Currently Approved Prophylactic HPV Vaccines

Diane M Harper

Disclosures

Expert Rev Vaccines. 2009;8(12):1663-1679. 

In This Article

Abstract and Introduction

Abstract

Cervarix® and Gardasil® are two prophylactic HPV vaccines designed primarily for cervical cancer prevention. Cervarix is effective against HPV-16, -18, -31, -33 and -45, the five most common cancer-causing types, including most causes of adenocarcinoma for which we cannot screen adequately. Gardasil is effective against HPV-16, 18 and 31, three common squamous cell cancer-causing types. In addition, Gardasil is effective against HPV-6 and -11, causes of genital warts and respiratory papillomatosis. The most important determinant of vaccine impact to reduce cervical cancer is its duration of efficacy. To date, Cervarix's efficacy is proven for 6.4 years and Gardasil's for 5 years.

Introduction

Within the last three decades, human papillomavirus (HPV) infection has been found to be necessary but not sufficient for the development of cervical cancer.[1] Cytologic and histologic correlations with cervical cancer were initially described contemporaneously by zur Hausen[2] and by Meisels and Fortin,[3,4] with a rapid subsequent increase in knowledge both in the human and animal papillomaviruses. zur Hausen continued to elucidate the oncogenic mechanisms of HPV for which he was awarded the Nobel Prize in 2008.[5] Several scientists continued to work to isolate and fabricate the L1 virus-like particles (VLPs),[6] which form the basis of the prophylactic HPV vaccines.

Most HPV infections never progress to cancer, but the small fraction of HPV infections that do become cervical cancer cause over 250,000 deaths annually worldwide.[7] HPV infections are common and, most often but not necessarily, are associated with sexual activity. Multiple studies indicate that the rate of oncogenic HPV infection is between 5 and 10% for children prior to sexual activity;[8–10] the incidence increases to 30% when women become sexually active, decreases in their late 30s to 10% and increases again to 15% in women over 60 years of age.[11] HPV vaccines offer the potential to decrease the incidence rate of HPV infection. Where secondary prevention programs (e.g., Pap screening or HPV testing) are not nationally organized, decreasing the baseline rate of HPV infection should lead to population-based reductions in cervical cancer after several decades of widespread female vaccination. Where secondary prevention programs are vigorous and well-attended, prophylactic vaccination should reduce the number of diagnostic work-ups for abnormal screens and decrease the need for excisional therapies for precancerous lesions in as little as 3 years after vaccinating a currently HPV-uninfected sexually active population.

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