A scientific report published by the European Centre for Disease Prevention and Control (ECDC) finds that vaccination against the Human Papillomavirus (HPV) is an effective prevention strategy against cervical cancer. Available HPV vaccines protect against two high-risk HPV types that are estimated to be responsible for 73% of cervical cancer cases in Europe, and are spread by sexual contact.
The report identifies young adolescent girls who have not yet become sexually active as the key group to be vaccinated, though “catch-up programmes” for slightly older girls could be helpful in bringing forward the benefits of the vaccine. The report nonetheless stresses that vaccination is complementary to cervical cancer screening and that a strong emphasis on national screening programmes must be maintained. While the ECDC report provides evidence on when and how HPV vaccination programmes could be effective, decisions on whether to introduce them lie with the EU Member States. A number of countries are considering introducing HPV vaccination programmes, and some have already done so.
Speaking at the European Cervical Cancer Summit in Brussels, Professor Johan Giesecke, ECDC’s Chief Scientist said:
“Vaccinating young adolescent girls against the Human Papillomavirus is likely to reduce the number of women who develop cervical cancer, provided that cervical cancer screening programmes are maintained. HPV vaccination programmes do not eliminate the need for cervical cancer screening, even for women who have been vaccinated. Screening and HPV vaccination need to be made to work together in a cost-effective way that produces maximum benefit for women.”
Cervical Cancer and HPV Infections in the EU
Cervical cancer is the second most common cancer after breast cancer among women aged 15-44 years in the EU. Each year, there are around 33 000 cases of cervical cancer in the EU, and 15 000 deaths. The primary cause of cervical cancer is persistent infection of the genital tract by a high-risk HPV type.
Policy options for health decision makers
ECDC produced its report on HPV vaccines at the request of the European Commission and several of the EU Member States. The purpose of the report is to assist Member States in decision making on the introduction of HPV vaccines by reviewing evidence of their likely public health impact and setting out policy options arising from the evidence. Coordinated by ECDC, a panel of independent experts was set up to conduct this analysis. The conclusions of this panel were then reviewed by ECDC scientists and ECDC’s Advisory Forum (which brings together senior scientists from the Member States).
The two HPV vaccines that have been developed, Gardasil® (manufactured by Sanofi Pasteur MSD) and Cervarix® (manufactured by GlaxoSmithKline Biologicals), were reviewed by the panel. Both protect against HPV types 16 and 18, the viruses that are responsible for an estimated 73% of cervical cancer cases in Europe. The panel concluded that the maximum benefit from these vaccines would be found in giving them to young adolescent girls before they become sexually active.
The exact age range of this group will vary from country to country, depending on the average age at which girls become sexually active, but will typically be in the range of 12-15 years old. Because it takes decades for cervical cancer to develop, the public health benefits of vaccinating adolescent girls will not start to show for many years. Cervical cancer screening programmes will need to be continued for the older generations of women who have not been vaccinated, and even for the generation that is vaccinated, as there will still be a risk (albeit a lower one) of developing cervical cancer due to an infection with HPV types other than 16 and 18.
The report finds school-based immunisation is likely to be the lowest cost option for the delivery of vaccines to young adolescent girls, though whether this option is available will vary from country to country. Other settings such as doctors’ surgeries and medical clinics are also considered to be important sites for immunisation.
Cost effectiveness will vary across the Member States
There is evidence from some countries that introduction of HPV vaccination programmes may be cost effective as a cancer prevention measure. However, healthcare costs vary across Europe, so this analysis needs to be done by individual Member States.
Monitoring and evaluation is critical to evaluate the impact
To date, only 5-year follow-up data on the HPV vaccines is available and many questions remain to be answered. Systems to monitor long-term efficacy, vaccine coverage and compliance, integration with other prevention strategies and vaccine safety are therefore considered to be critical in order to evaluate the overall impact of HPV vaccination programmes.
Materials provided by European Centre For Disease Prevention And Control. Note: Content may be edited for style and length.
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