Monitoring of human papillomavirus vaccination.

Persistent infection with oncogenic human papillomavirus (HPV) is a necessary causal factor in the development of cervical cancer. Moreover, HPV, predominately type 16 and to a lesser degree type 18, is linked causally to varying proportions of other anogenital cancers (vulva, vagina, penis, anus) as well as cancers elsewhere in the body (oropharynx, larynx, conjunctiva). HPV types 6 and 11 cause most of genital warts and recurrent respiratory papillomatosis. Effective prophylactic vaccines have been developed. In this review, we address briefly the immunological aspects of HPV infection and the results of HPV vaccination trials. Internationally standardized monitoring and evaluation of prophylactic HPV vaccination programmes will be essential for arriving at the most cost-effective strategies for cancer control.

Translational mini-review series on vaccines: Monitoring of human papillomavirus vaccination.

Persistent infection with oncogenic human papillomavirus (HPV) is a necessary cause of cervical cancer. Moreover, HPV type 16 (and to a lesser degree HPV type 18) is linked with more rare cancers, namely cancer of the vulva, vagina, penis, anus, oropharynx and larynx. Effective prophylactic vaccines have been developed. In this review, we briefly address immunological aspects of HPV infection and the results of HPV vaccination trials. Internationally standardized monitoring and evaluation of prophylactic HPV vaccination programmes will be essential for arriving at the most (cost-)effective strategies for cancer control.

A survey of seroprevalence of human papillomavirus types 16, 18 and 33 among children.

The importance and natural history of HPV infections in childhood is incompletely understood. We performed a survey for presence of serum antibodies to HPV capsids among 1031 children aged 0 to 13 years, resident in Stockholm, Sweden. The HPV seroprevalence among these children was 3.0% for HPV16, 0.6% for HPV18 and 2.7% for HPV33. By comparison, among simultaneously analyzed positive control panels comprising women with CIN or healthy women with type-specific cervical HPV DNA, seroprevalence of HPV 16, 18 and 33 was 69%, 58% and 63% respectively. The results suggest that HPV infection in childhood is not common.

Human papillomavirus antibody responses among patients with incident cervical carcinoma.

The human papillomavirus (HPV) is recognized as a major cause of cervical cancer precursor lesions. HPV serology is a key method in the continuing elucidation of the importance of HPV exposure for cancer development and in predicting HPV-associated diseases. To extend previous HPV serological studies on cervical cancer, serum samples from a consecutive series of 216 women with incident untreated cervical carcinoma and 243 age- and sex-matched healthy blood donors were evaluated for the presence of antibodies against HPV capsids, a marker of past or present HPV exposure, as well as against several cervical cancer-associated defined HPV epitopes. Among the capsid antibody responses, HPV type 16 seropositivity had the strongest association with cervical cancer (OR 2.7, 95% CI 1.8-4.2), but HPV 18 and HPV 33 seropositivities were also significantly associated with cervical cancer (OR 1.6, 95% CI 1.1-2.5; and OR 1.5, 95% CI 1.0-2.2, respectively). The antibody responses against the defined HPV epitopes were confirmed to be associated with cervical cancer, at ORs ranging from 1.4 to 2.0. In conclusion, the study confirms that antibodies against defined HPV epitopes are associated with cervical cancer and provides evidence that seropositivities for HPV types 16, 18, and 33 are associated with cervical cancer risk.

Cervical mucus antibodies against human papillomavirus type 16, 18, and 33 capsids in relation to presence of viral DNA.

To investigate whether cervical mucus antibodies against human papillomavirus (HPV) capsids are associated with the detection of HPV DNA or HPV-related cytological diagnoses, 611 samples of cervical secretions from 359 women referred to a colposcopy clinic were tested by an enzyme-linked immunosorbent assay for the presence of immunoglobulin A (IgA) antibodies against HPV capsids of HPV type 16, 18, or 33 and for the presence of cervical HPV DNA by PCR. Among subjects with at least one cervical sample positive for HPV type 16 (HPV-16) DNA, 28.1% also had at least one HPV-16 IgA-positive cervical sample (odds ratio [OR] = 2.9; P = 0.0003). IgA to HPV-18 was also more common among HPV-18 DNA-positive subjects (OR = 3.1; P = 0.0325) and IgA to HPV-33 was more common among HPV-33 DNA-positive subjects (OR = 4.2; P = 0.0023). Cervical IgA antibodies to HPV-16 were also more common among patients with cervical intraepithelial neoplasia, particularly among patients with cervical intraepithelial neoplasia grade I (P < 0.0005). The data indicate that an HPV type-restricted IgA antibody response against HPV capsids is detectable in cervical mucus and is associated with a concomitant cervical HPV infection.

Pill scare linked to rise in abortions.

PIP: It is argued that the British media exposure of the potential harmful side effects from oral contraceptive use contributed to raising fears and panic among users. The government in 1995 announced that there was double the risk of deep vein thrombosis from use of contraceptive pills containing gestodene or desogestrel. The government was advised by the Committee on Safety of Medicines. The British Pregnancy Advisory Service (BPAS) announced that the rise in abortions after the announcement could have been due to the pill scare. BPAS reported that during December 1995-February 1996 the number of abortions performed increased by 823 over the number reported in the same period a year before. The increase reversed a declining trend in abortions performed by a service that carries out 20% of all abortions in Great Britain. A BPAS spokesperson suggested that women panicked and stopped taking their pills, even though the government warned against an abrupt stop in usage. Women appeared to have not understood that risk was highest among overweight women and women with a prior history of thromboses. Findings from a BPAS survey that was conducted among almost 300 women with unplanned pregnancies showed that over 40% of women stopped taking their contraceptive pills immediately after the government's warning. 61% did not finish taking their remaining pills in the month's cycle. Under 20% of women switched to another contraceptive method. Another BPAS survey among 90 women that sought contraceptive advice at BPAS clinics found that nearly 50% of women expected the pill to be an unsafe method. It was suggested that media messages should have emphasized that the risk of unplanned pregnancies was much greater than the risks of deep vein thromboses.^ieng

Conization for cervical intraepithelial neoplasia is followed by disappearance of human papillomavirus deoxyribonucleic acid and a decline in serum and cervical mucus antibodies against human papillomavirus antigens.

OBJECTIVE: Our purpose was to investigate whether conization for cervical intraepithelial neoplasia eliminates human papillomavirus deoxyribonucleic acid and effects the levels of serum and cervical mucus antibodies against human papillomavirus antigens. STUDY DESIGN: Analysis of paired cervical brush and serum samples taken from 23 women with cervical intraepithelial neoplasia before and 16 to 27 months after conization was performed for presence of human papillomavirus deoxyribonucleic acid by polymerase chain reaction and for human papillomavirus antibodies by enzyme-linked immunosorbent assay. RESULTS: Four women had recurrent cervical intraepithelial neoplasia, whereas 19 women were disease free. Eighteen of 23 women were positive for human papillomavirus deoxyribonucleic acid before treatment. At follow-up only the 4 women with recurrent cervical intraepithelial neoplasia were positive. Serum immunoglobulin G levels and A levels and immunoglobulin A levels in cervical mucus against most of the tested human papillomavirus antigens had declined at follow-up. CONCLUSIONS: Human papillomavirus deoxyribonucleic acid was regularly eliminated and human papillomavirus antibody levels, especially local immunoglobulin A, declined after efficient treatment, suggesting that conization may be effective for treating the underlying human papillomavirus infection.