Abstract
Introduction: Human papillomavirus (HPV) linked cancers can affect the cervix, vulva, vagina, penis, anus, rectum and oropharynx. It is estimated that more than eighty percent of all HPV linked cancers arise from the cervix, almost all of the evidence for prophylactic vaccine prevention of incident type specific HPV infection is in cervical disease. The early vaccine to be approved, Gardasil, has been substituted by Gardasil 9 whose overall prevention of CIN 3 disease is not-inferior to that of the competing cervical cancer HPV vaccine, Cervarix.
Aim of work: In this review, we will discuss HPV vaccine
Methodology: We did a systematic search for HPV vaccines using PubMed search engine (http://www.ncbi.nlm.nih.gov/) and Google Scholar search engine (https://scholar.google.com). All relevant studies were retrieved and discussed. We only included full articles.
Conclusions: Prophylactic HPV vaccines are commercially available and part of many high income nations' immunization budgets. While Cervarix remains the most cost effective vaccine with proven efficacy in one dose, theWHO recommends two doses for either Gardasil9 or Cervarix for those up to 15 years of age, and three doses for women 15 years or older. TheWHO recommendations are based on induced antibody titers at month 7 for Gardasil and Gardasil9 as there are currently no efficacy data for these vaccines in fewer than three doses. TheWHO recommendations for Cervarix are based on efficacy data in addition to immunogenicity data. Three dose efficacy preventing CIN 2 or worse by any HPV type is about 62% for both Cervarix and Gardsail9; the three dose efficacy preventing CIN 3 or worse by any HPV type is 93% for Cervarix and 43% for Gardasil, with no data for Gardasil9. All three vaccines lead to reduced numbers of colposcopies and excisional cervical therapies. Head to head trials indicate that Cervarix has superior immunogenicity compared to Gardasil for T-cell and B-cell functions for both HPV 16 and 18; there are no data for Gardasil9's comparable immunogenicity. The immunogenicity data for HPV 18/45 induced by Gardasil and Gardasil9 indicates that long term surveillance for HPV 18/45 disease breakthrough must be in place. Revaccinating females already HPV vaccinated is expensive and causes harmwith no evidence of any improved prevention of HPV infections.