Prophylactic HPV vaccines: reducing the burden of HPV-related diseases

HPV-associated diseases, such as cervical and other anogenital cancers, cervical and anal intraepithelial neoplasia, genital warts, and recurrent respiratory papillomatosis confer considerable morbidity and mortality, and are significant health care concerns. Successful vaccination strategies that protect against HPV infection are expected to substantially reduce HPV-related disease burden. Prophylactic HPV vaccines in late stages of clinical testing are composed of HPV L1 capsid protein that self-assemble into virus-like particles (VLPs) when expressed in recombinant systems. Proof-of-principle trials have suggested that intramuscular injections of VLPs results in strong adaptive immune responses, both B- and T-cell mediated, that are capable of neutralizing subsequent natural infections. Furthermore, phase 2 trials of a bivalent vaccine designed to protect against high-risk HPV types 16 and 18 and a quadrivalent vaccine designed to protect against HPV 16 and 18, and low-risk, genital wart-causing HPV 6 and 11 have demonstrated that VLP vaccines reduce the incidence of HPV-associated disease in vaccinated individuals. To derive the greatest public health benefit, HPV vaccines offering protection from cervical cancer and genital warts will, ideally, be administered prior to the initiation of sexual activity; therefore, educational initiatives will be essential to communicate the risks and adverse consequences of HPV infection and to foster widespread vaccine acceptance.