HPV HANDBOOK - Zervita

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THE POTENTIAL PUBLIC HEALTH IMPACT OF VACCINES AGAINST HPVPermission for vaccine licensing would ensue, if it were demonstratedthat HPV vaccines can prevent steps in CC pathogenesis. 2 Theintroduction of vaccination programmes with promising, thoughincomplete, evidence of efficacy has a precedent: in the UK,meningococcal vaccination was introduced early because of thesubstantial potential benefits, in terms of lives saved. 24 However, earlylicensing of HPV vaccines carries with it the responsibility of long-termfollow-up of initial trials, to determine the duration of protection fromincident infection; to confirm the expected protection against highgradedysplasia; and to provide sufficient safety data to evaluate theincidence of rare adverse events. Whilst the results of HPV vaccinationmay not be immediate or medium-term, the benefits are potentiallylarge.Cost and purpose of a HPV vaccineWhere screening to prevent CC is adequate, it should be maintained,both to ‘mop up’ cases of infection and subsequent progressionamongst those unvaccinated or unprotected, and to cover theremaining pathogenic HPV types not included within the vaccine. Costis likely to become a major issue, since the regions that are most inneed of HPV vaccines are those where screening is ineffective,because they are typically those least able to afford such healthcaremeasures. Current VLP vaccine production methods are expensiveand are tailored to parenteral administration. An oral vaccine may bemore cost-effective 25 and easier and safer to administer.Decreasing the incidence of HPV infection and cervical dysplasia couldresult in some savings in the developed world, where screening andintervention programmes are costly. 26 However, HPV vaccination mayprovide the greatest benefit in the developing world, where resourcesfor screening are scarce.75
3: HPV AND CERVICAL CANCER: PUBLIC HEALTH PERSPECTIVESSummary• HPV control, rather than elimination or eradication, should bethe first goal of vaccine programmes• Modelling results indicate that:– Vaccination of men as well as women has little benefitin reducing CC incidence compared to vaccinating womenalone– Vaccine coverage of at least 66% is needed to decreaseCC incidence substantially– A lag-phase of about 60 years and 40 years occurs from theintroduction of vaccination until the full benefits of adecreased incidence of CC and LSIL, respectively, arerealized– Introduction of an HPV vaccine for the purpose of reducingtype-specific LSIL has the potential to save lives76
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THE HEALTH PROFESSIONAL’SHPV HAND
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ContentsList of contributors 7Intro
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Introduction to the HPV Handbook se
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3: HPV AND CERVICAL CANCER: PUBLIC
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Page 26 and 27: 2. HPV testing as a screeningtest:
Page 28 and 29: HPV TESTING AS A SCREENING TEST: TH
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Page 66 and 67: THE POTENTIAL PUBLIC HEALTH IMPACT
Page 80 and 81: Indexadenocarcinoma,detection by HP
Page 82 and 83: INDEXuse in ASCUS 53use to confirm
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HPV HANDBOOK - Zervita

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