Since vaccines against human papillomavirus (HPV) were made available in Europe in 2006, they have been highly effective in preventing infection and disease caused by strains of HPV covered by the vaccine types, and the European Society of Gynecologic Oncology and the European Federation for Colposcopy strongly support gender-neutral vaccination programs for children and young adolescents, according to a position paper published in the European Journal of Cancer.
Available clinical efficacy and real-world data are summarized and discussed in the position paper, revealing that disease reduction is best with early vaccination and coverage of more than 70%. Also, gender-neutral vaccination programs not only provide direct protection for all men but also improve coverage.
In terms of implementation, the most effective programs appear to be school-based, and the recommendation is for 2 doses at an interval of 6 to 12 months to children younger than 15 years. After age 15 years, the standard 3-dose regime is recommended. Further, a broad catch-up program of young adults, both men and women, also improves effectiveness.
The HPV vaccines also appear to be effective in sexually active individuals of both sexes with previous, cleared infections. Along with local treatment of HPV-related disease, vaccination also appears reduce recurrent or subsequent HPV-related disease. The study authors noted, however, that the most effective approach to cervical cancer prevention is a combination of HPV vaccination and screening, and that screening intervals may increase in vaccinated cohorts.
According to the study authors, the upper age limit for vaccination is not yet known and will be country-specific and depend on cost-efficacy. However, they also believe that, “the infrastructure required for national vaccination is far more easily implemented than national call and recall screening programs, with high coverage making prevention more accessible in low-income settings.”
The researchers also stated that the vaccines have “excellent safety profiles,” and population-based data from vaccinated cohorts in the real world, outside of clinical trials, prove the effectiveness of the vaccines, especially in those countries with good coverage. The researchers concluded that, “with the introduction of HPV vaccination and the increased accuracy of HPV testing in primary screening, there is the potential to almost eliminate cervical cancer.” Therefore, the European Society of Gynecologic Oncology supports gender-neutral vaccination programs for children and young adolescents and, if feasible, a catch-up program for young adults.
Joura EA, Kyrgiou M, Bosch FX, et al. Human papillomavirus vaccination: The ESGO-EFC position paper of the European society of Gynaecologic Oncology and the European Federation for colposcopy. Eur J Cancer. 2019;116:21-26.