Update of human papillomavirus vaccination

Abstract

Infection with one of 15 types of high-risk human papillomavirus (HPV) is the cause of cervical cancer. Worldwide, 70% of cervical cancer is caused by either HPV type 16 or 18. The current HPV vaccine is composed of virus-like particles (VLPs) of the L1 capsid protein as well as adjuvant. Quadrivalent HPV vaccine contains L1 VLPs from HPV types 6, 11, 16, and 18, and the bivalent vaccine contains HPV 16 and 18 L1 VLPs. HPV vaccines have demonstrated almost 100% efficacy in preventing HPV 16- or 18- associated cervical intraepithelial neoplasia grade 3 or worse (CIN3+) in large-scale randomized studies. The HPV vaccine was confirmed to be safe by the WHO Global Advisory Committee for Vaccine Safety after reviewing information from clinical trials and post-marketing surveillance of two HPV vaccines. Local injection site reactions were the most commonly observed side effect, and these resolved spontaneously. A three-dose schedule is recommended prior to sexual contact and potential exposure to HPV, but a two-dose schedule is also recommended for adolescent girls aged 9 to 13 years. Recently, cervical cancer screening and HPV vaccination to prevent cervical cancer and HPV-related disease have become major public health issues. The effects of HPV vaccination, such as a rapid decrease in HPV prevalence, genital warts, and cervical precancerous lesions, have been observed in several countries in which HPV vaccination coverage is very high. At this point, cost-effectiveness analysis should be performed in Korea with the view to include HPV vaccination in the national immunization program to increase the coverage of HPV vaccination. In the future, we can eradicate cervical cancer through the universal HPV prophylactic vaccine and therapeutic HPV vaccine, together with cervical cancer screening.