> Anti-HPV vaccine questions and answers

As is often the case with vaccines, of recent production, nothing is known with respect to the needà and the timing of booster doses. At the time, in fact, not c’è a related immunological to determine whether the immunity will be acquired to correspond to a clinical efficacy.

In the course of natural infection in fact many women do not develop an immune response measurable [1]. From the available data obtained following 241 women, it seems that the protection is maintained during 5 years, but this awaits further confirmation [1,2].

Finland has decided to evaluate the impact of vaccination on a cohort of over 20 thousand adolescents invited to participate in a study of the effectiveness of the HPV vaccine. The adolescents who accepted the invitation were randomized to receive the anti-HPV vaccine (2404 girls) or the vaccine anti-hepatitis A virus–HAV (2404 girls); a control group did not receive any vaccine (9464 girls) [3].

the Data relating to the effectiveness and duration of protection will be available to this cohort in 2020 when the studio avrà recruited at least 3300 girls in the arm HPV, 3300 in the arm HAV and 9500 in the arm control and sarà has elapsed follow-up.

A quale età vaccinare?

As shown by RCTS to be effective, it is crucial that the vaccine be administered in women with a history negative for HPV of serotypes in vaccine. For this reason, the vaccine has been studied in young people and is suitable for girls of 12 years old, when the greater is the probability; that have not yet begun any activitiesà sexual. It is known that the HPV infection can; as in, totally silent and autorisolversi without which the woman perform has been infected. The vaccine currently available has not recorded indication for use in young women over 26 years, in males [1,2]. In Italy, the vaccine will beà administered free of charge in adolescents 12 years of age.

What impact has the vaccination on screening with the Pap Test?

Many researchers emphasize the importance to continue and involve more and more women in the screening programs for the early identification of cervical lesions in view of the introduction of vaccination antiHPV [1,4,5].

The vaccination, effective on precancerous lesions by serotypes in vaccine HPV 6/11/16/18, if confirmed effective in preventing the cancerous lesions, however, do not eliminerà that 30% of cervicocarcinomi caused by the other serotypes, which as we have seen, are also present in Italy. The effectiveness of vaccination in preventing 70% of the cervicocarcinomi serviceà the cohort of twelve year old boys (2008), and willà then occur not before 2030.

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On that population, reducing the prevalence of the disease, it becomes even more useful surveillance with screening, since the changed picture of the prevalence of the disease will reduceà the positive predictive value of screening the same. In the latter, it is feared that, at the time of dissemination of the vaccination anti-HPV, a false sense of security indurrà women participate less than they do today, screening programs.

Rapporto costo/efficacia

From the registration of the vaccine quadrivalente several attempts have been made to analyze the best vaccination strategies and models with the best cost/effectiveness [6-8]. These models use assumptions based on data that is not certain, such as: the impact on cervical cancer prevented, the interval from vaccination and the subsequent recalls, the eventual effectiveness of vaccination on males.

These variables, which, for the moment, there are no data, are included in the models using different values and give rise to predictions very different from the other. For the evaluation più information is, therefore, necessary to wait.

edited SaPeRiDoc

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Bibliography

1. Saslow D, Castle PE, Cox JT, Davey DD, Einstein MH, Ferris DG, Goldie SJ, Harper DM, Kinney W, Moscicki AB, Noller KL, Wheeler CM, Ades T, Andrews KS, Doroshenk MK, Kahn KG, Schmidt C, Shafey O, Smith RA, Partridge EE, Garcia F. American Cancer Society Guideline for Human Papillomavirus (HPV) Vaccine Use to Prevent Cervical Cancer and Its Precursors. CA Cancer J Clin. 2007;57:7-28 [Medline]

2. Centers for Disease Control and Prevention. Quadrivalent Human Papillomavirus Vaccine Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Early Release 2007;56:1-24

3. Lehtinen M, Apter D, Dubin G, Kosunen E, Isaksson R, korpi danger EL, Kyh-Osterlund L, Ransom T, Luostarinen T, Niemi L, Palmroth J, Petaja T, Rekonen P, the strait of water H, Siitari-Mattila M, Svartsj S, ms tuomivaara L, Vilkki M, Pukkala E, Paavonen J. Enrolment of 22,000 adolescent women to cancer registry follow-up for long-term human papillomavirus vaccine efficacy: guarding against guessing. Int J STD AIDS. 2006;17:517-21

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4. World Health Organization. Preparing for the introduction of HPV vaccines. Policy and programme guidance for countries. UNFPA & World Health Organization, Geneva 2006.

5. Filia A, Verteramo R, Donati S, Ciofi degli Atti M. genital Infections by HPV and carcinoma of the uterine cervix. The epicenter, ISS, Rome, March 2007.

6. Elbasha EH, Dasbach EJ, Insinga RP. Model for assessing human papillomavirus vaccination strategies. Emerg Infect Dis 2007;13:28-41 [Medline]

7. Handsfield HH, Ault KA, Palefsky JM. Preventing STD-related cancers: an update on vaccination strategies. [Medscape]

8. Van de Velde N, Brisson M, Boily MC. Modeling human papillomavirus vaccine effectiveness: quantifying the impact of parameter uncertainty. Am J Epidemiol 2007;165:762–775 [Medline]

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Page updated on April 1, 2007

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