Human papillomavirus vaccine and cervical cancer prevention: practice and policy implications for pharmacists.
OBJECTIVE
To review the epidemiology and natural history of human papillomavirus (HPV), summarize relevant clinical trials of the prophylactic HPV vaccines, and describe the practice and policy implications that HPV vaccine represents for pharmacists.


METHODS
Search of Medline through June 2007 using keywords human papillomavirus vaccine, Gardasil, and Cervarix; meeting abstracts; bibliographies from selected articles; and National Institutes of Health clinical trials registry.


METHODS
English language review articles, clinical trials, and published abstracts were considered for inclusion.


RESULTS
HPV is a sexually transmitted infection that is necessary for the development of cervical cancer, and types 16 and 18 are associated with 70% of cases of invasive cervical cancer worldwide. A quadrivalent prophylactic vaccine against HPV-6, -11, -16, and -18 is currently available, and a bivalent vaccine targeting HPV-16 and -18 is under review by the Food and Drug Administration. Both are highly effective at preventing persistent HPV infection and precancerous lesions caused by vaccine-specific HPV. HPV vaccine is currently indicated for girls aged 9 to 26 years, but ongoing trials are evaluating the efficacy in other populations. Implementation of a vaccine administration program is an area of opportunity for new policies to include pharmacists in the administration of prophylactic HPV vaccines. Pharmacists are allowed to administer vaccinations in 46 states and can potentially play a role in HPV vaccine administration. For this to happen, however, multiple legal and regulatory changes must occur.


CONCLUSIONS
Prophylactic HPV vaccines safely and effectively prevent HPV infection and precancerous lesions in the cervix. The availability of these vaccines also create new clinical opportunities for community pharmacists, provided needed legal, regulatory, and policy changes are made.
McIntosh
Jennifer
J
Johns Hopkins Hospital, Baltimore, MD, USA. j.mcintosh@neu.edu
Sturpe
Deborah A
DA
Khanna
Niharika
N
D000293:Adolescent; D000328:Adult; D002648:Child; D002986:Clinical Trials as Topic; D005260:Female; D006291:Health Policy; D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18; D006801:Humans; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000627:therapeutic use*; D010595:Pharmacists; D011230:Precancerous Conditions / Q000209:etiology / Q000517:prevention & control / Q000821:virology; D024382:Professional Role; D002583:Uterine Cervical Neoplasms / Q000209:etiology / Q000517:prevention & control* / Q000821:virology
D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18; D053918:Papillomavirus Vaccines; C510352:human papillomavirus vaccine, L1 type 16, 18