Prompt: As a healthcare professional, a colleague asks your opinion as to which HPV strains should be covered in a new treatment. Based on your reading from the Sarid and Gao 2011 article, what would your recommendation be, and when should the treatment be administered? What evidence supports your opinion?
Currently, vaccines protecting against HPV 16 and 18 exist and have been proven to be effective protection from those two strains. However, there is presently no single vaccine which protects against all four high-risk strains, nor the eight strains which are probably carcinogenic. These 12 strains together have been recognized to cause nearly all cases of cervical cancer, and have been linked to cases of anogenital cancer, a subset of head and neck cancers, and possibly more. Thus, we must consider investing in the development of vaccines protecting against additional HPV strains.
Unfortunately, the creation and production of new vaccines happens to be both expensive and time-consuming. So, an attempt at developing a vaccine protecting from all strains is highly unrealistic. It is much more conceivable to target a small number of additional strains first, with the other two high-risk strains (HPV 31 and 45) being the priority.
It is in my opinion that a quadrivalent vaccine protecting from all four high-risk HPVs should be the next step in treatment and protection of HPV infections. HPV is known to cause warts, which have been studied and determined to contain virus particles and to be contagious. Since HPV is a sexually transmitted disease, this vaccine would be ideally administered in the years before when a patient may become sexually active, such as during early puberty. This is so the immune system has adequate time to develop immunity before the transmission would occur. Additionally, since vaccines are known to lose their effectiveness over time, this gives the patient the most protection when they are most likely to come in contact with the virus.
In previous years, the current HPV vaccine was primarily suggested only to female patients due to the initially noted correlation of HPV and cervical cancer. However, due to the more recent evidence that HPV causes additional forms of cancer, male patients should also receive the vaccine to prevent cases of HPV-related cancers which may affect both genders, as well as to limit the overall transmission of infections.
By treating all patients, regardless of gender, with a vaccine designed to protect against the fours strains of HPV which have been proven to have a high risk of causing cancer, hypothetically we can prevent the most cases of HPV-related cancer in the most cost and time efficient manner.
References:
Sarid, R. and Gao, S. 2011. Viruses and human cancer: From detection to causality. Cancer Lett. 305(2):218-27.
