Two prophylactic vaccines have been licensed by the FDA and the EMA. Both vaccines protect against new infections with the two most common HPV types in cervical cancer, HPV16 and HPV18 (Gardasil, Merck & Co, NJ, USA; Cervarix, GSK Biologicals, Rixensart, Belgium) . When given to HPV uninfected young women, both vaccines are close to 100% effective against persistent infection with HPV16/18, responsible for 70% of cervical cancer. One of the vaccines includes in addition two low-risk HPV types that are associated with genital warts (HPV6 and HPV11) (Gardasil). Moreover, it has been shown that the vaccines also provide substantial cross-protection against other HPV types involved in cervical cancer, in particular HPV types 31, 33 and 45.
Currently, research is focused on the development of vaccines that offer a protection against a larger range of HPV types than Gardasil and Cervarix. A broad-spectrum HPV vaccine targeting seven high-risk and two low-risk HPV types is currently evaluated in efficacy and safety trials (V503, Merck & co, NJ, USA). The high-risk HPV types included in the broad-spectrum vaccine are associated with 90% of cervical cancers.
Since 2008, 22 European countries have introduced HPV vaccination in routine immunization programmes for girls with target ages between 10-14 years. Catch-up vaccination of older girls in the initial year(s) of the vaccination programmes have also been provided for varying ages but within the range of 15-26 years. Initially, HPV vaccination was only licensed when administered as a three doses series. Recently, evidence emerged that a 2-dose regimen provides similar protection as a 3-dose regimen. Consequently, the WHO and several national programs changed their recommendation from 3-dose to 2-dose vaccination for girls age < 15 years (Weekly Epid. Record (2014,89:221-236)).
New populations that may benefit from HPV vaccination include men and adult women. Male vaccination is currently already incorporated in the school-based immunization programme in Australia. There are no advanced initiatives in Europe yet on male vaccination. Male vaccination may have a direct beneficial effect on HPV-related disease in men (for example anal cancer, or head-and-neck cancers), as well as an indirect effect on cervical cancer by reducing the HPV prevalence in the general population. Female adult vaccination could reduce the acquisition of HPV infections which may allow the use of longer screening intervals and offer novel prevention policy in countries where high-quality regular screening is difficult to realize.