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BMJ 2009; 339 doi: (Published 14 July 2009) Cite this as: BMJ 2009;339:b2820

Cervarix protects against high grade cervical lesions

Human papillomavirus (HPV) types 16 and 18 cause around 70% of cervical cancers worldwide, and GlaxoSmithKline’s bivalent vaccine against both types is already being given to teenage girls in several countries. Final analyses from the company’s large efficacy trial suggest that Cervarix prevents 70.2% (96.1% CI 54.7% to 80.9%) of high grade cervical intraepithelial neoplasia (CIN grade 2 or worse) lesions in young women who have no evidence of current or past infection when vaccinated. They analysed around 9000 participants aged 15-25. All had at least one dose of Cervarix or a control hepatitis A vaccine, and they were meant to represent the target population for primary vaccination—teenage girls who haven’t yet had sex.

So called “catch-up” vaccination programmes are also a possibility, so the authors did further analyses in a broader population that included sexually active women, one quarter of whom had already been infected with HPV. Cervarix prevented 30.4% (16.4% to 42.1%) of CIN 2 or worse lesions during a follow-up of nearly three years.

The authors estimate that their vaccine also prevents between 37% and 54% of high grade cervical lesions caused by HPV types other than 16 or 18.

All well and good, says a linked comment (doi:10.1016/S0140-6736(09)61247-2), but these lethal viruses will never be eradicated until we also vaccinate boys and men.

Surgical refinements to microdiscectomy make little difference to patients

In 1997, surgeons refined traditional microdiscectomy to reduce tissue damage during surgery and potentially speed recovery. Initial trials looked promising, but the latest and largest shows that tubular discectomy may be associated with worse, not better, outcomes after a year. Three hundred and twenty eight adults with persistent leg pain from a herniated disc had a traditional microdiscectomy or a tubular discectomy. Both groups made a good recovery in the first two weeks. By the end of one year, those …

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