Routine vaccination programs have had a substantial impact on reducing the prevalence of a variety of infectious diseases. In light of the fact that human papillomavirus (HPV) is a prerequisite for virtually every case of cervical cancer and genital warts occurring worldwide, vaccination may be the most effective mechanism to prevent HPV infection and HPV-associated disease. HPV vaccines are created from noninfectious virus-like particles (VLPs) of the major capsid protein, L1, that closely mimic natural HPV virions. Proof-of-principle trials of monovalent vaccines that protect against high-risk HPV types such as HPV 16 or 18 have confirmed that intramuscular injection with VLPs induces the production of HPV type-specific neutralizing antibodies. A bivalent vaccine incorporating oncogenic HPV types 16 and 18 was shown to be safe, well tolerated, and 100% efficacious in preventing persistent HPV infection. A quadrivalent vaccine that protects against genital wart-causing HPV types (HPV 6 and 11) and oncogenic HPV types (HPV 16 and 18) demonstrated 100% efficacy in preventing clinical disease. Because VLP vaccines are prophylactic, vaccination before exposure to HPV will result in the greatest public health benefit; therefore, a successful vaccination program should target preadolescents and stress the importance of vaccination before sexual debut.
Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia