Eradication of human papillomavirus and elimination of HPV-related diseases – scientific basis for global public health policies

ABSTRACT

Introduction: Infections with oncogenic human papillomaviruses (HPV) globally cause about 9% of cancers in females and 1% of cancers in males. HPV disease burden can be effectively controlled by prophylactic HPV-vaccination provided it has high impact.

Areas covered: A unique series of biobank-based and health registry-based studies that exploit randomized intervention cohorts has provided data on population-level safety of HPV vaccination, duration of vaccine-induced protection and impact of gender-neutral HPV vaccination, providing a scientific basis for policies to eradicate oncogenic HPV types and associated diseases worldwide.

Expert commentary: The ultimate goal of HPV vaccination is the eradication of high-risk (hr) HPVs. Seventy-five percent coverage gender-neutral vaccination of early adolescents will rapidly eradicate also HPV16 from the general population.

KEYWORDS:

• Cancer
• eradication
• gender-neutral vaccination
• human papillomavirus
• herd effect
• impact
• resilience
• safety
• vaccine efficacy

Article highlights

• Safety – Health registry-based follow up of both large scale randomized trials and HPV vaccination programs have found no evidence of increased occurrence of new onset autoimmune diseases of adverse pregnancy outcomes.

• Immunogenicity – Resilience of antibody response post-vaccination has been described up to 15 years post-vaccination for all licensed HPV vaccines albeit with differences in the sustained antibody levels

• Long-term efficacy – No HPV-associated cancer cases have been identified in cohorts vaccinated with the bivalent or the quadrivalent HPV vaccine while unvaccinated females have been diagnosed with a significantly higher incidence of HPV-associated cancers.

• Impact of different vaccination strategies – A community-randomized trial shows that low to moderate coverage gender-neutral vaccination rapid establishes herd effect and overall protection against high-risk HPV types 18/31/33/35 but not against HPV16.

• Eradication – State of the science mathematical models predict that eradication of high-risk HPV types is possible if the gender-neutral vaccination program has 70% coverage in both sexes.

Declaration of interest

The author has previously received grants for his HPV vaccination studies from Merck & Co. Inc. and GSK vaccines through his employer University of Tampere, Finland.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was supported by funding from the Academy of Finland, EU Framework program 7 (CoheaHr Network), grant agreement number: 603019. The funder had no role in the conceptualization, design, data collection, analysis, decision to publish, or preparation of the manuscript.