The Need for Therapeutic HPV Vaccines as a Means of Curbing the Menace of Cervical Cancer

Cervical cancer incidence and mortality have decreased in high-income countries, but low- and middle-income countries continue to bear a significant burden from the disease. Human papillomavirus (HPV) vaccines are a promising alternative for disease control; however, their introduction is slow in settings with greater need. We conducted a review of HPV vaccine efficacy and effectiveness reported in clinical trials and population-based studies. Efficacy of HPV vaccines is close to 100% when using a three-dose schedule in HPV-negative young women (<25 years old) for protection against persistent infection and HPV vaccine-type associated pre-cancerous lesions. Furthermore, sustained protection for up to 12 years of follow-up has been demonstrated; cross-protection against non-vaccine types is particularly observed for the bivalent vaccine, and preliminary data regarding impact on invasive cancer have emerged. Given its lower efficacy, catch-up vaccination beyond 19 years of age and proposals for vaccinating adult women deserve careful evaluation in accurately designed studies and economic analyses. Despite positive results regarding immunogenicity and post-hoc analysis for cervical intra-epithelial neoplasia in clinical trials, population-based data for prime and booster two-dose schedules are not available. Evaluation of vaccine safety from surveillance systems in immunization programs that have already distributed more than 270 million doses found no association of HPV vaccination with serious side effects. The introduction of HPV vaccination in national immunization programs remains the main challenge in tackling the burden of cervical cancer (up to 2018, only 89 countries have introduced vaccination worldwide, and most of these are high-income countries). Access models and technical capacity require further development to help low- and middle-income countries to increase the pace of vaccine delivery. Alternative approaches such as one-dose schedules and vaccination at younger ages may help reduce the programmatic and economic challenges to adolescent vaccination.

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Avoiding mixed messages: HPV vaccines and the ‘cure’ for cervical cancer

Public health ethics and practice ◽

10.1332/policypress/9781847421029.003.0010 ◽

2009 ◽

pp. 155-170

Author(s):

Alison Hann ◽

Stephen Peckham

Keyword(s):

Cervical Cancer ◽

Hpv Vaccines ◽

Mixed Messages

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Adolescent characteristics and incidence of pre-malignant disease and invasive tumors of the cervix

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000884 ◽

2020 ◽

Vol 30 (7) ◽

pp. 959-968 ◽

Cited By ~ 2

Author(s):

Lital Keinan Boker ◽

Gilad Twig ◽

Vered Klaitman-Meir ◽

Estela Derazne ◽

Avi Shina ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Incidence ◽

Malignant Disease ◽

Overweight And Obesity ◽

Tall Stature ◽

Hpv Vaccines ◽

Cervical Cancer Incidence ◽

Historical Cohort ◽

Cervical Disease ◽

Adolescent Overweight

IntroductionPre-malignant cervical disease and invasive cervical cancer present a significant global health burden with respect to morbidity and mortality, mostly in low- and middle-income countries. Human papillomavirus (HPV) infection typically manifests for the first time in adolescence. We aimed to identify adolescent sociodemographic and anthropometric characteristics associated with subsequent risk for pre-malignant cervical disease and cervical cancer, in a country that offers free screening and HPV vaccines.MethodsThis historical cohort study included 969 123 Israeli women examined and anthropometrically measured at age 17 years between January 1967 and December 2011. Data on pre-malignant disease and invasive cervical tumors were obtained from the national cancer registry by linkage. We excluded non-Jewish minorities (a total of 25 472 women) and orthodox/ultraorthodox Jewish women since these populations are not required by law to serve in the military, as well as women with a pre-examination diagnosis of cancer. Cox proportional hazards regression models were applied per each lesion type, adjusted for origin, measured body mass index, height, education, dwelling type, birth year, and age at examination.ResultsIn total, 5094 and 859 incident pre-malignant cervical disease and cervical cancer cases, respectively, were diagnosed during a median follow-up of 17.6 years. Risk for both lesions was origin-dependent, with higher incidence in women of North-African origin (HR (pre-malignant cervical disease) 1.22, 95% CI 1.04 to 1.42; HR (cervical cancer) 1.87, 95% CI 1.30 to 2.69) compared with European origin. Height, lower education, and later birth year were associated with higher pre-malignant cervical disease and cervical cancer risk also. Adolescent overweight (HR 0.81, 95% CI 0.74 to 0.90) and obesity (HR 0.56, 95% CI 0.43 to 0.71) status were associated with reduced pre-malignant cervical disease but not cervical cancer incidence, as did urban (vs rural) residence.DiscussionEthnic background, tall stature, and education were associated with pre-malignant cervical disease and cervical cancer incidence, while adolescent overweight and obesity were inversely associated with only pre-malignant cervical disease. Despite free screening and HPV vaccines, these findings suggest that there is still a need for appropriate safe sex and screening education in adolescence.

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Cervical Coinfection with Human Papillomavirus (HPV) Types and Possible Implications for the Prevention of Cervical Cancer by HPV Vaccines

The Journal of Infectious Diseases ◽

10.1086/444391 ◽

2005 ◽

Vol 192 (7) ◽

pp. 1158-1165 ◽

Cited By ~ 98

Author(s):

Fabián Méndez ◽

Nubia Muñoz ◽

Héctor Posso ◽

Mónica Molano ◽

Victor Moreno ◽

...

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Hpv Vaccines ◽

Hpv Types

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Global reduction of cervical cancer with human papillomavirus vaccines: insights from the hepatitis B virus vaccine experience

Sexual Health ◽

10.1071/sh09134 ◽

2010 ◽

Vol 7 (3) ◽

pp. 383 ◽

Cited By ~ 8

Author(s):

Margaret E. Heffernan ◽

Suzanne M. Garland ◽

Mark A. Kane

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Hepatitis B Virus ◽

Hepatitis B ◽

Hpv Vaccination ◽

Primary Hepatocellular Carcinoma ◽

Health Providers ◽

Hpv Vaccines ◽

B Virus ◽

Global Reduction

Background: Worldwide, prophylactic vaccines against two major human cancers are now commercially available: hepatitis B virus (HBV) vaccines (first licensed in 1982) against primary hepatocellular carcinoma and human papillomavirus (HPV) vaccines (first licensed 2006) against cervical cancer. Initial implementation strategies for HBV vaccination were not successful in preventing disease in the community: it took 15 years for significant global reduction in the burden of this disease. Methods: We compare and contrast HBV vaccine experiences to challenges for successful global HPV vaccination strategies, and make recommendations accordingly. Results: Lessons from HBV immunisation for successful outcomes with HPV immunisation showed that several factors need to be met: (i) the engagement of key stakeholders in all aspects of planning and delivery of HPV vaccine strategies; (ii) understanding the specific characteristics of targeted population groups; (iii) global cooperation and support with WHO recommendations; (iv) Government supported mass immunization programs and cooperation between public and private entities; (v) affordable HPV vaccines for some regions; (vi) culturally appropriate and diverse public education programs in targeted health promotion strategies; (vii) pro-active health providers and parents in encouraging adolescents to undertake HPV vaccination; and (vii) eventual immunisation of infants. Conclusions: The key to success will be affordable, readily deliverable HPV vaccines to young girls as universal campaigns.

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HPV vaccines: the beginning of the end for cervical cancer

Current Opinion in Immunology ◽

10.1016/j.coi.2007.01.004 ◽

2007 ◽

Vol 19 (2) ◽

pp. 232-238 ◽

Cited By ~ 30

Author(s):

Graham R Leggatt ◽

Ian H Frazer

Keyword(s):

Cervical Cancer ◽

Hpv Vaccines

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Chapter 21: Modelling the impact of HPV vaccines on cervical cancer and screening programmes

Vaccine ◽

10.1016/j.vaccine.2006.05.116 ◽

2006 ◽

Vol 24 ◽

pp. S178-S186 ◽

Cited By ~ 105

Author(s):

Geoffrey P. Garnett ◽

Jane J. Kim ◽

Katherine French ◽

Sue J. Goldie

Keyword(s):

Cervical Cancer ◽

Hpv Vaccines ◽

The Impact

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Prophylactic human papillomavirus vaccines: the beginning of the end of cervical cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200409000-00004 ◽

2004 ◽

Vol 14 (5) ◽

pp. 751-761 ◽

Cited By ~ 3

Author(s):

W. A. A. Tjalma ◽

M. Arbyn ◽

J. Paavonen ◽

T. R. Van Waes ◽

J. J. Bogers

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Neutralizing Antibodies ◽

Hpv Vaccination ◽

Phase Iii ◽

Hpv Vaccines ◽

Therapeutic Vaccines ◽

The Status ◽

Prophylactic Vaccines

Persistent infection with one of the oncogenic human papillomavirus (HPV) types is a necessity for the development of cervical cancer. By HPV vaccination, cervical cancer could become a very rare disease. Two types of HPV vaccines can be distinguished: (i) therapeutic vaccines which induce cellular immunity targeted against epithelial cells infected with HPV and (ii) prophylactic vaccines inducing virus-neutralizing antibodies protecting against new but not against established infections. At present, several vaccines have been developed and tested in clinical trials. The vaccines are generally well tolerated and highly immunogenic. The current clinical data indicate that prophylactic vaccines are very effective against new persistent infections and the development of cervical intraepithelial lesions. The protection is type specific. However, the follow-up of the vaccination trials is still short. The effect of HPV vaccines on future cancer incidence will only be known after decades of follow-up. This article will address the status of recently terminated phase II and currently running phase III trials with prophylactic HPV vaccines.

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Human Rights in Health Equity: Cervical Cancer and HPV Vaccines

American Journal of Law & Medicine ◽

10.1177/009885880903500207 ◽

2009 ◽

Vol 35 (2-3) ◽

pp. 365-387 ◽

Cited By ~ 4

Author(s):

Joanna N. Erdman

Keyword(s):

Cervical Cancer ◽

Human Rights ◽

International Law ◽

Health Equity ◽

Social Disparities ◽

Policy Outcome ◽

Hpv Vaccines ◽

Remedial Measure ◽

Human Right ◽

Policy Objective

AbstractThis article seeks to demonstrate that health equity, as an empirical and normative concept, is reflected in the human rights to health and equality under international law. The obligations on government that flow from health equity as a human right are then examined. These include the obligation to act in pursuit of health equity as a policy objective, and the obligation to enact measures to ensure health equity as a policy outcome. These obligations are considered in relation to a promising remedial measure for social disparities in cervical cancer: HPV vaccines.

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