hpv vaccination - infectious diseases - home · 2016. 5. 24. · hpv vaccination : 10 years...
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HPV vaccination
Béatrice Swennen, MD, MPH
PROVAC Ecole de Santé Publique – ULB
Diagnostic et surveillance maladies infectieuses, 19 mai 2016
Malik H; 2014 Arch Virol
HPV L1 Virus Like Particle
Bivalent HPV (bHPV) Quadrivalent HPV (qHPV)
Nonavalent HPV (9HPV)
Cervarix© Gardasil© Gardasil 9©
Antigen L1-HPV16 L1-HPV18
L1-HPV6 L1-HPV11 L1-HPV16 L1-HPV18
L1-HPV6 L1-HPV11 L1-HPV16 L1-HPV18 L1-HPV31 L1-HPV33 L1-HPV45 L1-HPV52 L1-HPV58
Host for antigen preparation
Hi-5 Baculovirus Yeast Saccharomyces cerevicae
Yeast Saccharomyces cerevicae
Adjuvant AS04 Alum Alum
Schema 3 doses 2 doses
0-1-6 months since 9 years 0-6 young girls 9-14y
0-2-6 months since 9 y 0-6 young girls 9-14y
0-2-6 months since 9 y 0-6 months, 0-12 months Young 9-13 Y (in study)
EMA licensed Belgium Drugstore Vaccination Program
2007 2007 FWB 2011, VL 2015
2007 2007 VL 2010
2015 2016?
HPV Vaccination : 10 years programme
• Programme « Girls - Women vaccination » • Target : prevention of Cervical carcinoma and persistent infection
• Secondary : reduction of genital warts
• Population impact has been demonstrated
• Duration of protection for 9 years for both vaccines
• 2 doses schedule for 9-14 years of age
Arbyn et al, J Pathol 2014
Countries with HPV vaccine in the national immunization programme
* Includes partial introduction
Data source: WHO/IVB Database, as of 12 April 2016
Map production Immunization Vaccines and Biologicals (IVB),
World Health Organization
The boundaries and names shown and the designations used on this map do not imply the
expression of any opinion whatsoever on the part of the World Health Organization
concerning the legal status of any country, territory, city or area or of its authorities, or
concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent
approximate border lines for which there may not yet be full agreement. ©WHO 2016. All
rights reserved.
Introduced* to date (66 countries or 34%)
Not Available,
Not Introduced/No Plans (128 countries or 66%)
Not applicable
Girls and Women >50% vaccine Coverage Girls and Women >50% vaccine Coverage
Change in genital warts diagnosis during the first 4 years after introduction qHPV
WOMEN
Drolet et al, Lancet Infect Dis 2015
Change in genital warts diagnosis during the first 4 years after introduction qHPV
Girls and Women >50% vaccine Coverage Girls and Women >50% vaccine Coverage
MEN
Drolet et al, Lancet Infect Dis 2015
Crude prevalence of HPV before and after vaccine implementation
Crude prevalence of individual high-risk HPV types
Laczano, Vaccine 2013
Efficacy of bHPB and qHPV vaccines
Increased role of HPV in several cancer
• Ano-genital area in both men and women • 100% of cervical cancer
• 80% of anal cancer
• 43% of vulvar cancer
• 70% of invasive vaginal carcinomas
• 50% of penile
• 70% of the oropharyngeal squamous cell carcinoma (1/3 of Head & Neck cancer
Lovie K et al ; Oral Oncology, 2015; 51:341
Trends in H&N cancers in England 1995 to 2011 up to 2025
Future of HPV vaccination
• 9Valent vaccine • L1-HPV6, L1-HPV11
• L1-HPV16 ,L1-HPV18, L1-HPV31, L1-HPV33, L1-HPV45, L1-HPV52, L1-HPV58
• Universal vaccination?
• Group at risk vaccination MSM?
Arbyn et al, J Pathol 2014
9 HPV
Joura et al ;Cancer Epidemiol Biomarkers Prev; 2014
HPV in men and rationale for immunization
• Total burden of HPV associated deseases in Men < in Women
• In Europe: estimated cases per year • Penis cancer : 1100 • Anal Cancer : 1600 • Head and Neck : 11.600 • Genital warts : 329.000
• Prevalence of infection in men doesn’t varied by age
• Men are constantly reinfected (no good immune protection induced from natural infection)
• No screening programme for infection in men
• MSM are at higher risk of HPV infection (no effect of women vaccination)
HPV prevalence at enrollment by age: any oncogenic HPV infection (Mexico)
Anna R. Giuliano et al. Cancer Epidemiol Biomarkers Prev 2008;17:2036-2043
Universal vaccination?
• Protect men and women against HPV related ano-genital cancer and reduce burden in both genders
• Accelerate control of HPV vaccine type circulation (elimination of HPV vaccine strains)
• Reduce Gender and social inequalities
Fig. 2. Reduction of the remaining HPV-16,-18-anal cancer burden in females and males in Europe through
female-only HPV vaccination and universal HPV vaccina-tion (age 12 years, 70% VCR).