 Q4:國際抗癌聯盟（UICC）建議最有效預防子宮頸癌的方法是? A4:施打HPV疫苗 + 定期子宮頸抹片檢查 41

感謝您的聆聽 Any Question ? 42