[Human papillomavirus vaccines]. / Vaccination contre le papillomavirus humain.

ABSTRACT

OBJECTIVES: To assess the efficacy, the tolerance, the duration of protection and the limitations of papillomavirus vaccines and to determine the potential indications for prophylactic vaccination. MATERIALS AND METHODS: Medline, Biosis and Pascal contents were searched to July 2007. Of 546 abstracts, 30 studies were selected. RESULTS: Prophylactic vaccines are composed of L1 virus-like particles. They are well-tolerated and effective in preventing HPV 16/18 infections and related cervical diseases in young women who are naive to HPV 16/18 after five years of follow-up. In addition, the quadrivalent vaccine prevents HPV 6/11 infections and their consequences. The bivalent vaccine may also prevent HPV 31/45 infections by cross-protection. Young girls before sexual debut are the main target for prophylactic vaccines. Indeed, they demonstrate an excellent immune response after injection and the prevalence of HPV infection increases dramatically after the first sexual intercourse. However, vaccines are ineffective in healthy HPV 16/18 carriers or on existing lesions. Prophylactic vaccines are not effective in women infected by other oncogenic HPV. Therapeutic vaccine effects against cervical dysplasia are currently being assessed. CONCLUSION: Prophylactic vaccination against HPV is effective, well-tolerated, and should be associated with screening to optimize the prevention of cervical cancer.