Efficacy and Safety of HPV-Vaccinationgerman translation / full article
A few years ago vaccination against Human Papilloma Virus was approved in the European Union as the first „vaccination against cancer“. What is current best evidence regarding the efficacy and safety of the HPV-vaccination? Can it be generally recommended? Who should be vaccinated and how often?
The efficacy of vaccination against HPV-types 6, 11, 16 and 18 has been shown in several randomised controlled trials regarding the prevention of HPV-infections and cervical intraepithelial neoplasias (CIN). The NNV (number needed to vaccinate) is about 1600 to prevent one CIN. Genital warts can also be prevented by the quadrivalent vaccine. It is still unclear, however, whether the vaccination also leads to a reduction of invasive cervical cancer. Due to incomplete cross-immunity against other oncogenic HPV-types regular pap-smears need to be maintained inspite of the vaccination. After far more than 50 million vaccinations applied, a high level of safety can be attributed to the HPV-vaccination. Serious adverse drug events are extremely rare and could not be causally associated to the vaccination with certainty. Considering the overpriced vaccine and the continued necessity of pap-smears, the cost-benefit ratio appears to be negative in developed countries. In developing countries a lower price has been negotiated with the producer which may result in a positive cost-benefit ratio there. Up to now it is unclear how long immunity persists after two or three vaccinations.