Harper Diane M
Department of Bioinformatics and Personalized Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64139, USA.
Public Health Genomics. 2009;12(5-6):319-30. doi: 10.1159/000214922. Epub 2009 Aug 11.
Cervarix and Gardasil, 2 human papillomavirus (HPV) vaccines, have been approved and implemented globally in young adolescent women with the hope of reducing the incidence of cervical cancer several decades hence. This program is dependent on the concept of 'immunobridging': antibody titers generated in young adolescents that are the same or higher than generated in HPV-naive 16- to 26-year-old women, the population in which efficacy is proven. Likewise, realizing a decline in cervical cancer from young adolescent female vaccination depends on the duration of vaccine efficacy, and the population coverage reached. While we patiently wait for results from our young adolescent vaccination programs, newly released data indicates that the immunogenicity and efficacy of the vaccines for young adult women with prior HPV exposure is equal or superior to that seen for young adolescents. This same concept of immunobridging supported by limited efficacy data offers the potential to reduce cervical cancer precursors within just a few years in our young sexually active adult women, a population secondary to our young adolescents. The HPV vaccines are not therapeutic. Neither vaccine will inhibit an already HPV-infected basal epithelial cell which continues to transform differentiated epithelial layers into cervical dysplasias. There is a clinical hope, though, already supported by early data, that the vaccines are capable of neutralizing HPV virions in host tissues from both auto-inoculated infections and infections in other organs than the cervix, thereby making it possible for these vaccines to prevent less common HPV-associated cancers of the penis, vagina, vulva, anus, oral cavity and oro-pharynx. Both vaccines have been shown to be generally safe in the phase II and phase III randomized controlled trials over 3-6.4 years. Post-marketing surveillance of Cervarix and Gardasil continues to show that they are safe for most women despite rarely occurring serious events.
卉妍康（Cervarix）和加德西（Gardasil）这两种人乳头瘤病毒（HPV）疫苗已在全球获批并应用于青春期少女，以期几十年后降低宫颈癌的发病率。该计划依赖于“免疫桥接”的概念：青春期少女产生的抗体滴度与未感染HPV的16至26岁女性相同或更高，而后者是已证实疫苗有效的人群。同样，通过青春期少女接种疫苗实现宫颈癌发病率下降取决于疫苗效力的持续时间以及所达到的人群覆盖率。在我们耐心等待青春期少女疫苗接种计划的结果时，新公布的数据表明，对于既往有HPV暴露史的成年女性，这些疫苗的免疫原性和效力等同于或优于青春期少女。有限的效力数据支持的这一免疫桥接概念，为在短短几年内降低年轻性活跃成年女性（仅次于青春期少女的人群）的宫颈癌前病变提供了可能。HPV疫苗并非治疗性药物。两种疫苗都无法抑制已感染HPV的基底上皮细胞，这种细胞会继续将分化的上皮层转化为宫颈发育异常。不过，已有早期数据支持一种临床希望，即这些疫苗能够中和宿主组织中因自身接种感染以及宫颈以外其他器官感染而产生的HPV病毒粒子，从而使这些疫苗有可能预防阴茎、阴道、外阴、肛门、口腔和口咽等部位较不常见的HPV相关癌症。在为期3至6.4年的II期和III期随机对照试验中，两种疫苗总体上均显示安全。卉妍康和加德西的上市后监测继续表明，尽管会发生罕见的严重事件，但对大多数女性来说它们是安全的。
