Prevention of Human Papillomavirus Infections and Associated Diseases by Vaccination: A New Hope for Global Public Health
Prevention of Human Papillomavirus Infections and Associated Diseases by Vaccination: A New Hope for Global Public Health
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DOI：
10.1159/000214922
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发表时间：
2009-01-01
影响因子：
1.7
通讯作者：
Harper, Diane M.
中科院分区：
文献类型：
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作者：
Harper, Diane M.
Cervarix（R）和Gardasil（R）是两种人乳头瘤病毒（HPV）疫苗，已在全球范围内获得批准，并在年轻的青春期妇女中实施，希望在几十年后降低宫颈癌的发病率。该计划依赖于“免疫桥接”的概念：在年轻青少年中产生的抗体滴度与HPV初治的16至26岁女性中产生的抗体滴度相同或更高，该人群的疗效得到了证实。同样，实现年轻少女接种疫苗后宫颈癌发病率的下降取决于疫苗效力的持续时间和达到的人口覆盖率。在我们耐心等待青少年疫苗接种计划的结果时，新发布的数据表明，既往暴露于HPV的年轻成年女性的疫苗免疫原性和有效性与青少年相同或上级。有限的疗效数据支持的免疫桥接概念，有可能在短短几年内减少性活跃的年轻成年女性的宫颈癌前体，这是一个仅次于青少年的人群。HPV疫苗不具有治疗性。两种疫苗都不能抑制已经感染HPV的基底上皮细胞，该细胞继续将分化的上皮层转化为宫颈发育不良。不过，临床上的希望已经得到早期数据的支持，即这些疫苗能够中和来自自身接种感染和宫颈以外其他器官感染的宿主组织中的HPV病毒粒子，从而使这些疫苗有可能预防阴茎、阴道、外阴、肛门、口腔和口咽等不太常见的HPV相关癌症。在3-6.4年的II期和III期随机对照试验中，两种疫苗均显示出总体安全性。Cervarix和Gardasil的上市后监测继续表明，尽管很少发生严重事件，但它们对大多数女性是安全的。版权所有（C）2009 S. Karger AG，巴塞尔
Cervarix(R) and Gardasil(R), 2 human papillomavirus (HPV) vaccines, have been approved and implemented globally in young adolescent women with the hope of reducing the incidence of cervical cancer several decades hence. This program is dependent on the concept of 'immunobridging': antibody titers generated in young adolescents that are the same or higher than generated in HPV-naive 16- to 26-year-old women, the population in which efficacy is proven. Likewise, realizing a decline in cervical cancer from young adolescent female vaccination depends on the duration of vaccine efficacy, and the population coverage reached. While we patiently wait for results from our young adolescent vaccination programs, newly released data indicates that the immunogenicity and efficacy of the vaccines for young adult women with prior HPV exposure is equal or superior to that seen for young adolescents. This same concept of immunobridging supported by limited efficacy data offers the potential to reduce cervical cancer precursors within just a few years in our young sexually active adult women, a population secondary to our young adolescents. The HPV vaccines are not therapeutic. Neither vaccine will inhibit an already HPV-infected basal epithelial cell which continues to transform differentiated epithelial layers into cervical dysplasias. There is a clinical hope, though, already supported by early data, that the vaccines are capable of neutralizing HPV virions in host tissues from both auto-inoculated infections and infections in other organs than the cervix, thereby making it possible for these vaccines to prevent less common HPV-associated cancers of the penis, vagina, vulva, anus, oral cavity and oro-pharynx. Both vaccines have been shown to be generally safe in the phase II and phase III randomized controlled trials over 3-6.4 years. Post-marketing surveillance of Cervarix and Gardasil continues to show that they are safe for most women despite rarely occurring serious events. Copyright (C) 2009 S. Karger AG, Basel