Human Papillomavirus Vaccine

Mi-Kyung Kim; Jae Hong No; Yong-Sang Song

doi:10.5124/jkma.2009.52.12.1180

J Korean Med Assoc > Volume 52(12); 2009 > Article

Kim, No, and Song: Human Papillomavirus Vaccine

Continuing Education Column

J Korean Med Assoc 2009; 52(12): 1180-1186.

Published online: January 10, 2009

DOI: http://doi.org/10.5124/jkma.2009.52.12.1180

Human Papillomavirus Vaccine

Mi-Kyung Kim, MD, Jae Hong No, MD, Yong-Sang Song, MD

Department of Obstetrics and Gynecology, Seoul National University College of Medicine E – mail: yssong@snu.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Cervical cancer is the second most common cancer affecting women worldwide. Cervical cancer is caused by persistent infection with high-risk types of human papillomavirus (HPV). The most common oncogenic HPV genotypes are 16 and 18, causing approximately 70% of all cervical cancers. Recently, two HPV vaccines, quadrivalent (HPV 6, 11, 16, 18) and bivalent (HPV 16, 18) vaccines, have been licensed and are now marketed in Korea. HPV vaccines are prepared from virus-like particles (VLPs) produced by recombinant technology. Clinical trials have confirmed that both vaccines have high efficiency against persistent infection of HPV 16 or 18 and moderate to severe precancerous lesions. In women who have no evidence of past or current infection with the HPV genotypes in the vaccine, both vaccines show > 90% protection against persistent HPV infection for up to 5 years after vaccination. In addition, vaccine efficacy against precancerous lesions associated with HPV 16/18 was reported to be 100%. Although most clinical trials to date have investigated the effectiveness of HPV vaccines in young females, elderly females and males may also be candidates for HPV vaccines. Since HPV vaccines are prophylactic, the largest impact of vaccination is expected to result from high coverage of young adolescents before exposure to HPV. Cervical cancer screening will still be required, even after HPV vaccines are introduced, although the screening program may need to be adapted to achieve cost-effective reductions in the burden of cervical cancer prevention strategies.

Key words: Cervical cancer; Human papillomavirus; Vaccination; Prevention

Figure 1.

HPV prevalence in HPV-associated cancers. Adapted from (6).

Table 1.

Characteristics of the two HPV vaccines

	Quadrivalent vaccine	Bivalent vaccine
Manufacturer and trade name	Merck; Gardasil	Glaxo Smith Kline; Cervarix
VLPs of genotypes	6, 11, 16, 18	16, 18
Substrate	Yeast	Baculovirus expression system
Adjuvant	Aluminum	ASO4
Schedule	0, 2, 6 month	0, 1, 6 month
Adolescent safety and immunogenicity bridging trials	Females and males, 9∼15 years	Females 10∼14 years; males 10∼18 years
Other trials in progress or due to start	Efficacy study in males Efficacy study in women > 26 years Studies of administration at the same time as other vaccines Safety and immunogenicity in HIV-infected and other immunocompromised groups	Efficacy, immunogenicity, bridging and safety studies in women > 26 years Studies of administration at the same time as other vaccines Safety and immunogenicity in African populations, including HIV-infected women

Table 2.

Efficacy of the quadrivalent HPV vaccine among women who received three doses of vaccine according to protocol and had no evidence of past or current infection with the vaccine-related HPV genotypes.

Clinical endpoint	Vaccine		Placebo		Vaccine efficacy
Clinical endpoint	No. of women	No. of cases	No. of women	No. of cases	Vaccine efficacy
HPV 16/18-related CIN 2/3 or AIS	8,579	1	8,550	85	99% (93∼100)
HPV 16/18-related VIN 2/3	7,811	0	7,785	8	100% (42∼100)
HPV 16/18-related VaIN 2/3	7,811	0	7,785	7	100% (31∼100)
HPV 6/11/16/18-related genital warts (condyloma)	7,897	1	7,899	91	98.9% (93.7∼100)

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