Scientific evidence on immunization with this quadrivalent vaccine suggests that it

• substantially reduces the risk of pre-cancer and cancer of the cervix caused by HPV types 16 & 18^2,3,4 (responsible for ~70% of all cervical cancers in the US⁵ )

• substantially reduces the risk of genital warts caused by HPV types 6 & 11⁶ (responsible for ~90% of all genital warts in the US⁷ )

• substantially reduces the risk of precancerous vulvar and vaginal lesions caused by HPV types 16 & 18⁸

• is cost effective when administered to adolescent females⁹


However, there is no evidence to suggest that the vaccine

• is effective against HPV types that are present at the time of immunization¹⁰

• reduces the risk of other sexually transmitted infections (STIs)

• offers any protection against the other consequences of nonmarital sexual activity such as pregnancy and emotional damage


Furthermore, currently

• one study suggests that immunization may provide limited protection against precancerous lesions caused by other types of HPV¹¹

• the duration of immunity following immunization is unknown

• the role of the vaccine for males is under investigation


Therefore, we

• promote abstinence for unmarried persons as a primary method to prevent pregnancy,^12,13 STIs including HIV,¹⁴ and the emotional consequences of sexual activity¹⁵

• promote monogamy as a primary method to prevent STIs including HIV¹⁶

• support the development and widespread use of vaccines against HPV and other STIs

• encourage further research into the duration of immunity and the optimal timing of immunization

• recommend continued regular health screening and counseling including pelvic examinations, Pap tests, and appropriate STI screening


Finally, we encourage physicians to counsel all their patients regarding sexual health.

References:

1. FDA. FDA licenses new vaccine for prevention of cervical cancer and other diseases in females caused by human papillomavirus. Available at http://www.fda.gov/bbs/topics/NEWS/2006/NEW01385.html. Accessed July 17, 2006.

2. Koutsky LA, et al. A controlled trial of a human papillomavirus type 16 vaccine. N Engl J Med. 2002;347(21):1645-51.

3. FUTURE II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med 2007;356:1915-27.

4. FUTURE II Study Group. Prophylactic efficacy of a quadrivalent human papillomavirus (HPV) vaccine in women with virilogic evidence of HPV infection. J Infect Dis. 2007;196:1438-46.

5. Munoz N, et al. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med. 2003;348(6):518-27.

6. FUTURE II Study Group. Prophylactic efficacy of a quadrivalent human papillomavirus (HPV) vaccine in women with virilogic evidence of HPV infection. J Infect Dis. 2007;196:1438-46.

7. Villa LL, et al. Prophylactic quadrivalent human papillomavirus (types 6, 11, 16, and 18) L1 virus-like vaccine in young women: a randomized double-blind placebo-controlled mutlicentre phase II efficacy trial. Lancet Oncol. 2005;6(5):271-8.

8. FUTURE II Study Group. Prophylactic efficacy of a quadrivalent human papillomavirus (HPV) vaccine in women with virilogic evidence of HPV infection. J Infect Dis. 2007;196:1438-46.

9. Goldie SJ, et al. Projected clinical benefits and cost-effectiveness of a human papillomavirus 16.18 vaccine. J Nat Cancer Inst. 2004;96(8):604-614.

10. FUTURE II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med 2007;356:1915-27.

11. Moscicki AB. HPV vaccines: today and in the future. J Adolesc Health. 2008;43:S26-S40.

12. Vincent ML, et al. Reducing adolescent pregnancy through school and community--based education. JAMA 1987;257:3382-86.

13. Doniger AS, et al. Impact evaluation of the "Not Me, Not Now" abstinence-oriented, adolescent pregnancy prevention communications program, Monroe County, New York. J Health Communications 2001.

14. Green EG. Rethinking AIDS Prevention: Learning from success in developing countries.Westport, CT: Praeger, 2003.

15. Hallfors DD, Waller MW, Bauer D, et al. Which comes first in adolescence--sex and drugs or depression? Am J Prev Med. 2005;29(3):163-70.

16. Michael, RT, et al. Sex in America: A Definitive Survey. 1st ed. viii, 300 p vols. Boston: Little, Brown, 1994, 1-300.