DÄ internationalArchive1-2/2008Human Papillomavirus and Cervical Cancer - Current Status of Vaccination Against Human Pathogenic Papillomavirus: Low Efficacy

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Human Papillomavirus and Cervical Cancer - Current Status of Vaccination Against Human Pathogenic Papillomavirus: Low Efficacy

Dtsch Arztebl Int 2008; 105(1-2): 22. DOI: 10.3238/arztebl.2008.0022a

Hirte, M; Rabe, S; Schmidt-Troschke, S

LNSLNS The FUTURE II study (1) shows a significantly lower efficacy for HPV vaccination than the authors imply in their euphoric article: its efficacy across all cervical lesions is just 17%. In high grade cervical dysplasia, the best surrogate parameter for cervical carcinoma, no statistically significant effect at all is demonstrable for HPV vaccination (2).

A leading article in the New England Journal of Medicine (3) therefore describes the effect of HPV vaccination as modest; it is expected to be useful to the health services only in the most favourable of circumstances. The efficacy of side-effect free cervical screening on the other hand is 90%. In conclusion: vaccinated individuals still need screening, but screened individuals do not need vaccination.

In addition to the inadequately established efficacy, caution should have been indicated in STIKO (the German Standing Committee on Vaccination) on account of other unresolved problems such as serotype replacement, side effects, the unclear duration of action, and possible negative effects on motivation for screening.

The HPV vaccination guidelines must not least be viewed critically due to the massive lobbying on the part of the manufacturers: in Germany as elsewhere, decision makers have been supported by both manufacturers in the run up to the recommendation for vaccination, and the fact that one of the authors profits directly from the sale of the medications promoted in his article also raises questions.

Before a vaccination program is introduced whose exorbitant cost could increase statutory health insurance contributions by up to 0.1%, its costs, efficacy, and safety should be compared with those of other preventive strategies in a Health Technology Assessment, e.g., with strategies such as anti smoking campaigns or education programs aimed at promoting a healthy lifestyle or preventing cancer.
DOI: 10.3238/arztebl.2008.0022a

Dr. med. Martin Hirte
Dr. med. Steffen Rabe
Dr. med. Stefan Schmidt-Troschke
“Ärzte für individuelle Impfentscheidung e.V.“
Gerhard-Kienle-Weg 4
58313 Herdecke, Germany

Conflict of interest statement
The authors declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
1.
FUTURE II Study Group: Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med 2007, 356: 1915–27. MEDLINE
2.
Arznei-Telegramm: HPV-Impfstoff Gardasil: Nutzen zu hoch eingeschätzt? AT 2007; 38: 57–9.
3.
Sawaya GF, SMith-McCune K: HPV vaccination – more answers, more questions. N Engl J Med 2007; 19: 1991–3. MEDLINE
1. FUTURE II Study Group: Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med 2007, 356: 1915–27. MEDLINE
2. Arznei-Telegramm: HPV-Impfstoff Gardasil: Nutzen zu hoch eingeschätzt? AT 2007; 38: 57–9.
3. Sawaya GF, SMith-McCune K: HPV vaccination – more answers, more questions. N Engl J Med 2007; 19: 1991–3. MEDLINE

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