Nutzen einer generellen HPV-Impfung bei sexuell aktiven Frauen

Zusammenfassung

Die meisten Zervixkarzinome sind auf die HPV (humane Papillomviren)-Genotypen 16 oder 18, anogenitale Warzen fast immer auf die HPV-Genotypen 6 oder 11 zurückzuführen. In placebokontrollierten Studien ließen sich Infektionen und assoziierte klinische Läsionen durch einen Impfstoff gegen HPV (6, 11, 16, 18) bei primär nicht infizierten Frauen nahezu vollständig verhindern. Neue Daten zeigen jedoch, dass auch Frauen, die sexuell aktiv sind bzw. bereits eine Infektion durchgemacht haben, von der Impfung profitieren. Diese Ergebnisse implizieren den Nutzen einer generellen HPV-Impfung bei sexuell aktiven Frauen.

Summary

Most cervical cancers are caused by human papillomavirus (HPV) genotypes 16 or 18, while almost all the anogenital warts are related to HPV 6 and 11. In placebo-controlled trials, a vaccine against HPV (6, 11, 16, 18) almost completely prevented infections and associated clinical lesions in primarily not infected women. Furthermore, new data demonstrate that sexually active women, as well as those with prior infection, also benefit from the vaccine. These results suggest that a general vaccination programme for sexually active women will be beneficial.

Schlüsselwörter

humane Papillomaviren (HPV) - Zervixkarzinom - Kondylome - HPV-Impfung

Keywords

human papillomavirus (HPV) - cervical cancer - condyloma - HPV vaccination

Literatur

• 1 Barr E, Sings H L. Prophylactic HPV vaccines: New interventions for cancer control. Vaccine 2008 doi:10.1016/j.vaccine.2008.07.056
• 2 Evander M, Edlund K, Gustafsson A. et al . Human papillomavirus infection is transient in young women: a population-based cohort study.  J Infect Dis. 1995;  171 1026-1030
• 3 Ferris D, Garland S. for the Quadrivalent HPV Vaccine Investigators .Evaluation of quadrivalent HPV 6/11/16/18 vaccine efficacy against cervical and anogenital disease in subjects with prior vaccine HPV type infection. Kuala Lumpur (Malaysia); 13th International Congress on Infectious Diseases 19.-22. Juni 2008
• 4 Garland S M, Hernandez-Avila M, Wheeler C M, Perez G, Harper D M, Leodolter S. et al . Quadrivalent vaccine against human papillomavirus to prevent anogenital disease.  N Engl J Med. 2007;  356 1928-19435
• 5 Harper. et al . Sustained immunogenicity and high efficacy against HPV-16/18 related cervical neoplasia: Long-term follow up through 6.4 years in women vaccinated with Cervarix (GSK’s HPV 16/18 AS04 candidate vaccine).  Gynecol Oncol. 2008;  109 158-159
• 6 Ho G YF, Bierman R, Beardsley L, Chang C J, Burk R D. Natural history of cervicovaginal papillomavirus infection in young women.  N Engl J Med. 1998;  338 423-438
• 7 Jansen K U, Shaw A R. Human papillomavirus vaccines and prevention of cervical cancer.  Annu Rev Med. 2004;  55 319-331
• 8 Joura E A, Leodolter S, Hernandez-Avila M, Wheeler C M, Perez C, Koutsky L A. et al . Efficacy of a quadrivalent prophylactic human papillomavirus (types 6,11, 16,18)L1 virus-like particle vaccine against high-grade vulval and vaginal lesions: a combined analysis of three clinical trials.  Lancet. 2007;  369 1693-1702
• 9 Kjaer S K, Breugelmanns G, Munk, Junge J, Watson M, Iftner T. Population- based prevalence, type- and age-specific distribution of HPV in women before introduction of an HPV-vaccination program in Denmark.  Int J Cancer. 2008;  123 1864-1870
• 10 Lacey C JN. for the Gardasil Phase III Investigators .Continued efficacy of quadrivalent HPV (types 6/11/16/18) L1 VLP vaccine in preventing cervical or external genital disease: 4 years of follow-up. Lissabon, Portugal; 20th European College of Obstetrics and Gynecology 4.-8. März 2008
• 11 Melnikow J, Nuovo J, Willan A R. et al . Natural history of cervical squamous intraepithelial lesions: a meta-analysis.  Obstet Gynecol. 1998;  92 727-735
• 12 Munoz N, Bosch F X, de Sanjose S. et al . International Agency for Research on Cancer Multicenter Cervical Study Group: Epidemiological classification of human papillomavirus types associated with cervical cancer.  N Engl J Med. 2003;  348 518-527
• 13 Munoz N, Bosch F X, Castellsagué X. et al . Against which human papillomavirus types shall we vaccinate and screen? The international perspective.  Int J Cancer. 2004;  111 278-285
• 14 Paavonen J. and the FUTURE II Study Group . Baseline demographic characteristics of subjects enrolled in international quadrivalent HPV (types 6/11/16/18) vaccine clinical trials.  Curr Med Res Opin. 2008;  24 1623-1634
• 15 Parkin D M, Bray F. Chapter Two: The burden of HPV-related cancers.  Vaccine. 2006;  24 (Suppl 3) S11-25
• 16 Robert-Koch-Institut . Impfung gegen humane Papillomaviren (HPV) für Mädchen von 12 bis 17 Jahren – Empfehlung und Begründung.  Epidemiologisches Bulletin. 2007;  12 97-103
• 17 Pathirana D, Hillemanns P, Petry K -U, Becker N, Brockmeyer N H, Erdmann R. et al . S3-Leitlinie zur Impfprävention HPV-assoziierter Neoplasien.  Chemother J. 2008;  17 120-128
• 18 Paavonen J, Jenkins D, Bosch F X, Naud P, Salmerón J. et al . Efficacy of a prophylactic adjuvanted bivalent L1 virus-like-particle vaccine against infection with human papillomavirus types 16 and 18 in young women: an interim analysis of a phase III double-blind, randomised controlled trial.  Lancet. 2007;  369 2161-70
• 19 Siegrist C A. et al . Human Papillomavirus Immunization in adolescent and young adults.  The Pediatric Infectious Disease Journal. 2007;  26 (11) 979-84
• 20 The FUTURE II Study Group . Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions.  N Engl J Med. 2007;  356 1915-1927
• 21 The FUTURE II Study Group . Prophylactic efficacy of a quadrivalent human papillomavirus (HPV) vaccine in women with virological evidence of HPV infection.  J Infect Dis. 2007;  196 1438-1446
• 22 Verstraeten. et al .Analysis of adverse events of potential autoimmune aetiology in a large integrated safety database of AS04 adjuvant vaccines. Vaccine 2008, Oct 7 (published online ahead)
• 23 Villa L L, Costa RL LR, Petta C A, Andrade R P, Ault K A, Giuliano A R. et al . Prophylactic quadrivalent human papillomavirus (types 6, 11, 16, 18) L1 virus-like particle vaccine in young women: a randomised double-blind placebo-controlled multicentre phase II efficacy trial.  Lancet Oncol. 2005;  6 271-278
• 24 Walboomers J MM, Jacobs M V, Manos M M. et al . Human papillomavirus is a necessary cause of invasive cervical cancer worldwide.  J Pathol. 1999;  189 12-19
• 25 Wiley D J, Douglas J, Beutner K, Cox T, Fife K, Moscicki A B. et al . External genital warts; diagnosis, treatment and prevention.  Clin Infect Dis. 2002;  35 (Suppl 2) S210-224
• 26 zur Hausen H. Condylomata acuminata and human genital cancer.  Cancer Res. 1976;  36 794