Human Papillomavirus

Human papillomavirus and HPV vaccines: a review
FT Cutts,a S Franceschi,b S Goldie,c X Castellsague,d S de Sanjose,d G Garnett,e WJ Edmunds,f P Claeys,g KL Goldenthal,h DM Harper i & L Markowitz j

Abstract Cervical cancer, the most common cancer affecting women in developing countries, is caused by persistent infection with “high-risk” genotypes of human papillomaviruses (HPV). The mostcommon oncogenic HPV genotypes are 16 and 18, causing approximately 70% of all cervical cancers. Types 6 and 11 do not contribute to the incidence of high-grade dysplasias (precancerous lesions) or cervical cancer, but do cause laryngeal papillomas and most genital warts. HPV is highly transmissible, with peak incidence soon after the onset of sexual activity. A quadrivalent (types 6, 11, 16 and 18)HPV vaccine has recently been licensed in several countries following the determination that it has an acceptable benefit/risk profile. In large phase III trials, the vaccine prevented 100% of moderate and severe precancerous cervical lesions associated with types 16 or 18 among women with no previous infection with these types. A bivalent (types 16 and 18) vaccine has also undergone extensiveevaluation and been licensed in at least one country. Both vaccines are prepared from non-infectious, DNA-free virus-like particles produced by recombinant technology and combined with an adjuvant. With three doses administered, they induce high levels of serum antibodies in virtually all vaccinated individuals. In women who have no evidence of past or current infection with the HPV genotypes in thevaccine, both vaccines show > 90% protection against persistent HPV infection for up to 5 years after vaccination, which is the longest reported follow-up so far. Vaccinating at an age before females are exposed to HPV would have the greatest impact. Since HPV vaccines do not eliminate the risk of cervical cancer, cervical screening will still be required to minimize cancer incidence. Tiered pricingfor HPV vaccines, innovative financing mechanisms and multidisciplinary partnerships will be essential in order for the vaccines to reach populations in greatest need.
Bulletin of the World Health Organization 2007;85:719–726.
Une traduction en français de ce résumé figure à la fin de l’article. Al final del artículo se facilita una traducción al español. .‫الرتجمة العربية لهذه الخالصة يف نهايةالنص الكامل لهذه املقالة‬

Introduction
Cervical cancer is estimated to affect approximately 500 000 women each year, of whom 80% live in developing countries. Virtually all cervical cancer cases result from genital infection with human papillomavirus (HPV). Well-organized programmes of regular gynaecological screening and treatment of precancerous lesions have been very effective inpreventing squamous cervical cancer (the most common kind) but have had less impact on adenocarcinoma 1 and are difficult to implement in low-resource settings. In 2006, a quadrivalent vaccine was licensed in several countries, and a bivalent vaccine has recently been licensed in Australia. Countries will need
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to consider whether and how to use these new vaccines. This document provides an overviewof key information on HPV and HPV vaccines for policy-makers. It is based on a longer document (“Human Papillomavirus and HPV vaccines: technical information for policy-makers and health professionals”) that has been reviewed by an international group of experts, available online at: http://www.who.int/vaccinesdocuments/DocsPDF07/866.pdf.

HPV and cancers

Human papillomaviruses are DNA virusesthat infect basal epithelial (skin or mucosal) cells. There is international consensus that “high-risk” genotypes, including genotypes 16, 18, 31, 33, 35,

39, 45, 51, 52, 56, 58, 59 and 66, can lead to cervical cancer 2 and are associated with other mucosal anogenital and head and neck cancers. Infections with other genotypes, termed “low-risk,” can cause benign or low-grade cervical tissue...