Human Papillomavirus cervical cancers than primary cytology screening.21 Given the high
negative predictive value of HPV testing, considerably increasing screening intervals could result in significant savings, and reducing the numbers of non-responders in screening programs could be achieved by offering women self-sampling. Adequately measuring the effect of HPV vaccination in a population will be important by linking screening and vaccination registries. HPV vaccinations in public and individual healthcare settings need to be registered centrally to calculate vaccination coverage and to follow up vaccinated and unvaccinated women. Other issues such as duration of HPV vaccine efficacy and the need for booster vaccinations can only be addressed by analyzing correctly gathered data.
1. Garland SM, Steben M, Sings HL, et al., Natural history of genital warts: analysis of the placebo arm of 2 randomized phase III trials of a quadrivalent human papillomavirus (types 6, 11, 16, and 18) vaccine, J Infect Dis, 2009;199(6):805–14.
2. Derkay CS, Wiatrak B, Recurrent respiratory papillomatosis: a review, Laryngoscope, 2008;118(7):1236–47.
3. de Sanjose S, Quint WG, Alemany L, et al., Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study, Lancet Oncol, 2010;11(11):1048–56.
4. Bouvard V, Baan R, Straif K, et al., A review of human carcinogens—part B: biological agents, Lancet Oncol, 2009;4:321–2.
5. Ault KA, Future II Study Group, Effect of prophylactic human papillomavirus L1 virus-like-particle vaccine on risk of cervical intraepithelial neoplasia grade 2, grade 3, and adenocarcinoma in situ: a combined analysis of four randomized clinical trials, Lancet, 2007;369(9576):1861–8.
6. Paavonen J, Naud P, Salmerón J, et al., Efficacy of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA): final analysis of a double-blind, randomised study in young women, Lancet, 2009;374(9686):301–14.
7. Muñoz N, Manalastas R Jr, Pitisuttithum P, et al., Safety, immunogenicity, and efficacy of quadrivalent human papillomavirus (types 6, 11, 16, 18) recombinant vaccine in
Although HPV-related cancers are less frequent in men than in women, the prevention of genital warts, anal cancer, and head and neck cancers is an obvious reason for recommending HPV vaccination. In addition, by vaccinating boys, the risk of HPV infection in their non-vaccinated female partners is reduced by providing herd immunity. Furthermore, men having sex with men will not have the benefit of having herd immunity from a vaccinated female partner. Without any doubt, lowering the costs of HPV vaccines will be pivotal in recommending and funding vaccination for both sexes. n
women aged 24–45 years: a randomised, double-blind trial, Lancet, 2009;373(9679):1949–57.
8. Giuliano AR, Palefsky JM, Goldstone S, et al., Efficacy of quadrivalent HPV vaccine against HPV infection and disease in males, N Engl J Med, 2011;364(5):401–11.
9. De Carvalho N, Teixeira J, Roteli-Martins CM, et al, Sustained efficacy and immunogenicity of the HPV-16/18 AS04- adjuvanted vaccine up to 7.3 years in young adult women, Vaccine, 2010;28(38):6247–55.
10. Merck and Co, Inc., Gardasil product information. Available at:
wwww.merck.com/product/usa/pi_circulars/g/gardasil/gardasil _pi.pdf (accessed October 19, 2011).
11. Einstein MH, Baron M, Levin MJ, et al., Comparison of the immunogenicity and safety of Cervarix and Gardasil human papillomavirus (HPV) cervical cancer vaccines in healthy women aged 18–45 years, Hum Vaccin, 2009;5(10):705–19.
12. Centers for Disease Control and Prevention (CDC), National, state, and local area vaccination coverage among adolescents aged 13–17 years—United States, 2009, MMWR Morb Mortal Wkly Rep, 2010;59(32):1018–23.
13. Brabin L, Roberts SA, Stretch R, et al., Uptake of first two doses of human papillomavirus vaccine by adolescent schoolgirls in Manchester: prospective cohort study, BMJ, 2008;336(7642):1056–8.
14
www.zorg-en-gezondheid.be/vaccinaties (accessed October 19, 2011).
15. Watson M, Shaw D, Molchanoff L, et al., Challenges, lessons
learned and results following the implementation of a human papilloma virus school vaccination program in South Australia, Aust N Z J Public Health, 2009;33(4):365–70.
16. Rondy M, Van Lier A, van de Kassteele J, et al., Determinants for HPV vaccine uptake in the Netherlands: a multilevel study, Vaccine, 2010;28(9):2070–5.
17. Brotherton JML, Fridman M, May C, et al., Early impact of the HPV vaccination program on cervical abnormalities in Victoria, Australia: an ecological study, Lancet, 2011;377(9783):2085–92.
18. Fairley CK, Hocking JS, Gurrin LC, et al., Rapid decline in presentations of genital warts after the implementation of a national quadrivalent human papillomavirus vaccination programme for young women, Sex Transm Infect, 2009;85(7):499–502.
19. Cuzick J, Castanon A, Sasieni P, Predicted impact of vaccination against human papillomavirus 16/18 on cancer incidence and cervical abnormalities in women aged 20–29 in the U.K., Br J Cancer, 2010;102(5):933–9.
20. Kreimer AR, González P, Katki HA, et al., Efficacy of a bivalent HPV 16/18 vaccine against anal HPV 16/18 infection among young women: a nested analysis within the Costa Rica Vaccine Trial, Lancet Oncol, 2011;12(9):862–70.
21. Dillner J, Rebolj M, Birembaut P, et al., Long term predictive values of cytology and human papillomavirus testing in cervical cancer screening: joint European cohort study, BMJ, 2008;337:a1754.
In the near future, healthcare providers should urgently consider the need for HPV vaccination in boys and young men as new data on the quadrivalent vaccine suggest that vaccine efficacy is similar for both sexes.8
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