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International Conference “Tackling Infectious Diseases: Information for Action”
Ulaanbaatar, Blue Sky Tower, Oct.20-21, 2016
THE BURDEN OF CANCERS ATTRIBUTABLE
TO INFECTIONS:
WORDWIDE AND IN MONGOLIA
Prof. P.Nymadawa, MD, PhD, DSc(Med),
International Conference “Tackling Infectious Diseases: Information for Action”
Ulaanbaatar, Blue Sky Tower, Oct.20-21, 2016
THE BURDEN OF CANCERS ATTRIBUTABLE
TO INFECTIONS:
WORDWIDE AND IN MONGOLIA
1. Infectious agents causing cancers
2. Current prevalence of cancers attributable to
infections and possibilities to take under
control
Академич П.Нямдаваа
2
International Conference “Tackling Infectious Diseases: Information for Action”
Ulaanbaatar, Blue Sky Tower, Oct.20-21, 2016
INFECTIOUS AGENTS LEADING TO CANCERS
( IARC, 2012)
[M.Plummer et al. (2016), The lancet: Global Health, http://dx.doi.org/10.2016/S.2214-109X(16)-30143-7]
Helicobacter pylori → stomach cancer
HBV → hepatocellular carcinoma (HCC)
HCV → HCC
HPV → cervix uteri cancer, vulvar carcinoma, penile carcinoma, vaginal carcinoma, anal
carcinoma, carcinoma of oropharynx including tonsils and base of tongue, laryngeal
cancer, cancer of oral cavity
5.
EBV → Hodgkin’s lymphoma, Burkitt’s lymphoma [endemic in some countries of
Africa], naso-pharyngeal carcinoma [endemic in South China and some countries of
South-East Asia]
6.
HHV-8 → Kaposi’s sarcoma
7.
HTLV-1 → adult Т-cell leukaemia and lymphoma [endemic in some parts of Japan and
Karibbean]
8. Opisthorchis viverrini → bile duct cancer [endemic in some countries of South-East Asia,
like Thailand]
9.
Clonorchis sinensis → bile duct cancer [endemic in South China and some countries of
South-East Asia, like Kampuchi, Laos ]
10. Schistosoma haematolobium → bladder carcinoma [endemic in some countries Africa,
South America and South-East Asia]
1.
2.
3.
4.
Академич П.Нямдаваа
3
International Conference “Tackling Infectious Diseases: Information for Action”
Ulaanbaatar, Blue Sky Tower, Oct.20-21, 2016
THE BURDEN OF CANCERS ATTRIBUTABLE
TO INFECTIONS:
WORDWIDE AND IN MONGOLIA
1. Infectious agents causing cancers
2. Current prevalence of cancers attributable to
infections and possibilities to take under
control
Академич П.Нямдаваа
4
“Халдварт өвчний тулгамдсан асуудал, шийдвэрлэх арга зам: мэдээллээс үйлдэлрүү”
Олон улсын эрдэм шинжилгээний хурал, Улаанбаатар, Блү Скай Төв, 2016.10.20-21
PREVALENCE OF CANCERS CAUSED BY INFECTIOUS AGENTS:
WORLDWIDE, BY TYPES OF CANCERS
(http://canceratlas.cancer.org/risk-factors/infection/)
Академич П.Нямдаваа
5
International Conference “Tackling Infectious Diseases: Information for Action”
Ulaanbaatar, Blue Sky Tower, Oct.20-21, 2016
PREVALENCE OF CANCERS CAUSED BY INFECTIOUS AGENTS:
WORLDWIDE, BY COUNTRIES
(2012: IARC/GLOBOCAN)
[M.Plummer et al. (2016), The lancet: Global Health, http://dx.doi.org/10.2016/S.2214-109X(16)-30143-7]
Академич П.Нямдаваа
6
International Conference “Tackling Infectious Diseases: Information for Action”
Ulaanbaatar, Blue Sky Tower, Oct.20-21, 2016
DISTRIBUTION OF REGISTERED CASES OF H.pylori DETECTION
AND GASTRIC CARCINOMA:
WORDWIDE, PER 100 000 POPULATION, 2012
- So far there is no vaccine
against H.pylori infection;
- There are existing effective
diagnostic tests to detect
early infection and
medicaments to cure fully
the infection before
development of gastric
carcinoma;
- There is no special program
in Mongolia to detect and
cure H.pylori infection to
prevent gastric carcinoma;
Академич П.Нямдаваа
7
International Conference “Tackling Infectious Diseases: Information for Action”
Ulaanbaatar, Blue Sky Tower, Oct.20-21, 2016
GEOGRAPHICAL DISTRIBUTION OF THE REGISTERED HCC :
WORLDWIDE, per 100 000 POPULATION, 2012
[http://globocan.iarc.fr/old/FactSheets/cancers/liver-new.asp]
Академич П.Нямдаваа
8
International Conference “Tackling Infectious Diseases: Information for Action”
Ulaanbaatar, Blue Sky Tower, Oct.20-21, 2016
DISTRIBUTION OF THE REGISTERED HBV [HBsAg+] INFECTION,
WORLDWIDE
[http://www.medsci.org/ms/getimage.php?name=ijmsv02p0050g01.gif}
Академич П.Нямдаваа
9
International Conference “Tackling Infectious Diseases: Information for Action”
Ulaanbaatar, Blue Sky Tower, Oct.20-21, 2016
DEPENDENCE OF HBV PERSISTENCE FROM THE AGE OF INFECTION
[M.Kane , In: Hepatitis B in the Asian-Pacific Region, Ed.A.Zuckerman, v.2,
% of a risk becoming HBV carrier
RCPL, 1998, p.101-110;]
During
the birth
1-6 months
7-12 months
1-4 years
Above 5 years
Age of infection
Академич П.Нямдаваа
10
International Conference “Tackling Infectious Diseases: Information for Action”
Ulaanbaatar, Blue Sky Tower, Oct.20-21, 2016
HCC cumulative index
CORRELATION BETWEEN HBV-BURDEN AND HCC
Term of observation (years)
Chen et al; JAMA 2006
Академич П.Нямдаваа
11
International Conference “Tackling Infectious Diseases: Information for Action”
Ulaanbaatar, Blue Sky Tower, Oct.20-21, 2016
CHARACTERISTICS OF HBV ANTIVIRALS RELEASED FOR
PRESCRIPTION
[P.P.Batu et al (2012): http://file.scirp.org/Html/3-1320086_19608.htm]
Академич П.Нямдаваа
12
International Conference “Tackling Infectious Diseases: Information for Action”
Ulaanbaatar, Blue Sky Tower, Oct.20-21, 2016
VIRAL HEPATITIS MORBIDITY DYNAMICS AND TRENDS IN
MONGOLIA, 1952-2020
300
250
200
8
1952:
Registration,
obligatory
reporting of
“infectious
jaundice”
cases
1987: First field trial of
HepB vaccine
7
1971: Introduction of
HBsAg detection tests
into health service
6
5
150
4
3
100
2012: First
field trial
of HepA
vaccine
50
2
1
0
0
1952
1957
1962
1967
Morbidity per 10,000
1972
1977
CI 95%
1982
Trend
1987
1992
HCC
1997
2002
Trend HCC
2007
2012
2017
CI 95% HCC
Prof.P.Nymadawa, MD, PhD, DSc(Med), MAMS
13
International Conference “Tackling Infectious Diseases: Information for Action”
Ulaanbaatar, Blue Sky Tower, Oct.20-21, 2016
AGE DISTRIBUTION OF REGISTERED VIRAL HEPATITIS CASES IN
DIFFERENT PERIODS
1981-1990
(average)
2001-2010
(average)
1991-2000
(average)
1%
7%
20%
25%
26%
30%
38%
6%
10%
13%
55%
16%
29%
26%
0-1 нас
1-4 нас
5-9 нас
10-14 нас
15-с дээш
Академич П.Нямдаваа
14
International Conference “Tackling Infectious Diseases: Information for Action”
Ulaanbaatar, Blue Sky Tower, Oct.20-21, 2016
STRATEGY OF ERADICATION OF VIRAL HEPATITIS B IN MONGOLIA
(P.Nymadawa, 1990; +2009, +2015)
I stage: 1990-1992
– Hep B vaccination trials (1987-1990)
– Shift to use disposable syringes and needles for all injectable vaccines (1991)
– establishment of local production capacity for disposable syringes and needles (1990-1994)
– Development of local technology of production for Hep B vaccine and diagnostic kits for HBV
detection (1987-1993)
II stage: 1993-2000 (2010)
– obligatory vaccination with Hep B vaccine of all newborns (1993/1991)
– Shift to use disposable syringes and needles for all injections (1996)
– Local production of Hep B vaccine and some diagnostic kits (from 1993)
III stage: (2001 -2020 ) from 2015
– Screening of all pregnant women for HBsAg and HBeAg; if positive, treatment with Tenofovir
from 28th week of pregnancy and administration of Hep B vaccine first dose with anti-HBV-HIG
– immunization with HepB vaccine all health workers and medical students
– Cure of HBV carriers (appropriate antiviral chemotherapy: Tenofovir, Entacavir depending on
HBV concentration)
– Early diagnosis and cure of HCC: (regular screening for AFP concentration in HBV carriers;
ultrasonografic screening of liver in case of AFP concentration level 2 times and more over the
normal range; treat with Tenofovir and surgical removal of cancer nodes within 0.5 cm
diameter)
Prof.P.Nymadawa, MD, PhD,
DSc(Med), MAMS
15
International Conference “Tackling Infectious Diseases: Information for Action”
Ulaanbaatar, Blue Sky Tower, Oct.20-21, 2016
anti-HCV PREVALENCE: WORLDWIDE[F.Gower et
al., J.Hepatol., 2014]
Академич П.Нямдаваа
16
International Conference “Tackling Infectious Diseases: Information for Action”
Ulaanbaatar, Blue Sky Tower, Oct.20-21, 2016
NATURAL HISTORY OF HCV INFECTION
[http://hepatitiscnewdrugresearch.com/hepatitiscnewdrugresearch.com16624644434cf7073079610/natural-history-of-hcv.html]
Академич П.Нямдаваа 17
International Conference “Tackling Infectious Diseases: Information for Action”
Ulaanbaatar, Blue Sky Tower, Oct.20-21, 2016
аnti-HCV in DIFFERENT AGE GROUPS:
in MONGOLIA and the NETHERLANDS
V.Saraswat,, et al. (2015): Historical epidemiology of HCV infections in selected countries, JVH, 22(s1):6-25;
(http://onlinelibrary.wiley.com/doi/10.1111/jvh.12350/full);
Академич П.Нямдаваа 18
International Conference “Tackling Infectious Diseases: Information for Action”
Ulaanbaatar, Blue Sky Tower, Oct.20-21, 2016
MODELLING of DECREASE OF HEPATITIS SEQUALAE in
MONGOLIA USING of DAA
E.Gane, et al (2015): Strategies to manage hepatitis C virus (HCV) infection disease burden, JVH, 22(s1):46-73;
(http://http://onlinelibrary.wiley.com/doi/10.1111/jvh.12352/full)
Академич П.Нямдаваа
19
International Conference “Tackling Infectious Diseases: Information for Action”
Ulaanbaatar, Blue Sky Tower, Oct.20-21, 2016
DISTRIBUTION CANCERS CAUSED BY HPV
http://www.ansci.wisc.edu/jjp1/ansci_repro/misc/project_websites_07/tue07/HPV_Vac
cine/What%20is%20HPV.html
Академич П.Нямдаваа
20
International Conference “Tackling Infectious Diseases: Information for Action”
Ulaanbaatar, Blue Sky Tower, Oct.20-21, 2016
GEOGRAPHICAL PREVALENCE OF CERVICAL CANCER REGISTERED CASES
WORLDWIDE (per 100 000 population, 2012)
[http://globocan.iarc.fr/old/FactSheets/cancers/cervix-new.asp]
Академич П.Нямдаваа
21
International Conference “Tackling Infectious Diseases: Information for Action”
Ulaanbaatar, Blue Sky Tower, Oct.20-21, 2016
HIGH-RISK HPV GENOTYPES FOR CERVICAL CANCER:
WORLDWIDE
[http://www.seegene.com/neo/en/support/story/story33.php]
Академич П.Нямдаваа
22
International Conference “Tackling Infectious Diseases: Information for Action”
Ulaanbaatar, Blue Sky Tower, Oct.20-21, 2016
MORTALITY FROM CERVICAL CANCER,
WORLDWIDE (per 100 000 population, 2012)
[http://globocan.iarc.fr/old/FactSheets/cancers/cervix-new.asp]
Академич П.Нямдаваа
23
International Conference “Tackling Infectious Diseases: Information for Action”
Ulaanbaatar, Blue Sky Tower, Oct.20-21, 2016
NATURAL HISTORY OF HPV INFECTION
[https://en.wikipedia.org/wiki/File:Genital_HPV_infection_incidence_graph.png]
Академич П.Нямдаваа
24
International Conference “Tackling Infectious Diseases: Information for Action”
Ulaanbaatar, Blue Sky Tower, Oct.20-21, 2016
HPV PREVALENCE in MONGOLIA:
BY AGE GROUPS AND CLINICAL MANIFESTATIONS
[G.Binderya, in the Materials of this Conference, 2016]
Total HPV positivity 35.7%
Академич П.Нямдаваа
25
International Conference “Tackling Infectious Diseases: Information for Action”
Ulaanbaatar, Blue Sky Tower, Oct.20-21, 2016
HPV GENOTYPES DETECTED in MONGOLIA:
ГЕНОТИПЭЭР
[G.Binderya, in the Materials of this Conference, 2016]
HPV subtype prevalence among HPV positive (%)
16.0
14.7
14.0
12.0
11.1
10.7
10.1
10.0
8.8
8.1
8.0
7.2
6.8
7.5
7.5 7.5
6.8
6.5 6.5
6.2
6.0
5.2
4.6
4.0
5.5
5.2
3.9
5.9
6.5
6.2
4.2
3.6
3.3
3.3
2.0
0.0
0.0
Академич П.Нямдаваа
26
International Conference “Tackling Infectious Diseases: Information for Action”
Ulaanbaatar, Blue Sky Tower, Oct.20-21, 2016
HPV VACCINATION:
RELIABLE METHOD OF PREVENTION FOR CERVICAL CANCER
- Gardasil®, Merck
HPV 6, 11, 16, 18
- Cervarix®, GlaxoSmithKline
HPV 16, 18
WHO Recommendation:
2 doses of any vaccine
with 6 months interval
between 9 and 15 years
old girls
http://www.who.int/reproductivehealth/topics/cancers/fight-cervical-cancer/en/
Академич П.Нямдаваа
27
International Conference “Tackling Infectious Diseases: Information for Action”
Ulaanbaatar, Blue Sky Tower, Oct.20-21, 2016
THANK YOU
FOR YOUR KIND ATTENTION
Академич П.Нямдаваа 28