Journals club - HPV vaccine

Curriculum statement 5. Healthy people: promoting health and preventing disease.

Key trials

  • Cervarix is adjuvanted with aluminium hydroxide with monophosphoryl lipid A (ASO4). This has been used in a hepatitis B vaccine, where it was shown to generate a stronger and longer-lasting immune response than a vaccine containing aluminium hydroxide alone (Cancer Immunol Immunother 2008; 57: 443-51).
  • One study showed 90.4 per cent efficacy against cervical intraepithelial neoplasia 2 and 3 associated with HPV16 or HPV18 (Lancet 2007; 369: 2,161-70).
  • A pilot study achieved a 70.6 per cent uptake for the first dose of vaccine, with a drop of only 2.1 per cent for the second dose (BMJ 2008; 336: 1,056-8).

However, the uptake of the vaccine in this study was highest in girls from affluent, white backgrounds, who have the lowest incidence of cervical cancer.

  • The HPV vaccine does appear to be associated with a greater risk (2.6 per 100,000 doses) of anaphylaxis than other immunisations (CMAJ 2008; 179: 525-33).

Evidence base

  • The Royal College of Obstetricians and Gynaecologists has welcomed the government's implementation of the HPV vaccination programme in teenage girls.
  • The DoH accepted advice from the Joint Committee on Vaccination and Immunisation regarding the HPV vaccine.
  • The introduction of the HPV vaccine into the National Immunisation Programme has been detailed in a CMO publication (see www.dh.gov.uk).

Guidelines

  • The DoH has chosen Cervarix HPV vaccine for the national immunisation campaign.
  • For optimal protection, the vaccine needs to be given before the onset of sexual activity.
  • The routine vaccination of girls aged 12-13 years of age started in September 2008.
  • The choice of vaccine has been criticised by many experts because it 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.
  • Vaccinated women will still need to have regular cervical smear tests because:
    vaccination will take several years to reduce the incidence of cervical cancer;
    vaccination does not offer protection against all HPV types;
    unvaccinated women will not be protected.

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

HPV points

  • Persistent HPV infection can lead to cervical cancer.
  • HPV infection affects approximately 1 in 5 women.
  • Cervarix is the vaccine of choice for the HPV vaccination programme in the UK.
  • Data on long-term immunity with the vaccine is not yet available.
  • Poor uptake of the vaccine is a concern.

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