HPV disease burden

1
HPV disease burden

• HPV is the most common STD in the US
• 6.2 million new cases/year in the US
• over half of all sexually active persons become
  infected at some time
• Causes cervical abnormalities and cancer,
  anogenital cancers, and genital warts

2

• Over 100 subtypes
• HPV 16/18 cause 70 of cervical cancer, AIS and
  CIN3 and 50 of CIN2
• HPV 6/11/16/18 cause 35-50 of CIN 1

3
HPV vaccines

• Merck Quadrivalent ( HPV 6/11/16/18)
• Licensed by FDA 6/06 and recommended by ACIP 6/06
• GSK Bivalent (HPV 16/18)
• expected to file with FDA 12/06

4
Gardasil (Merck Quadrivalent)

• Recommendations of CDCs Advisory Committee on
  Immunization Practices (ACIP) June 29, 2006
• 3 doses
• routine for girls 11-12, as early as 9 and also
  women 13-26
• ideally given before onset sexual activity, but
  sexually active women should be vaccinated

5
Many remaining questions

• School entry laws vary from state to state
• Insurance coverage of vaccine
• cost 120/dose
• Inclusion in Vaccines for Children program
• Need for booster doses
• Boys?
• Challenges to getting 11-12 year olds into the
  physicians office

6
No changes to recommendations for screening

• HPV 16/18 cause only 70 of cervical cancer
• The future? Perhaps delayed screening or widened
  screening intervals.