CONCISE REVIEW FOR CLINICIANSHuman Papillomavirus and Vaccination
Section snippets
PATHOPHYSIOLOGY
Human papillomaviruses are small, nonenveloped, double-stranded DNA viruses; their 8-kB circular genome encodes the encapsulating structural proteins L1 and L2, as well as several early genes that enable viral transcription and replication and interact with the host genome. Approximately 100 types of HPV have been identified; those that infect the genital area have a predilection for mucous membranes. The low-risk types can cause benign or low-grade cervical cell changes, genital warts, and
CLINICAL SEQUELAE
Since the 1950s, the number of deaths due to cervical cancer in the United States has decreased by more than 70% and continues to decline by nearly 4% a year,3 with widespread use of Pap testing. This decrease has been observed primarily in squamous cell cancers rather than adenocarcinomas, which are more difficult to detect with Pap tests. The clinical sequelae of HPV infection are not limited to cervical cancer and its precursor lesions; they have also been associated with several other types
RISK FACTORS
Genital HPV infection is transmitted primarily by genital contact. Sexual activity remains the most consistent predictor of infection. In a study of women aged 18 to 25 years, HPV infection was found in 14.3% of women with 1 lifetime sex partner, in 22.3% of women with 2 lifetime sex partners, and in 31.5% of women with more than 3 lifetime sex partners.6, 9 In the 2002 National Survey of Family Growth, 24% of female respondents in the United States were sexually active by age 15 years, 40% by
HPV VACCINE
On June 8, 2006, the US Food and Drug Administration licensed the quadrivalent HPV vaccine by Merck and Co., Inc. Recombinant DNA technology is used to express the L1 major capsid protein of HPV in yeasts (Saccharomyces cerevisiae), which self-assemble to form empty shells resembling a virus, called viruslike particles (VLPs). The VLPs have the same outer L1 protein coat as HPV but contain no genetic material. The vaccine uses these VLPs as antigens to induce a strong protective immune
CONCLUSION
Human papillomavirus infection is the most common sexually transmitted infection in the United States. Persistent infection with high-risk types can lead to precancerous and cancerous lesions. The new quadrivalent HPV vaccine appears to confer a high degree of protection against HPV-6, HPV-11, HPV-16, and HPV-18, which are responsible for 70% of cervical cancers and 90% of genital warts. If the vaccine's duration of protection proves to be sufficient or can be maintained through booster
CME Questions About HPV Vaccine
- 1.
Which one of the following best describes the percentage of genital warts and cervical cancers covered by the quadrivalent vaccine's protection against HPV-6, HPV-11, HPV-16, and HPV-18?
- a.
70% of genital warts and 90% of cervical cancers
- b.
90% of genital warts and 70% of cervical cancers
- c.
30% of genital warts and 50% of cervical cancers
- d.
50% of genital warts and 30% of cervical cancers
- e.
100% of both genital warts and cervical cancers
- a.
- 2.
Which one of the following is the most common mode of HPV
REFERENCES (24)
- et al.
Prophylactic quadrivalent human papillomavirus (types 6, 11, 16, and 18) L1 virus-like particle vaccine in young women: a randomised double-blind placebo-controlled multicentre phase II efficacy trial
Lancet
(2005) - et al.
Immunologic responses following administration of a vaccine targeting human papillomavirus types 6, 11, 16, and 18
Vaccine
(2006 Jul 7) - et al.
Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised control trial
Lancet
(2006) Human papillomaviruses and cancer: questions and answers
FDA licenses new vaccine for prevention of cervical cancer and other diseases in females caused by human papillomavirus: rapid approval marks major advancement in public health. FDA News 2006 June 8
Detailed guide: cervical cancer: what are the key statistics about cervical cancer? Revised Aug 4, 2006
- et al.
American Cancer Society guideline for human papillomavirus (HPV) vaccine use to prevent cervical cancer and its precursors
CA Cancer J Clin
(2007) - et al.
Human papillomavirus infection and cervical cancer
- et al.
Quadrivalent human papillomavirus vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP)
MMWR Recomm Rep
(2007) - et al.
Natural history of cervicovaginal papillomavirus infection in young women
N Engl J Med
(1998)
Case-control study of human papillomavirus and oropharyngeal cancer
N Engl J Med
Human papillomavirus infection among sexually active young women in the United States: implications for developing a vaccination strategy
Sex Transm Dis
Cited by (27)
Barriers to Human Papillomavirus Vaccine Acceptability in Israel
2013, VaccineCitation Excerpt :The two vaccines are accessible in the private market and are partially covered by supplementary health insurance policies. To promote vaccine uptake, the Advisory Committee on Immunization Practices (ACIP) in the United States recommended universal vaccination of all 11–12 year-old girls as part of routine preventive care visits, and comprehensive “catch-up” vaccination of adolescent and young adult women between the ages of 13 and 26 years [5]. Despite ACIP recommendation, vaccination coverage rates in the United States remain low: in 2010, 47.7% of 13–17 year-old girls had received one or more doses of HPV vaccine.
Human Papillomavirus Vaccination. Current Indications and Future Directions.
2013, Obstetrics and Gynecology Clinics of North AmericaCitation Excerpt :Women aged 19 to 26 years of age, perhaps, have the highest rates of HPV infection and HPV-related diseases.73,74 Seventy-four percent of the new HPV infections annually occur among women aged 15 to 24 years.75 However, reports by the CDC 2 to 5 months after HPV vaccination approval showed that only 10% of women aged 18 to 26 years had initiated the vaccine series.76
Knowledge about cervical cancer among Polish and Finnish female students
2011, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :In the meantime, the rising incidence of cervical cancer among women aged 15–34, in both Poland and Finland, is a problem of growing importance [10,13]. The trend can be put down to changing sexual behaviour: among other factors the average number of women's sexual partners has grown [2,10], while the age of sexual initiation has decreased [10,14]. Changing sexual behaviours increase the risk of acquiring human papillomavirus (HPV) infection [3].
Quadrivalent Human Papillomavirus recombinant vaccine associated lipoatrophy
2009, VaccineCitation Excerpt :However, both patients remain concerned about the appearance and cosmetic implication of their lesions. Human Papillomavirus is the most common sexually transmitted infection in the United States, with approximately 6 million new cases annually [5–7]. It is responsible for almost 100% of cervical cancer [8], which is the second most common cancer among women worldwide [9–11].
On completion of this article, you should be able to (1) review pathophysiology and transmission of human papillomavirus, (2) cite efficacy and safety profile of the new human papillomavirus vaccine, and (3) summarize current guidelines for use of the vaccine.