Abstract
Primary prevention by vaccination against infectious diseases and in particular viral infections has been one of the greatest successes in medicine. The two currently available prophylactic vaccines against human papillomaviruses (HPVs) consist of virus-like particles (VLPs) produced by recombinant DNA technology. Both products contain VLPs of the viruses (HPV16 and 18) that induce about 70% of the worldwide occurring cases of cervical cancer as well as a substantial fraction of malignant tumors of the vulva, penis, perianal area and oropharynx. For both vaccines, an efficacy of almost 100% against persistent infection by HPV16 and 18 and high-grade intraepithelial lesions (CIN, VIN, VaIN) was demonstrated in clinical trials with up to 8.4 years of follow-up. One of the vaccines also contains VLPs of HPV6 and 11 ('quadrivalent vaccine') for the prevention of genital warts (condylomata acuminata). Protection against lesions that are induced by genetically related nonvaccine types was reported most likely due to cross-neutralizing antibodies. While the natural immunity is weak and only transient, vaccination has shown to induce a sustained high immune response. Prevention of cervical cancer cases will only be seen in population-based surveys at the earliest 10 years after introduction of the vaccine. In Australia, a first success of a vaccination campaign became obvious by reduction of the incidence of genital warts. Vaccinating males is a reasonable means to reduce the risk of infection in women but it also provides them with a direct: benefit through the recently documented efficacy of the quadrivalent vaccine against genital warts. Copyright (C) 2012 S. Karger AG, Basel