Ault Kevin A
Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA.
Obstet Gynecol Surv. 2006 Jun;61(6 Suppl 1):S26-31. doi: 10.1097/01.ogx.0000221187.63574.5c.
Routine vaccination programs have had a substantial impact on reducing the prevalence of a variety of infections diseases. In light of the fact that human papillomavirus (HPV) is a prerequisite for virtually every case of cervical cancer and genital warts occurring worldwide, vaccination may be the most effective mechanism to prevent HPV infection and HPV-associated disease. HPV vaccines are created from noninfectious virus-like particles (VLPs) of the major capsid protein, L1, that closely mimic natural HPV virions. Proof-of-principle trials of monovalent vaccines that protect against high-risk HPV types such as HPV 16 or 18 have confirmed that intramuscular injection with VLPs induces the production of HPV type-specific neutralizing antibodies. A bivalent vaccine incorporating oncogenic HPV types 16 and 18 was shown to be safe, well tolerated, and 100% efficacious in preventing persistent HPV infection. A quadrivalent vaccine that protects against genital wart-causing HPV types (HPV 6 and 11) and oncogenic HPV types (HPV 16 and 18) demonstrated 100% efficacy in preventing clinical disease. Because VLP vaccines are prophylactic, vaccination before exposure to HPV will result in the greatest public health benefit; therefore, a successful vaccination program should target preadolescents and stress the importance of vaccination before sexual debut.
常规疫苗接种计划对降低多种传染病的流行率产生了重大影响。鉴于人乳头瘤病毒（HPV）实际上是全球范围内每一例宫颈癌和尖锐湿疣病例的必要条件，接种疫苗可能是预防HPV感染及HPV相关疾病的最有效机制。HPV疫苗由主要衣壳蛋白L1的无感染性病毒样颗粒（VLP）制成，这些颗粒与天然HPV病毒粒子极为相似。针对如HPV 16或18等高风险HPV类型的单价疫苗的原理验证试验证实，肌肉注射VLP可诱导产生HPV型特异性中和抗体。一种包含致癌性HPV 16型和18型的二价疫苗被证明是安全的，耐受性良好，在预防持续性HPV感染方面100%有效。一种预防引起尖锐湿疣的HPV类型（HPV 6和11）和致癌性HPV类型（HPV 16和18）的四价疫苗在预防临床疾病方面显示出100%的有效性。由于VLP疫苗是预防性的，在接触HPV之前接种疫苗将带来最大的公共卫生效益；因此，一个成功的疫苗接种计划应针对青春期前儿童，并强调在首次性行为之前接种疫苗的重要性。
