Reduced dose human papillomavirus vaccination: An update of the current state-of-the-art

Zheng Quan Toh, Paul Licciardi, James Fong, Suzanne Garland, Sepehr Tabrizi, Fiona Russell, Edward (Kim) MULHOLLAND

    Research output: Contribution to journal › Article

    Abstract

    Human papillomavirus (HPV) infection is the primary cause of genital warts, some oropharyngeal cancers and anogenital cancers, including cervical, vagina, vulvar, anal and penile cancers. Primary prevention of cervical cancer requires the prevention of high-risk HPV infections, particularly HPV genotypes 16 and 18. Both Gardasil®  and Cervarix®  vaccines when administered by a three-dose schedule have been demonstrated to be effective against cervical, vulva, and vaginal cancer precursors from vaccine genotypes in phase III clinical trials, and post-marketing studies; Gardasil®  vaccine also offers additional protection against anal cancer precursors. However, high costs of HPV vaccines and the logistics of delivering a three-dose schedule over 6 months are challenging in countries with limited resources. Several studies have demonstrated non-inferiority in antibody response between adolescents (9-15 years old) who received two doses (6 months apart) and women (>15 years old) who received the standard three-dose schedule. These studies provided evidence for the World Health Organization and European Medical Association to revise its recommendation to give two instead of three doses of HPV vaccine to adolescents below 15 years of age, provided the 2nd dose is given 6 months apart. Although reduced dose schedules can alleviate costs and logistics associated with HPV vaccination, especially in resource-poor countries, there are still gaps in this area of research, particularly regarding long-term protection. This review discusses the findings on antibody response and clinical outcomes in studies evaluating reduced dose HPV schedules, and highlights the important considerations of its implementation. In addition, other important immunological biomarkers that may be associated with long-term protection are highlighted and discussed. 
    Original languageEnglish
    Pages (from-to)5042-5050
    Number of pages9
    JournalVaccine
    Volume33
    Issue number39
    DOIs
    Publication statusPublished - 2015

    Fingerprint

    Papillomaviridae
    Appointments and Schedules
    Vaccination
    vaccination
    Vaginal Neoplasms
    Uterine Cervical Neoplasms
    Vulvar Neoplasms
    Anus Neoplasms
    Papillomavirus Vaccines
    dosage
    Papillomavirus Infections
    Antibody Formation
    uterine cervical neoplasms
    Genotype
    Penile Neoplasms
    Oropharyngeal Neoplasms
    Costs and Cost Analysis
    vaccines
    Human papillomavirus 18
    Condylomata Acuminata

    Cite this

    Toh, Z. Q., Licciardi, P., Fong, J., Garland, S., Tabrizi, S., Russell, F., & MULHOLLAND, E. K. (2015). Reduced dose human papillomavirus vaccination: An update of the current state-of-the-art. Vaccine, 33(39), 5042-5050. https://doi.org/10.1016/j.vaccine.2015.07.102
    Toh, Zheng Quan ; Licciardi, Paul ; Fong, James ; Garland, Suzanne ; Tabrizi, Sepehr ; Russell, Fiona ; MULHOLLAND, Edward (Kim). / Reduced dose human papillomavirus vaccination : An update of the current state-of-the-art. In: Vaccine. 2015 ; Vol. 33, No. 39. pp. 5042-5050.
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    Toh, ZQ, Licciardi, P, Fong, J, Garland, S, Tabrizi, S, Russell, F & MULHOLLAND, EK 2015, 'Reduced dose human papillomavirus vaccination: An update of the current state-of-the-art', Vaccine, vol. 33, no. 39, pp. 5042-5050. https://doi.org/10.1016/j.vaccine.2015.07.102

    Reduced dose human papillomavirus vaccination : An update of the current state-of-the-art. / Toh, Zheng Quan; Licciardi, Paul; Fong, James; Garland, Suzanne; Tabrizi, Sepehr; Russell, Fiona; MULHOLLAND, Edward (Kim).

    In: Vaccine, Vol. 33, No. 39, 2015, p. 5042-5050.

    Research output: Contribution to journal › Article

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    AU - Toh, Zheng Quan

    AU - Licciardi, Paul

    AU - Fong, James

    AU - Garland, Suzanne

    AU - Tabrizi, Sepehr

    AU - Russell, Fiona

    AU - MULHOLLAND, Edward (Kim)

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    N2 - Human papillomavirus (HPV) infection is the primary cause of genital warts, some oropharyngeal cancers and anogenital cancers, including cervical, vagina, vulvar, anal and penile cancers. Primary prevention of cervical cancer requires the prevention of high-risk HPV infections, particularly HPV genotypes 16 and 18. Both Gardasil®  and Cervarix®  vaccines when administered by a three-dose schedule have been demonstrated to be effective against cervical, vulva, and vaginal cancer precursors from vaccine genotypes in phase III clinical trials, and post-marketing studies; Gardasil®  vaccine also offers additional protection against anal cancer precursors. However, high costs of HPV vaccines and the logistics of delivering a three-dose schedule over 6 months are challenging in countries with limited resources. Several studies have demonstrated non-inferiority in antibody response between adolescents (9-15 years old) who received two doses (6 months apart) and women (>15 years old) who received the standard three-dose schedule. These studies provided evidence for the World Health Organization and European Medical Association to revise its recommendation to give two instead of three doses of HPV vaccine to adolescents below 15 years of age, provided the 2nd dose is given 6 months apart. Although reduced dose schedules can alleviate costs and logistics associated with HPV vaccination, especially in resource-poor countries, there are still gaps in this area of research, particularly regarding long-term protection. This review discusses the findings on antibody response and clinical outcomes in studies evaluating reduced dose HPV schedules, and highlights the important considerations of its implementation. In addition, other important immunological biomarkers that may be associated with long-term protection are highlighted and discussed. 

    AB - Human papillomavirus (HPV) infection is the primary cause of genital warts, some oropharyngeal cancers and anogenital cancers, including cervical, vagina, vulvar, anal and penile cancers. Primary prevention of cervical cancer requires the prevention of high-risk HPV infections, particularly HPV genotypes 16 and 18. Both Gardasil®  and Cervarix®  vaccines when administered by a three-dose schedule have been demonstrated to be effective against cervical, vulva, and vaginal cancer precursors from vaccine genotypes in phase III clinical trials, and post-marketing studies; Gardasil®  vaccine also offers additional protection against anal cancer precursors. However, high costs of HPV vaccines and the logistics of delivering a three-dose schedule over 6 months are challenging in countries with limited resources. Several studies have demonstrated non-inferiority in antibody response between adolescents (9-15 years old) who received two doses (6 months apart) and women (>15 years old) who received the standard three-dose schedule. These studies provided evidence for the World Health Organization and European Medical Association to revise its recommendation to give two instead of three doses of HPV vaccine to adolescents below 15 years of age, provided the 2nd dose is given 6 months apart. Although reduced dose schedules can alleviate costs and logistics associated with HPV vaccination, especially in resource-poor countries, there are still gaps in this area of research, particularly regarding long-term protection. This review discusses the findings on antibody response and clinical outcomes in studies evaluating reduced dose HPV schedules, and highlights the important considerations of its implementation. In addition, other important immunological biomarkers that may be associated with long-term protection are highlighted and discussed. 

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    KW - papillomavirus infection

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    Toh ZQ, Licciardi P, Fong J, Garland S, Tabrizi S, Russell F et al. Reduced dose human papillomavirus vaccination: An update of the current state-of-the-art. Vaccine. 2015;33(39):5042-5050. https://doi.org/10.1016/j.vaccine.2015.07.102

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