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Current prophylactic HPV vaccines and gynecologic premalignancies

Harper, Diane M

Current Opinion in Obstetrics and Gynecology: December 2009 - Volume 21 - Issue 6 - p 457–464
doi: 10.1097/GCO.0b013e328332c910
Women's health: Edited by Joseph Aquilina

Purpose of review Studies of the human papillomavirus (HPV) vaccines, Cervarix and Gardasil provide strong evidence for the recommendation that HPV vaccines may minimize the incidence of cervical cancer over time.

Recent findings Both Cervarix and Gardasil provided more than 90% efficacy in preventing cervical intraepithelial neoplasia grade 2+ (CIN 2+) disease caused by HPV 16 and 18 in women 16–26 years who were seronegative and PCR-negative for HPV 16 and 18 at baseline. Cervarix provides more than 75% efficacy in independent cross-protection against persistent HPV 31 and 45, and 47% efficacy against HPV 33; whereas Gardasil offers 50% efficacy only against persistent HPV 31. A reduction in excisional therapies for CIN 2+ is nearly 70% for Cervarix, and 40% for Gardasil. Cervarix efficacy is documented to 6.4 years; Gardasil's to 5 years. Immunologically, Cervarix induces three to nine-fold higher peak-neutralizing antibody titers to HPV 16/18 than Gardasil, has significantly higher cervicovaginal mucus-neutralizing antibody presence than Gardasil, and significantly higher B memory cell response than Gardasil. Safety reports indicate injection site reactions for both Cervarix and Gardasil. Rare serious adverse events have been reported.

Summary The benefits and risks of vaccination must be weighed with the benefits and risks of screening to reduce cervical cancer in a cost-effective manner.

Departments of Community and Family Medicine, Obstetrics and Gynecology, Informatics and Personalized Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood, Kansas City, Missouri, USA

Correspondence to Diane M. Harper, MD, MPH, MS, Professor, Vice-Chair, Research, Departments of Community and Family Medicine, Obstetrics and Gynecology, Informatics and Personalized Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood, 7900 Lee's Summit Road, Kansas City, MO 64139, USA Tel: +1 816 404 7107; fax: +1 816 404 7142; e-mail: diane.m.harper@gmail.com

© 2009 Lippincott Williams & Wilkins, Inc.