0929 Is it time to advocate Human Papillomavirus (HPV) immunization for all?

Having recognized the link between HPV and cervical cancer, the logical next step was the development of vaccines against the predominant serotypes (HPV-16/18 and 31,33,45). Bivalent and quadrivalent vaccines are effective and available, the former containing recombinant virus protein from HPV 6,11,16 and 18, and the latter containing HPV 16 and 18 particles combined with an ASO4 adjuvant. For both vaccines cross-reactivity has been demonstrated for HPV-16 and 31, and HPV-18 with 45. Life-long immunity is unlikely and boosting would therefore be a requirement. So now the question is, who should receive the vaccine and when? Clearly the concerns have been around cervical cancer, particularly in developing countries and especially those in which immune function is compromised by HIV/AIDS. A caveat here is that HPV serotypes in developing countries may be different from those detailed above, so before embarking on campaigns one must be sure of what one is able to immunize against. Given the appropriate vaccine, an obvious starting point would be young girls before the onset of sexual activity. Paediatricians as advocates for child and adolescent health would have an important role to play in considering and promoting inclusion of HPV immunization in health strategies. Such an intervention would offer protection to those who receive the vaccine, but would do little to eradicate HPV infection. Achievement of the latter would depend on also accessing males (adolescent and adult), as well as older women. Benefit would likely be greater than for cervical cancer alone since HPV 16, 18, 31 and 45 are also implicated in anal, penile, oropharyngeal and tonsillar cancers.

Read more:
Lancet 2009; 374: 268-270 and 301-14
J Infect Dis 2009; 199: 936-44
Pediatrics 2006; 118: 2135-45