HPV vaccination: new data and indication for secondary prevention

Human papillomaviruses (HPV) cause numerous benign and malignant lesions/tumors of skin and mucosa, including genital warts, recurrent laryngeal papillomatosis (RLP), precancerous lesions, and cancers of the cervix, vulva, vagina, anus, and penis as well as oropharyngeal cancer. Worldwide, 4-5% of all cancers are caused by HPV. Most HPV-associated diseases are vaccine preventable, whereby young age at vaccination or HPV naivety are important. In countries with high HPV vaccination rates among children and adolescents, we are already seeing large reductions in genital warts, high-grade cervical dysplasia (CIN2+), and cervical cancer. Off-label use of HPV vaccination around conization or for present HPV-induced lesions is discussed controversially. Three meta-analyses of HPV vaccination for post-conization prophylaxis show arying degrees of risk reduction for the development of CIN2+ after conization, with only two controlled trials available to date. For RLP, meta-analyses also conclude that off-label HPV vaccination may be useful as adjuvant therapy, but further studies are needed. Elimination of cervical cancer is a World Health Organization (WHO) goal. This requires HPV vaccination rates of 90% in girls up to 15 years of age. Efforts to increase vaccination rates are needed in Germany, where the HPV vaccination rate among 15-year-old girls is only 54%.