Clinical Indications for Human Papillomavirus Vaccination.

With the approval of a vaccine to prevent human papillomavirus (HPV) infection and the pending approval of a second vaccine, an exciting era has dawned that provides clinicians the opportunity to prevent a majority of lower genital tract cancers. Herein, we describe the quadrivalent and bivalent prophylactic HPV vaccines and examine how they can be incorporated into clinical practice. Efficacy and safety of the vaccines are discussed as are potential barriers to vaccination. Future questions and challenges are also reviewed. A quadrivalent virus-like particle vaccine has now been approved for use in girls and women ages 9-26 years. A second bivalent vaccine could be available soon. The development of these vaccines targeted against 2 oncogenic types of HPV infection (HPV 16 and 18) has made it possible to eliminate approximately 70% of all invasive cervical cancers in women worldwide and decrease the incidence of other lower genital tract cancers and precancers. Vaccine efficacy in clinical trials has been outstanding, with nearly 100% protection against high-grade lesions because of HPV vaccine types. It is extremely important that vaccinated and unvaccinated women continue with recommended cervical cancer screening because not all oncogenic HPV types are covered in currently developed vaccines. Prevention of most cervical cancer and a notable proportion of cervical precancers and other lower genital tract cancers is now possible with the clinical availability of prophylactic vaccination for girls and young women. Prevention of genital warts is also possible with the quadrivalent vaccine. However, knowledge about HPV infection and cervical cancer as well as the need to vaccinate against oncogenic HPV infection is still lacking among women and physicians; thus, continued education of patients and clinicians is necessary to optimize vaccine use and assure ongoing cytologic screening. [ABSTRACT FROM AUTHOR]