HPV Catch-Up Vaccination of Young Women
HPV Catch-Up Vaccination of Young Women
Human papillomavirus (HPV) is considered the most common sexually transmitted agent worldwide, and most sexually active women and men will experience an HPV infection during their lifetime. More than 100 types of HPV have been identified. However, a small number of HPV types contribute to a large proportion of HPV-related diseases. Most HPV infections resolve within 1–2 years, but some are persistent and are recognised as a necessary cause of cervical cancer and for its precursor lesions. Approximately 70% of cervical cancers in the world are attributed to two of the most common HPV types, 16 and 18. The World Health Organisation (WHO) International Agency for Research on Cancer judged that there was sufficient evidence to support a causal role of HPV 16 infection in carcinoma of the cervix, vulva, vagina, penis, anus, oral cavity, and oropharynx and tonsil. The evidence was also judged sufficient to recognize a causal role of HPV types 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59 in cervical cancer. It was estimated that 5.2% of all cancers worldwide are attributed to HPV infections. Genital warts have been linked to HPV infection, with approximately 100% of genital warts (condyloma acuminate) caused by either HPV 6 or 11. An increasing incidence of genital warts has been described over recent decades in Europe.
Efficient prophylactic vaccines could have an important public health impact. Since 2006, two vaccines (Cervarix and Gardasil) have been licensed for girls aged 9 to 26, and through age 45 years in some countries, and have been introduced in the childhood immunisation programme in many countries for girls aged 9 to 18. While prophylactic HPV vaccination has been shown to be effective in young girls, it is still unclear whether a catch-up vaccination of girls who were too old at time of vaccine introduction would be beneficial.
To the best of our knowledge, three meta-analyses have been published to date and they reported results on the effect of HPV vaccination of older girls on persistent HPV infection, and only on outcomes associated with the HPV types included in HPV vaccines. In this systematic review, we present results on prevention of all lesions regardless of the HPV status of the lesions. This is an appropriate measure of the public health impact of a HPV catch-up vaccination, as it estimates more accurately the expected reduction in total disease burden after implementation of such a vaccination program.
In this article, we present a systematic review of the international literature to investigate the health impact of a HPV catch-up vaccination of girls who were too old at the time of vaccine introduction. Taking into account the age range covered by HPV vaccines licensing, and the age at introduction of HPV vaccination in different countries, we have therefore examined the health impact of HPV vaccination of girls aged 16 and older.
Background
Human papillomavirus (HPV) is considered the most common sexually transmitted agent worldwide, and most sexually active women and men will experience an HPV infection during their lifetime. More than 100 types of HPV have been identified. However, a small number of HPV types contribute to a large proportion of HPV-related diseases. Most HPV infections resolve within 1–2 years, but some are persistent and are recognised as a necessary cause of cervical cancer and for its precursor lesions. Approximately 70% of cervical cancers in the world are attributed to two of the most common HPV types, 16 and 18. The World Health Organisation (WHO) International Agency for Research on Cancer judged that there was sufficient evidence to support a causal role of HPV 16 infection in carcinoma of the cervix, vulva, vagina, penis, anus, oral cavity, and oropharynx and tonsil. The evidence was also judged sufficient to recognize a causal role of HPV types 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59 in cervical cancer. It was estimated that 5.2% of all cancers worldwide are attributed to HPV infections. Genital warts have been linked to HPV infection, with approximately 100% of genital warts (condyloma acuminate) caused by either HPV 6 or 11. An increasing incidence of genital warts has been described over recent decades in Europe.
Efficient prophylactic vaccines could have an important public health impact. Since 2006, two vaccines (Cervarix and Gardasil) have been licensed for girls aged 9 to 26, and through age 45 years in some countries, and have been introduced in the childhood immunisation programme in many countries for girls aged 9 to 18. While prophylactic HPV vaccination has been shown to be effective in young girls, it is still unclear whether a catch-up vaccination of girls who were too old at time of vaccine introduction would be beneficial.
To the best of our knowledge, three meta-analyses have been published to date and they reported results on the effect of HPV vaccination of older girls on persistent HPV infection, and only on outcomes associated with the HPV types included in HPV vaccines. In this systematic review, we present results on prevention of all lesions regardless of the HPV status of the lesions. This is an appropriate measure of the public health impact of a HPV catch-up vaccination, as it estimates more accurately the expected reduction in total disease burden after implementation of such a vaccination program.
In this article, we present a systematic review of the international literature to investigate the health impact of a HPV catch-up vaccination of girls who were too old at the time of vaccine introduction. Taking into account the age range covered by HPV vaccines licensing, and the age at introduction of HPV vaccination in different countries, we have therefore examined the health impact of HPV vaccination of girls aged 16 and older.
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