Opportunities to improve immune-based prevention of HPV-associated cancers

Peter L. Stern , Richard BS. Roden
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引用次数: 11

Abstract

Immunization of adolescent girls with VLP vaccines, made of L1 proteins from the most medically significant high risk HPV types, is a major strategy for prevention of cervical cancer plus other HPV-associated cancers. Maximal population impact, including through herd immunity, requires high vaccination coverage. However, protection of unvaccinated women requires secondary prevention through cytology screening. Unfortunately in countries with the highest incidence/mortality due to cervical cancer HPV vaccination (or cytology screening) is not sufficiently available. Vaccination programme costs and a lack of accessibility of the populations for immunization remain significant hurdles. Several approaches could increase effective implementation of HPV vaccination. 1) Use of a single immunization of the current VLP vaccines. 2) Vaccination bundled with other paediatric vaccines with lower dosage to facilitate delivery, improve coverage and reduce costs through established logistics. 3) Local manufacture with lower cost systems (e.g. bacteria) for VLP or capsomer based vaccine production and utilization of additional protective epitopes (e.g L2) for increasing breadth of protection. However, all the latter need appropriate clinical validation. Gender neutral vaccination and extending routine vaccination strategies to women up to age 30 years in combination with at least one HPV screening test can also hasten impact on cancer incidence.

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改善hpv相关癌症免疫预防的机会
为少女接种VLP疫苗是预防宫颈癌和其他HPV相关癌症的主要策略,该疫苗由医学上最重要的高危HPV类型的L1蛋白制成。最大程度的人口影响,包括通过群体免疫,需要很高的疫苗接种覆盖率。然而,保护未接种疫苗的妇女需要通过细胞学筛查进行二级预防。不幸的是,在宫颈癌发病率/死亡率最高的国家,人乳头瘤病毒疫苗接种(或细胞学筛查)不足。疫苗接种规划的费用和人口无法获得免疫接种仍然是重大障碍。有几种方法可以提高HPV疫苗接种的有效实施。1)使用当前VLP疫苗的单次免疫。2)与其他剂量较低的儿科疫苗捆绑接种,以通过既定的物流便利交付、提高覆盖率和降低成本。3)本地生产低成本系统(如细菌)用于VLP或基于覆膜体的疫苗生产,并利用额外的保护性表位(如L2)以增加保护的广度。然而,后者都需要适当的临床验证。性别中立的疫苗接种和将常规疫苗接种策略扩展到30岁以下的妇女,并结合至少一项HPV筛查检测,也可以加速对癌症发病率的影响。
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审稿时长
14 weeks
期刊介绍: The official Journal of the International Papillomavirus Society Papillomavirus Research (PVR), the Journal of HPV and other Small DNA Tumor Viruses publishes innovative papers related to all aspects of papillomaviruses and other small DNA tumor viruses. The official journal of the International Papillomavirus Society, PVR is an open access publication that aims to bring together virologists, immunologists, epidemiologists and clinicians working in the booming field of HPV and animal papillomaviruses, polyomaviruses and other small DNA tumor viruses and their associated diseases, in order to foster and facilitate interdisciplinary communication. The journal welcomes original research articles, reviews, short communications, opinion articles and regional update reports on papillomaviruses and other tumor viruses in the following sections: a. Biology of papillomaviruses and related viruses from life cycle to cancer b. Epidemiology etiology and natural history studies c. Natural and induced immunity including vaccine research d. Intervention studies and strategies including i. Clinical studies and trials ii. HPV treatments iii. HPV vaccination programs iv. Diagnostics and screening e. Infection and disease prevention, modeling studies f. Guidelines and public health recommendations g. HPV Studies in special populations Regional and local studies on these viruses.
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