Global HPV vaccinationBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1042 (Published 16 February 2011) Cite this as: BMJ 2011;342:d1042
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HPV: beyond the rich world
Arie explores whats' being done to make HPV vaccination available to low
income countries focusing on prevention of cervical cancer by vaccinating
females. However, it is important to consider immunising men too not only
for reducing risk of transmission to women but also for HPV associated
cancers in men (anal, penile and oral cancers). The incidence of both anal
and oral cancers related to HPV is increasing in the general population as
well as among immunocompromised human immunodeficiency virus (HIV)
infection positive. Other HPV-related diseases of clinical significance
include condylomata acuminata (genital warts) and recurrent respiratory
papillomatosis.1 The quadrivalent HPV vaccine (Gardasil: HPV6, 11, 16,
18) has been shown to be highly efficacious in the prevention of genital
warts in women as well as precancerous lesions of the cervix, vulva, and
vagina. In addition, recent data from a randomized, placebo-controlled,
double-blind trial reported overall efficacy of 60.2% (95% confidence
interval [CI], 40.8 - 73.8) in reducing external genital lesions in young
men (16-26 years old) who were immunised with Quadrivalent human
papillomavirus (HPV) vaccine.2
In UK Cervarix (HPV 16, 18) GlaxoSmithKline is used for primary
prevention which also provides cross protection against HPV 31 and 45.
Research is underway by Merck (Gardasil: HPV 6, 11, 16, 18) to develop
next generation of vaccine which will protect against almost all types of
HPV. Thus, HPV vaccination programme should not only be extended to
developing countries but also to males.
Change in immunisation strategy especially in current economical pressures
in health sector will require robust cost benefit analysis. However cost
may be further reduced in future by developing a new generation of vaccine
which use subunits like capsomeres rather than virus like particles (VLP).
Palefsky JM. Human papillomavirus-related disease in men: not just a
women's issue. 2010.J Adolesc Health; 46(4 Suppl):S12-9.
Giuliano AR, Palefsky, JM, Goldstone, S Moreira, E, Penny, ME. 2011.
Efficacy of Quadrivalent HPV Vaccine against HPV Infection and Disease in
Males. N Engl J Med 364:401-411.
Competing interests: No competing interests