Human Papillomavirus Vaccines—Vaccinate and Catch Up!

Willy AJ Poppe
US Obstetrics & Gynecology, 2011;6(2):110-2
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Abstract

The effects of human papillomavirus (HPV) vaccines in women and men have been well demonstrated in a series of large clinical trials. The benefits of HPV vaccination in older girls and boys urgently need to be considered by healthcare providers because a high coverage of vaccination is essential in reducing the risk of HPV diseases in both sexes.
Keywords
Human papillomaviruses (HPV), HPV vaccine, vaccination, cancer prevention
Disclosure Willy AJ Poppe, MD, PhD, received funding through his institution as a clinical trial investigator for HPV vaccines from Merck and Co., Inc. and GlaxoSmithKline
Received: September 13, 2011 Accepted October 31, 2011
Correspondence: Willy AJ Poppe, MD, PhD, Department of Obstetrics and Gynecology, University Hospitals, Catholic University of Leuven, Campus Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium. E: willy.poppe@uzleuven.be

Two prophylactic human papillomavirus (HPV) vaccines have been developed and both have been shown to produce protective HPV antibodies when administered in a three-dose scheme. Protection against infection by HPVs is an effective way to prevent HPV-related diseases. HPV 6 and 11 cause about 90 % of genital warts in men and women and are the cause of recurrent respiratory papillomatosis.1,2 HPV 16 and 18 cause 70 % of cervical cancers and large proportions of other genital cancers in women, as well as anal cancer and head and neck cancers in men and women.3,4 The quadrivalent HPV vaccine Gardasil® was developed by Merck and provides protection against HPV 16, 18, 6, and 11. The bivalent HPV vaccine Cervarix®, produced by GlaxoSmithKline, provides protection against HPV 16 and 18. The antigenic portions of both vaccines consist of HPV L1 proteins that self-assemble to empty viral protein shells of virus-like particles. The vaccines differ in the HPV types included and the adjuvants used.

In Phase II and III clinical trials of girls and women aged 15–26 years, both vaccines have demonstrated excellent immunogenicity and efficacy in the prevention of lesions related to the HPV vaccine types for periods of at least four years.5,6 Efficacy of the quadrivalent vaccine has also been demonstrated in women aged 24–45 years.7 The quadrivalent vaccine prevents infection with HPV 16, 18, 6, and 11 and the development of related external genital lesions in men aged 16–26 years.8 Virtually all HPV-naïve trial participants responded to three doses of the vaccines. Cross-protection against some HPV 16 and 18 related types was demonstrated for both vaccines, although with a lesser degree of efficacy and unknown duration of effectiveness. These findings are from post hoc analyses because the phase III clinical trials were not designed to study the efficacy of protection against individual oncogenic HPV types. The exact duration of protection against HPV types is unknown but is over seven years for the bivalent vaccine and five years for the quadrivalent vaccine.9,10 The bivalent vaccine produced higher antibody titers against HPV 16 and 18 in a head-to-head immunogenicity trial, but to date, the immune correlate of protection against HPV infection is unknown.11 In the same head-to-head trial, women who received the bivalent vaccine were more likely to report local symptoms, fatigue, or myalgia than those receiving the quadrivalent vaccine. The safety of both vaccines has been demonstrated in large Phase II and III clinical trials and by postmarketing safety surveillance systems in many countries worldwide. Rates of serious adverse events and new diseases recorded during the clinical trials for both HPV vaccines did not differ among people in the vaccine groups and controls.

References:
  1. Garland SM, Steben M, Sings HL, et al., Natural history of genital warts: analysis of the placebo arm of 2 randomized phase III trials of a quadrivalent human papillomavirus (types 6, 11, 16, and 18) vaccine, J Infect Dis, 2009;199(6):805–14.
  2. Derkay CS, Wiatrak B, Recurrent respiratory papillomatosis: a review, Laryngoscope, 2008;118(7):1236–47.
  3. de Sanjose S, Quint WG, Alemany L, et al., Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study, Lancet Oncol, 2010;11(11):1048–56.
  4. Bouvard V, Baan R, Straif K, et al., A review of human carcinogens—part B: biological agents, Lancet Oncol, 2009;4:321–2.
  5. Ault KA, Future II Study Group, Effect of prophylactic human papillomavirus L1 virus-like-particle vaccine on risk of cervical intraepithelial neoplasia grade 2, grade 3, and adenocarcinoma in situ: a combined analysis of four randomized clinical trials, Lancet, 2007;369(9576):1861–8.
  6. Paavonen J, Naud P, Salmerón J, et al., Efficacy of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA): final analysis of a double-blind, randomised study in young women, Lancet, 2009;374(9686):301–14.
  7. Muñoz N, Manalastas R Jr, Pitisuttithum P, et al., Safety, immunogenicity, and efficacy of quadrivalent human papillomavirus (types 6, 11, 16, 18) recombinant vaccine in women aged 24–45 years: a randomised, double-blind trial, Lancet, 2009;373(9679):1949–57.
  8. Giuliano AR, Palefsky JM, Goldstone S, et al., Efficacy of quadrivalent HPV vaccine against HPV infection and disease in males, N Engl J Med, 2011;364(5):401–11.
  9. De Carvalho N, Teixeira J, Roteli-Martins CM, et al, Sustained efficacy and immunogenicity of the HPV-16/18 AS04- adjuvanted vaccine up to 7.3 years in young adult women, Vaccine, 2010;28(38):6247–55.
  10. Merck and Co, Inc., Gardasil product information. Available at: wwww.merck.com/product/usa/pi_circulars/g/gardasil/gardasil _pi.pdf (accessed October 19, 2011).
  11. Einstein MH, Baron M, Levin MJ, et al., Comparison of the immunogenicity and safety of Cervarix and Gardasil human papillomavirus (HPV) cervical cancer vaccines in healthy women aged 18–45 years, Hum Vaccin, 2009;5(10):705–19.
  12. Centers for Disease Control and Prevention (CDC), National, state, and local area vaccination coverage among adolescents aged 13–17 years—United States, 2009, MMWR Morb Mortal Wkly Rep, 2010;59(32):1018–23.
  13. Brabin L, Roberts SA, Stretch R, et al., Uptake of first two doses of human papillomavirus vaccine by adolescent schoolgirls in Manchester: prospective cohort study, BMJ, 2008;336(7642):1056–8.
  14. www.zorg-en-gezondheid.be/vaccinaties (accessed October 19, 2011).
  15. Watson M, Shaw D, Molchanoff L, et al., Challenges, lessons learned and results following the implementation of a human papilloma virus school vaccination program in South Australia, Aust N Z J Public Health, 2009;33(4):365–70.
  16. Rondy M, Van Lier A, van de Kassteele J, et al., Determinants for HPV vaccine uptake in the Netherlands: a multilevel study, Vaccine, 2010;28(9):2070–5.
  17. Brotherton JML, Fridman M, May C, et al., Early impact of the HPV vaccination program on cervical abnormalities in Victoria, Australia: an ecological study, Lancet, 2011;377(9783):2085–92.
  18. Fairley CK, Hocking JS, Gurrin LC, et al., Rapid decline in presentations of genital warts after the implementation of a national quadrivalent human papillomavirus vaccination programme for young women, Sex Transm Infect, 2009;85(7):499–502.
  19. Cuzick J, Castanon A, Sasieni P, Predicted impact of vaccination against human papillomavirus 16/18 on cancer incidence and cervical abnormalities in women aged 20–29 in the U.K., Br J Cancer, 2010;102(5):933–9.
  20. Kreimer AR, González P, Katki HA, et al., Efficacy of a bivalent HPV 16/18 vaccine against anal HPV 16/18 infection among young women: a nested analysis within the Costa Rica Vaccine Trial, Lancet Oncol, 2011;12(9):862–70.
  21. Dillner J, Rebolj M, Birembaut P, et al., Long term predictive values of cytology and human papillomavirus testing in cervical cancer screening: joint European cohort study, BMJ, 2008;337:a1754.
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