HPV vaccination

Béatrice Swennen, MD, MPH

PROVAC Ecole de Santé Publique – ULB

Diagnostic et surveillance maladies infectieuses, 19 mai 2016

Malik H; 2014 Arch Virol

HPV L1 Virus Like Particle

Bivalent HPV (bHPV) Quadrivalent HPV (qHPV)

Nonavalent HPV (9HPV)

Cervarix© Gardasil© Gardasil 9©

Antigen L1-HPV16 L1-HPV18

L1-HPV6 L1-HPV11 L1-HPV16 L1-HPV18

L1-HPV6 L1-HPV11 L1-HPV16 L1-HPV18 L1-HPV31 L1-HPV33 L1-HPV45 L1-HPV52 L1-HPV58

Host for antigen preparation

Hi-5 Baculovirus Yeast Saccharomyces cerevicae

Yeast Saccharomyces cerevicae

Adjuvant AS04 Alum Alum

Schema 3 doses 2 doses

0-1-6 months since 9 years 0-6 young girls 9-14y

0-2-6 months since 9 y 0-6 young girls 9-14y

0-2-6 months since 9 y 0-6 months, 0-12 months Young 9-13 Y (in study)

EMA licensed Belgium Drugstore Vaccination Program

2007 2007 FWB 2011, VL 2015

2007 2007 VL 2010

2015 2016?

HPV Vaccination : 10 years programme

• Programme « Girls - Women vaccination » • Target : prevention of Cervical carcinoma and persistent infection

• Secondary : reduction of genital warts

• Population impact has been demonstrated

• Duration of protection for 9 years for both vaccines

• 2 doses schedule for 9-14 years of age

Arbyn et al, J Pathol 2014

Countries with HPV vaccine in the national immunization programme

* Includes partial introduction

Data source: WHO/IVB Database, as of 12 April 2016

Map production Immunization Vaccines and Biologicals (IVB),

World Health Organization

The boundaries and names shown and the designations used on this map do not imply the

expression of any opinion whatsoever on the part of the World Health Organization

concerning the legal status of any country, territory, city or area or of its authorities, or

concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent

approximate border lines for which there may not yet be full agreement. ©WHO 2016. All

rights reserved.

Introduced* to date (66 countries or 34%)

Not Available,

Not Introduced/No Plans (128 countries or 66%)

Not applicable

Girls and Women >50% vaccine Coverage Girls and Women >50% vaccine Coverage

Change in genital warts diagnosis during the first 4 years after introduction qHPV

WOMEN

Drolet et al, Lancet Infect Dis 2015

Change in genital warts diagnosis during the first 4 years after introduction qHPV

Girls and Women >50% vaccine Coverage Girls and Women >50% vaccine Coverage

MEN

Drolet et al, Lancet Infect Dis 2015

Crude prevalence of HPV before and after vaccine implementation

Crude prevalence of individual high-risk HPV types

Laczano, Vaccine 2013

Efficacy of bHPB and qHPV vaccines

Increased role of HPV in several cancer

• Ano-genital area in both men and women • 100% of cervical cancer

• 80% of anal cancer

• 43% of vulvar cancer

• 70% of invasive vaginal carcinomas

• 50% of penile

• 70% of the oropharyngeal squamous cell carcinoma (1/3 of Head & Neck cancer

Lovie K et al ; Oral Oncology, 2015; 51:341

Trends in H&N cancers in England 1995 to 2011 up to 2025

Future of HPV vaccination

• 9Valent vaccine • L1-HPV6, L1-HPV11

• L1-HPV16 ,L1-HPV18, L1-HPV31, L1-HPV33, L1-HPV45, L1-HPV52, L1-HPV58

• Universal vaccination?

• Group at risk vaccination MSM?

Arbyn et al, J Pathol 2014

9 HPV

Joura et al ;Cancer Epidemiol Biomarkers Prev; 2014

HPV in men and rationale for immunization

• Total burden of HPV associated deseases in Men < in Women

• In Europe: estimated cases per year • Penis cancer : 1100 • Anal Cancer : 1600 • Head and Neck : 11.600 • Genital warts : 329.000

• Prevalence of infection in men doesn’t varied by age

• Men are constantly reinfected (no good immune protection induced from natural infection)

• No screening programme for infection in men

• MSM are at higher risk of HPV infection (no effect of women vaccination)

HPV prevalence at enrollment by age: any oncogenic HPV infection (Mexico)

Anna R. Giuliano et al. Cancer Epidemiol Biomarkers Prev 2008;17:2036-2043

Universal vaccination?

• Protect men and women against HPV related ano-genital cancer and reduce burden in both genders

• Accelerate control of HPV vaccine type circulation (elimination of HPV vaccine strains)

• Reduce Gender and social inequalities

Fig. 2. Reduction of the remaining HPV-16,-18-anal cancer burden in females and males in Europe through

female-only HPV vaccination and universal HPV vaccina-tion (age 12 years, 70% VCR).