Introduction

HPV infection is very common, with approximately6.2 million new cases of genital HPV reported each year [1]. HPV infection has the highest incidence of all sexually transmittedinfections and is most prevalent in young,sexually active individuals. [2, 3,]

It is estimated that a women’s life time risk of acquiring one or more genital HPV infection is at least 75%. There are approximately 40 - 60types of HPV specifically infecting the genitalarea and these are classified into 2 groups: high risk(or oncogenic) types and low-risk types. [4].High-risk types, the most common of which are HPV genotypes 16 and 18, are the causativeagent worldwide of 50% of cervical precancerouslesions (high-grade dysplasias) and 70% of cervical squamous cell carcinomas andadenocarcinomas. [4]. High-risk HPV types arealso implicated in 60% to 90% of otheranogenital cancers (such as vulvar, anal, andpenile cancers), 20% to 75% of oropharyngealcancers, and 25% of low-grade cervical lesions.[1, 3-5] HPV-18 is the second most common cause of cervical cancer and a more frequentcause of cervical adenocarcinoma than HPV-16.[6] The incidence of cervical adenocarcinoma is increasing and its precursor lesion is difficult to detect by routine Papanicolaou testing. [7]

The two most common low-risk HPVs, HPVgenotypes 6 and 11, cause approximately 90% ofgenital warts or condylomata accuminata, and 10% of low-grade cervical lesions.[8] They alsocause recurrent respiratory papillomatosis(RRP), a rare but potentially fatal disease causedpredominantly by vertical transmission frommother to infant, or that can present later in lifeas adult-onset RRP. [9-10]

HPV prophylactic vaccines

With the development of the HPV viral likeparticles (VLP), the first generation of prophylacticvaccines were possible. Phase 2 clinicalvaccine trials of prophylactic bivalent HPV 16/18and quadrivalent HPV-6/11/16/18 vaccinesdemonstrated that the vaccines were generallysafe, well tolerated, and highly immunogenic andhighly effective in preventing vaccine-relatedHPV infection. [11-12]

Prophylactic vaccines as a public health tool

In June 2006, a quadrivalent HPV vaccinewas approved by the US Food and Drug Administration(FDA) and by the Therapeutic GoodsAdministration (TGA) Australia for the preventionof HPV 6/11/16/18-associated cervical cancer,adenocarcinoma in situ (AIS), and cervicalintraepithelial neoplasia (CIN) grades 1 to 3,vulvar intraepithelial neoplasia (VIN) andvaginal intraepithelial neoplasia (VaIN) grades2/3, and genital warts in women.[13, 14] Abivalent vaccine that protects against HPV 16and 18 is currently under review by the FDA and

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