Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide. In the United States, an estimated 14 million persons are newly infected each year.1 Prevalence of any genital HPV is estimated at 42.5 percent among U.S. females aged 14-59 years.2 Although most HPV infections are self-limited and cause no symptoms, persistent infections can cause cervical and other cancers, including anal, oropharyngeal, penile, vaginal, and vulvar, as well as anogenital warts.
Ninety percent of genital warts are caused by HPV types 6 and 11. However, most HPV-associated cancers are caused by HPV types 16 and 18, including 15,000 cases of these cancers in females and 7,000 cases in males each year in the U.S.3 HPV is estimated to be responsible for 40-50 percent of all invasive penile cancers and is associated with almost all cervical cancers. Cervical cancer is the second most common cancer and the fifth leading cause of death in women worldwide with nearly 4,000 dying from this disease in the U.S. each year. Non-lethal morbidity from cervical dysplasia and cancer, and the costs associated with care, are large.4
Three HPV vaccines are licensed by the U.S. Food and Drug Administration (FDA) for use in the United States: a bivalent vaccine targets HPV types 16 and 18, a quadrivalent vaccine targets HPV types 6, 11, 16, and 18, and a nonavalent vaccine targets HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58. All vaccines are licensed for use in females; however, the quadrivalent and nonavalent vaccines are also licensed for use in males. The FDA-approved HPV vaccines have been shown to be safe in multiple published studies. They contain no viral DNA and are bioengineered to contain virus-like particles composed of type-specific HPV L1 protein, the major capsid protein. As of October 2015, more than 80 million doses of the quadrivalent vaccine have been administered in the United States, with no data suggesting significant increases in vaccine-specific adverse effects.
The HPV vaccines appear to be very effective and are useful even in individuals with prior sexual activity because exposure to all HPV vaccine types is uncommon. According to the Advisory Committee on Immunization Practices (ACIP)5 and U.S. professional organizations, including the American Committee on Gynecology and Obstetrics6 and the American Academy of Pediatrics,7 it is recommended that the vaccine series be administered to U.S. girls and boys at the target age of 11 or 12 years. The duration of vaccine-induced antibodies are known to be at least 9 years. Clinical studies demonstrate a high degree of efficacy in preventing genital lesions and intraepithelial neoplasia associated with HPV vaccine types.
Based on the prevalence and significance of HPV infection and its sequelae as well as the safety and efficacy of HPV vaccines, the American Urological Association (AUA) supports routine immunization with HPV vaccine for boys and girls 11 through 12 years of age. In 2018, the FDA recommended the expanded use of vaccines in women and men age 27 through 45 after reviewing effectiveness and safety. Therefore, the AUA recommends the vaccination of others not previously vaccinated aged 13 through 45 years in accordance with national recommendations from ACIP5 and the FDA.8
1 Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis 2013;40:187-93.
2 Hariri S, Unger ER, Sternberg M, et al. Prevalence of genital human papillomavirus among females in the United States, the National Health And Nutrition Examination Survey, 2003-2006. J Infect Dis 2011;204:566-73.
3 Saraiya M, Unger ER, Thompson TD, Lynch CF, Hernandez BY, Lyu CW, et al. US assessment of HPV types in cancers: implications for current and 9-valent HPV vaccines. HPV Typing of Cancers Workgroup. J Natl Cancer Inst 2015; doi: 10.1093/jnci/djv086
4 U.S. Cancer Statistics Working Group. United States cancer statistics: 1999-2010 incidence and mortality web-based report. Atlanta (Ga); Bethesda (MD): Centers for Disease Control and Prevention; National Cancer Institute; 2013. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6115a2.htm
5 Advisory Committee on Immunization Practices, Current HPV Vaccine Recommendations: http://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/hpv.html
6 American College of Gynecology and Obstetrics. Opinion #641, September 2015: http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Adolescent-Health-Care/Human-Papillomavirus-Vaccination
7 American Academy of Pediatrics. 2015 Red Book: http://redbook.solutions.aap.org/chapter.aspx?sectionId=88187200&bookId=1484&resultClick=1
8 Food and Drug Administration. 2018. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm622715.htm
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