Medeiros Rita, Vaz Susan, Rebelo Teresa, Figueiredo-Dias Margarida
Department of Gynaecology. Hospital and University Centre of Coimbra. Coimbra. Portugal.
Department of Gynaecology. Faculty of Medicine. University of Coimbra. Coimbra. Portugal.
Acta Med Port. 2020 Mar 2;33(3):198-201. doi: 10.20344/amp.12259.
Human papillomavirus is responsible for almost all cases of cervical cancer, an important portion of anogenital and oropharyngeal invasive and preinvasive lesions, as well as genital warts (condyloma acuminatum) and recurrent respiratory papillomatosis. Currently, three prophylactic vaccines against high-risk Human papillomavirus are commercialized in many countries worldwide.
To this non-systematic review the authors searched in MEDLINE/PubMed for systematic reviews, meta-analysis and randomized controlled trials, published in the last six years, using the terms "HPV", "non-cervical cancer" and "vaccine". Non-cervical cancers caused by human papillomavirus are less common lesions. However, its incidence has been increasing, while cervical cancer has declined, due mainly to highly effective screening programs. There are no formal screening programs for non-cervical cancers, so universal vaccination could have an important impact. The preventive effect of the vaccine is mainly studied and established in relation to cervical cancer, although it has also been demonstrated in the development of vulvar and vaginal lesions. To date, the efficacy in preventing anal and oropharyngeal diseases related with human papillomavirus is uncertain due to scarce supporting data and low vaccination coverage in men. The prevalence of injuries and subsequent absolute benefit of vaccination is lower in men, but it provides an additional benefit to the herd immunity achieved with the vaccination of women.
The total fraction of malignant and pre-malignant lesions attributed to Human papillomavirus genotypes contained in the nonavalent vaccine is significant in both women and men, which turns this vaccine into a great asset in terms of Public Health.
人乳头瘤病毒（HPV）几乎导致了所有宫颈癌病例，以及相当一部分肛门生殖器和口咽部位的浸润性及癌前病变，还有尖锐湿疣（生殖器疣）和复发性呼吸道乳头瘤病。目前，三种针对高危型人乳头瘤病毒的预防性疫苗在全球许多国家实现了商业化。
在本次非系统性综述中，作者检索了MEDLINE/PubMed数据库，查找过去六年发表的系统性综述、荟萃分析和随机对照试验，检索词为“HPV”“非宫颈癌”和“疫苗”。由人乳头瘤病毒引起的非宫颈癌是较为少见的病变。然而，其发病率一直在上升，而宫颈癌发病率下降，这主要归因于高效的筛查项目。目前尚无针对非宫颈癌的正规筛查项目，因此普遍接种疫苗可能会产生重要影响。疫苗的预防效果主要是针对宫颈癌进行研究和确立的，不过在预防外阴和阴道病变方面也得到了证实。迄今为止，由于支持数据稀少且男性接种覆盖率低，疫苗在预防与人乳头瘤病毒相关的肛门和口咽疾病方面的疗效尚不确定。男性接种疫苗后损伤的发生率及后续的绝对获益较低，但它为女性接种疫苗所实现的群体免疫提供了额外益处。
九价疫苗所包含的人乳头瘤病毒基因型导致的恶性和癌前病变在女性和男性中所占的总体比例都相当可观，这使得该疫苗在公共卫生方面成为一项重要资产。
