title: From the monovalent to the nine-valent HPV vaccine.
abstract: An investigational monovalent human papillomavirus (HPV) 16 virus-like particle vaccine has been shown to prevent persistent infection and cervical disease related to HPV 16 and was proof of concept (2002). Designed to prevent the bulk of invasive cervical cancer, quadrivalent (HPV 6/11/16/18) and bivalent (HPV 16/18) vaccines have been available since 2006 and 2007, respectively. They are highly effective in preventing HPV 16/18-related cervical precancer; the quadrivalent version also prevents genital warts related to HPV 6/11. It has been shown that the precursors of vulvar, vaginal and anal cancer related to the vaccine types are effectively prevented. This led to a paradigm shift from a female-only cervical cancer vaccine to a vaccine for the prevention of HPV-related disease and cancer for both sexes. Vaccination before the start of sexual activity is most effective, and consequently most programs target 9- to 12-year-olds. Additionally, recent studies have proven the noninferior immunoresponse of a two-dose schedule in these age cohorts. Gender-neutral vaccination has become more common; it improves coverage and also provides protection to all males. Recently a nine-valent HPV vaccine (HPV 6/11/16/18/31/33/45/52/58) was licensed; it provides high and consistent protection against infections and diseases related to these types, with ∼90% of cervical and other HPV-related cancers and precancers potentially being avoided. Coverage is key. Efforts must be made to provide HPV vaccination in low-resource countries that lack screening programs. In countries with cervical cancer screening, HPV vaccination will greatly affect screening algorithms.
authors.affiliation: Department of Gynecology and Obstetrics, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
authors.forename: S
authors.initials: S
authors.lastname: Pils
authors.affiliation: Department of Gynecology and Obstetrics, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria. Electronic address: elmar.joura@meduniwien.ac.at.
authors.forename: E A
authors.initials: EA
authors.lastname: Joura
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000517:prevention & control*; D003218:Condylomata Acuminata / Q000453:epidemiology / Q000517:prevention & control*; D055808:Drug Discovery / Q000639:trends; D005260:Female; D005833:Genital Neoplasms, Female / Q000453:epidemiology / Q000517:prevention & control*; D005834:Genital Neoplasms, Male / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007115:Immunization Schedule; D008297:Male; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D014611:Vaccination / Q000706:statistics & numerical data
chemical_list: D053918:Papillomavirus Vaccines
keywords: Cervical cancer; HPV vaccine; genital neoplasm; genital warts; papillomavirus infection