人乳头瘤病毒疫苗的现有知识综述:宫颈癌筛查质量保证欧洲指南附录
Review of current knowledge on HPV vaccination: an appendix to the European Guidelines for Quality Assurance in Cervical Cancer Screening.
作者信息
Arbyn Marc, Dillner Joakim
机构信息
Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium.
出版信息
J Clin Virol. 2007 Mar;38(3):189-97. doi: 10.1016/j.jcv.2006.12.009. Epub 2007 Jan 25.
The recognition of a strong etiological relationship between infection with high-risk human papillomavirusses and cervical cancer has prompted research to develop and evaluate prophylactic and therapeutic vaccines. One prophylactic quadrivalent vaccine using L1 virus-like particles (VLP) of HPV 6, 11, 16 and 18 is available on the European market since the end of 2006 and it is expected that a second bivalent vaccine containing VLPs of HPV16 and HPV18 will become available in 2007. Each year, HPV16 and HPV18 cause approximately 43,000 cases of cervical cancer in the European continent. Results from the phase-IIb and III trials published thus far indicate that the L1 VLP HPV vaccine is safe and well-tolerated. It offers HPV-naive women a very high level of protection against HPV persistent infection and cervical intra-epithelial lesions associated with the types included in the vaccine. HPV vaccination should be offered to girls before onset of sexual activity. While prophylactic vaccination is likely to provide important future health gains, cervical screening will need to be continued for the whole generation of women that is already infected with the HPV types included in the vaccine. Phase IV studies are needed to demonstrate protection against cervical cancer and to verify duration of protection, occurrence of replacement by non-vaccine types and to define future policies for screening of vaccinated cohorts. The European Guidelines on Quality Assurance for Cervical Cancer Screening provides guidance for secondary prevention by detection and management of precursors lesions of the cervix. The purpose of the appendix on vaccination is to present current knowledge. Developing guidelines for future use of HPV vaccines in Europe, is the object of a new grant offered by the European Commission.
高危型人乳头瘤病毒感染与宫颈癌之间存在着明确的病因学关联,这促使人们开展了研发和评估预防性及治疗性疫苗的研究。自2006年底起,一种使用人乳头瘤病毒6、11、16和18型L1病毒样颗粒(VLP)的预防性四价疫苗已在欧洲市场上市,预计一种包含人乳头瘤病毒16和18型VLP的二价疫苗将于2007年上市。在欧洲大陆,每年约有43000例宫颈癌由人乳头瘤病毒16和18型引起。迄今为止发表的IIb期和III期试验结果表明,L1 VLP人乳头瘤病毒疫苗安全且耐受性良好。它为未感染过人乳头瘤病毒的女性提供了高水平的保护,使其免受与人乳头瘤病毒持续感染以及与疫苗所含类型相关的宫颈上皮内病变的侵害。人乳头瘤病毒疫苗接种应在女孩开始性行为之前进行。虽然预防性疫苗接种可能会在未来带来重要的健康益处,但对于已经感染了疫苗所含人乳头瘤病毒类型的这一代女性,仍需继续进行宫颈癌筛查。需要开展IV期研究以证明对宫颈癌的保护作用,并验证保护持续时间、非疫苗类型的替代情况,以及确定对接种疫苗人群进行筛查的未来政策。《欧洲宫颈癌筛查质量保证指南》为通过检测和管理宫颈前驱病变进行二级预防提供了指导。关于疫苗接种的附录旨在介绍当前的知识。制定欧洲未来使用人乳头瘤病毒疫苗的指南是欧盟委员会一项新拨款的目标。