Top Tips in 2 minutes: human papilloma virus (HPV) vaccines.

Why:Cervical cancer kills just over 1000 women every year in the UK. It is the second most common cancer of women worldwide.
  • Infection with one of 15 high-risk human papilloma viruses (HPVs) is the main cause. Two types, HPV 16 and HPV 18, cause more than 70% of carcinoma of the cervix. HPV 6 and 11 cause genital warts, the commonest sexually transmitted viral infection in the UK.

  • HPV infection is extremely common in young sexually active women. One study showed that it affected 20% of 20–25 year old women. Ninety-three per cent of women attending one STD clinic had at least one type of HPV antibody.

  • It has been estimated that 40% of 15 year olds in England have had sexual intercourse. For effective prophylaxis vaccination should occur before the onset of sexual activity.

How:
  • Two HPV prophylactic vaccines have been developed. These are Cervarix™ a bivalent HPV 16/18 vaccine and Gardasil™ a quadrivalent HPV 16/18/6/11 vaccine. Three doses are needed over a 6-month period. The bivalent vaccine Cervarix has been chosen for the national vaccination programme.

  • It is VITAL that women appreciate that they must have cervical smears as part of the cervical cancer screening programme whether they have been immunised or not. This is because the vaccine will protect against the 70% of cancers caused by HPV 16 and 18 but not the 30% caused by other HPVs.

UK Joint Committee on Vaccination and Immunisation (JCVI) recommended the routine vaccination of girls aged 12–13 years of age starting from September 2008:
  • there will be a 2-year catch-up programme starting Autumn 2009 for girls up to 18 years;

  • girls aged 16–18 years will be offered the vaccine from Autumn 2009; and

  • girls aged 15–17 years will be offered the vaccine from Autumn 2010.

What next and when:Take home messages from the randomised controlled trials of HPV vaccines over 6 years:
  • They are effective in preventing HPV infection.

  • Protective antibodies are found in >98% of patients.

  • Antibody titres are greater than occur in natural infection.

  • They are safe with few side effects. Thirteen million doses have been administered worldwide.

  • The duration of protection is at least 6 years and there are indications that it is likely to be much longer. Follow-up studies are taking place to establish whether a booster dose will be needed

  • There is no data as yet on vaccine efficiency in women aged >26 years.

  • The Joint Committee on Vaccination and Immunisation acknowledge that a catch-up programme for all women aged 18–25 years is unlikely to be cost-effective but could benefit some individual women. The Department of Health is considering this further.

  • It has been recommended that vaccination should be given through schools.

  • No decision has yet been made as to which of the 2 vaccines will be used.

Patient informationhttp://www.patient.co.uk/showdoc/27001148/ on STIs and anogenital warts.
References/Web links:http://www.immunisation.nhs.uk
http://www.bashh.org
More top tips can be found at http://www.addenbrookes-pgmc.org.uk/handouts.asp?title=Primary%20Care
Who are you:Clare Henderson, GP, The Spinney Surgery, St Ives, Cambridgeshire
Robin Crawford, Consultant Gynaecologist, Addenbrookes Hospital, Cambridge.
Date:June 2008
Review dateJune 2010