Journals Club - HPV vaccine

By Louise Newson on the 14 October 2010

Dr Louise Newson brings us up to date with the latest research and guidance on the HPV vaccine.

Key trials. A phase III trial of the bivalent HPV vaccine has shown that efficacy against CIN2+ associated with HPV-16 and HPV-18 was 92.9 per cent (Lancet 2009; 374: 301-14).
Antibody concentrations against HPV-16 and HPV-18 have been shown to be substantially higher in vaccinated women than would be found after natural HPV infection. This remains the case for up to 20 years and suggests that a booster vaccine would be unnecessary (Gynecol Oncol 2009; 115 (supp 1): S1-S6).
Cervarix is adjuvanted with aluminium hydroxide with monophosphoryl lipid A (ASO4) which has been used in a hepatitis B vaccine, where it was shown to generate a stronger and longer-lasting immune response than vaccines containing aluminium hydroxide alone (Cancer Immunol Immunother 2008; 57: 443-51).

Evidence base

The most common barriers to the HPV vaccine have been shown to be the need for more information, sex-related concerns and worry regarding potential side-effects. Also, awareness of the vaccine was lower in women from ethnic minorities. (J Epidemiol Community Health 2009; 63: 1,010-5).
A phase II trial is now in its final analysis with a total of 6.4 years follow up after vaccination. None of the vaccine recipients developed CIN2+ during the follow-up period (Lancet 2009; 374: 1,975-85).
The introduction of the HPV vaccine into the national immunisation programme was detailed in a chief medical officer letter (see www.dh.gov.uk).

Guidelines

The choice of vaccine has been criticised by many experts as this means that the potential for vaccination against genital warts is lost.
The DoH has stated it is not cost effective for boys to be vaccinated.
At the end of the first year of the HPV immunisation programme, at least 1.4 million doses were given across the UK.
The total number and nature of suspected side-effects reported via the MHRA yellow card scheme during the first year were as expected.
Key conclusions from the Commission on Human Medicines (CHM) review were that the balance of risks and benefits of the HPV vaccine remains positive. No serious new risks have been identified in association with Cervarix despite significant exposure in the UK.

Useful websites

Contributed by Dr Louise Newson, a GP in the West Midlands

Book now to attend MIMS Women's Health in Primary Care Conference, Manchester, 16 November 2010 www.mimswomenshealthconference.com

HPV facts
HPV infection is very common in sexually active women. Women from ethnic minorities are less aware of the vaccine. Poor uptake of the vaccine is a concern. Long-term protection is likely with this vaccine.