HPV vaccination. Béatrice Swennen, MD, MPH PROVAC Ecole de Santé Publique ULB. Diagnostic et surveillance maladies infectieuses, 19 mai 2016

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1 HPV vaccination Béatrice Swennen, MD, MPH PROVAC Ecole de Santé Publique ULB Diagnostic et surveillance maladies infectieuses, 19 mai 2016

2 HPV L1 Virus Like Particle Malik H; 2014 Arch Virol

3 Antigen Host for antigen preparation Bivalent HPV (bhpv) Quadrivalent HPV (qhpv) Cervarix Gardasil Gardasil 9 L1-HPV16 L1-HPV18 Hi-5 Baculovirus L1-HPV6 L1-HPV11 L1-HPV16 L1-HPV18 Yeast Saccharomyces cerevicae Nonavalent HPV (9HPV) L1-HPV6 L1-HPV11 L1-HPV16 L1-HPV18 L1-HPV31 L1-HPV33 L1-HPV45 L1-HPV52 L1-HPV58 Yeast Saccharomyces cerevicae Adjuvant AS04 Alum Alum Schema 3 doses 2 doses EMA licensed Belgium Drugstore Vaccination Program months since 9 years 0-6 young girls 9-14y FWB 2011, VL months since 9 y 0-6 young girls 9-14y VL months since 9 y 0-6 months, 0-12 months Young 9-13 Y (in study) ?

4 HPV Vaccination : 10 years programme Programme «Girls - Women vaccination» Target : prevention of Cervical carcinoma and persistent infection Secondary : reduction of genital warts Population impact has been demonstrated Duration of protection for 9 years for both vaccines 2 doses schedule for 9-14 years of age

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6 Countries with HPV vaccine in the national immunization programme Introduced* to date (66 countries or 34%) * Includes partial introduction Not Available, Not Introduced/No Plans Not applicable (128 countries or 66%) Data source: WHO/IVB Database, as of 12 April 2016 Map production Immunization Vaccines and Biologicals (IVB), World Health Organization The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved.

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8 Drolet et al, Lancet Infect Dis 2015 Change in genital warts diagnosis during the first 4 years after introduction qhpv Girls and Women >50% vaccine Coverage Girls and Women >50% vaccine Coverage WOMEN

9 Drolet et al, Lancet Infect Dis 2015 Change in genital warts diagnosis during the first 4 years after introduction qhpv Girls and Women >50% vaccine Coverage Girls and Women >50% vaccine Coverage MEN

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11 Crude prevalence of HPV before and after vaccine implementation

12 Crude prevalence of individual high-risk HPV types

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14 Laczano, Vaccine 2013

15 Efficacy of bhpb and qhpv vaccines

16 Increased role of HPV in several cancer Ano-genital area in both men and women 100% of cervical cancer 80% of anal cancer 43% of vulvar cancer 70% of invasive vaginal carcinomas 50% of penile 70% of the oropharyngeal squamous cell carcinoma (1/3 of Head & Neck cancer

17 Trends in H&N cancers in England 1995 to 2011 up to 2025 Lovie K et al ; Oral Oncology, 2015; 51:341

18 Future of HPV vaccination 9Valent vaccine L1-HPV6, L1-HPV11 L1-HPV16,L1-HPV18, L1-HPV31, L1-HPV33, L1-HPV45, L1-HPV52, L1-HPV58 Universal vaccination? Group at risk vaccination MSM?

19 9 HP

20 Joura et al ;Cancer Epidemiol Biomarkers Prev; 2014

21 HPV in men and rationale for immunization Total burden of HPV associated deseases in Men < in Women In Europe: estimated cases per year Penis cancer : 1100 Anal Cancer : 1600 Head and Neck : Genital warts : Prevalence of infection in men doesn t varied by age Men are constantly reinfected (no good immune protection induced from natural infection) No screening programme for infection in men MSM are at higher risk of HPV infection (no effect of women vaccination)

22 HPV prevalence at enrollment by age: any oncogenic HPV infection (Mexico) Anna R. Giuliano et al. Cancer Epidemiol Biomarkers Prev 2008;17:

23 Universal vaccination? Protect men and women against HPV related ano-genital cancer and reduce burden in both genders Accelerate control of HPV vaccine type circulation (elimination of HPV vaccine strains) Reduce Gender and social inequalities

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25 Fig. 2. Reduction of the remaining HPV-16,-18-anal cancer burden in females and males in Europe through female-only HPV vaccination and universal HPV vaccina-tion (age 12 years, 70% VCR).