HPV VACCINATION: Why does the door to a splendid future still remain closed?

HPV genital infections are the most frequent sexually transmitted infections of viral origin and definitely represent a global burden with significant oncogenic potential. HPV infection causes external genital warts, and some HPV types are strongly associated with cancer or precancerous lesions. HPV induced cancers are mostly (but not only!) those of the ano-genital region, such as cervical, anal, vulvar, penile cancer, etc., but the cancers of the mouth and/or throat are also included.

HPV infection causes external genital warts, and some types of HPV are strongly associated with cancer or precancerous lesions. This all can be effectively and safely prevented by HPV vaccination, but vaccination rates are still too low to permanently break the chain of infection – which means the door to a ‘splendid future’ is still not widely open! At the 27th EADV Congress that opened in Paris today, the EADV called for new information policies and target group-specific communication strategies to achieve an adequate level of vaccination within the population.

External genital warts could now be effectively prevented by administering the quadrivalent (4v) or nonavalent (9v) vaccines that protect against HPV variants 6, 11, 16,18 (4v), and additionally against 31, 33, 45, 52, 58 (9v) strains that most frequently cause warts and cancers. HPV vaccine has been shown to be up to 100% effective in preventing external genital warts. After the introduction of 4v vaccine in Australia, a 4-year follow-up study [1] showed a 59% reduction in the prevalence of external genital warts. A new meta-analysis published in May 2018 [2] examined evidence from more than 70,000 women. It showed that there is “high-certainty evidence that HPV vaccines protect against cervical precancer in adolescent girls and young women aged 15 to 26. The effect is higher for lesions associated with HPV16/18 than for lesions irrespective of HPV type.” What is more, the study did not find an increased risk of serious adverse effects.

Cervical cancer is the most common form of cancer associated with HPV. According to the WHO, there were an estimated 529,000 new cases and 274,00 deaths due to cervical cancer in 2008 [3]. On the WHO website, too, one reads that “Vaccination of girls is recommended as a priority, as part of comprehensive efforts to prevent and control cervical cancer.” [4]

However, HPV vaccination efficacy in preventing infections with high risk HPV types has been proven not only for women and girls, but also for men and boys. It has also been found that men are infected just as frequently with HPV as women, which in turn causes various cancers among men also (penile, anal and oropharyngeal carcinomas). There is definitely no medical reason, therefore, for excluding boys from HPV vaccination programmes. That applies all the more, given that confining HPV vaccination to one gender only makes it much more difficult to achieve herd immunity. For boys and girls alike, HPV vaccination is recommended in early adolescence, at an age of 9–14 years.

Levels of participation in vaccination programmes are still too low in many European countries, however. In Germany, for example, a mere 40% of girls and hardly any boys are vaccinated. According to Professor Harald zur Hausen, the pioneer of HPV vaccination and a winner of the Nobel prize for medicine, 85% of all boys would need to be vaccinated if the HPV infection chain is to be broken [5].

To put it in a nutshell: HPV vaccines have proven to be safe and effective. Most European health systems also offer vaccination without co-payment. So why do the doors to a splendid future without genital warts and HPV-associated cancers still remain closed? Professor Mihael Skerlev, Croatia, Chairman of the EADV taskforce for HPV infection, as well as Prof. Gerd Gross, Germany and Prof. Arne Wikström, Sweden, on behalf of the whole team, attribute the low rate of vaccination to a lack of information within the population. “People are not sufficiently informed about the health benefits of vaccination. The health authorities do not seem to have realised the cost savings that vaccination can produce for the health systems, even direct and immediate cost savings, over and beyond the prevention of cancer, simply as a result of a declining incidence of external genital warts. That would lead to a massive reduction in clinic workload and huge savings.”

The EADV appeals for information campaigns that reach boys and girls directly, via the social media, for example. “It can’t be right that we have effective preventive measures against genital warts and HPV-associated tumours, but that this is not known to the target group, namely young teenagers”, says Skerlev. At the Annual Congress in Paris, which opened today, the EADV called for new information policies aimed at an adequate level of vaccination within the population, in order to break the HPV infection chains once and for all.

References

[1] Ali H, Donovan B, Wand H, Read TR, Regan DG, Grulich AE, Fairley CK, Guy RJ. Genital warts in young Australians five years into national human HPV vaccination programme: national surveillance data. BMJ. 2013; 346: f2032

[2] https://www.ncbi.nlm.nih.gov/pubmed/29740819

[3] http://www.who.int/immunization/topics/hpv/en/

[4] http://www.euro.who.int/en/health-topics/disease-prevention/vaccines-an…

[5] https://www.aerzteblatt.de/nachrichten/95785/Impfkommission-empfiehlt-H…

Founded in 1987, EADV is a non-profit association whose vision is to be the premier European Dermato-Venereology Society, with the key aims of improving the quality of patient care, providing continuing medical education (CME) for all Dermato-Venereologists in Europe, and advocacy on behalf of the specialty and patients.

www.eadv.org