Evid Based Nurs 2008 Treatment 11

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Review: vaccines against human

papillomavirus prevent cervical cancer
precursors in young women
BMJ Publishing Group Ltd and RCN Publishing Company Ltd
Evid Based Nurs 2008 11: 11

doi: 10.1136/ebn.11.1.11
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General practice / family medicine (20449 articles)
Immunology (including allergy) (44751 articles)
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Cervical cancer (1038 articles)
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Treatment
Review: vaccines against human Outcomes: high-grade cervical lesions (high-grade squamous
intraepithelial lesion or grade 2 or 3 cervical intraepithelial
papillomavirus prevent cervical cancer neoplasia [CIN]), any grade cervical lesions, persistent HPV
infection, external genital lesions, and adverse events.
precursors in young women
MAIN RESULTS
QUESTION
HPV vaccines reduced the risks of all outcomes in the
Do vaccines against human papillomavirus (HPV) prevent
modified intention-to-treat population that included 84–
cervical cancer precursors in young women?
100% of randomised women (table). Groups did not differ
for serious adverse events (table).
METHODS
Data sources: Medline and EMBASE/Excerpta Medica (to
May 2007); Medline in process (to June 2007); Cochrane CONCLUSION
Library and Cochrane Central Register of Controlled Trials Vaccines against human papillomavirus (HPV) in young
(Issue 1, 2007); conference proceedings (2004–7); clinical trial women prevent persistent infection and precancerous cervical
registers; Google Scholar; public health announcements; disease associated with vaccine-specific HPV types.
reference lists; and vaccine manufacturers.
Study selection and assessment: randomised controlled
ABSTRACTED FROM
trials (RCTs) that compared a vaccine against >1 oncogenic
Rambout L, Hopkins L, Hutton B, et al. Prophylactic
type of HPV with placebo or no HPV vaccine for prophylaxis
vaccination against human papillomavirus infection and
of oncogenic HPV-related infection and disease in women. 9
disease in women: a systematic review of randomized
reports of 6 RCTs (n = 40 323; mean age 20 y, range 15–26 y)
controlled trials. CMAJ 2007;177:469–79.
met the selection criteria. 1 RCT (n = 2392) evaluated a
monovalent HPV 16 vaccine, 2 RCTs (n = 19 757) evaluated a Correspondence to: Ms L Rambout, Ottawa Hospital, Ottawa, Ontario, Canada;
bivalent HPV 16/18 vaccine, and 3 RCTs (n = 18 174) lrambout@ottawahospital.on.ca
evaluated a quadrivalent HPV 6/11/16/18 vaccine. Quality
Source of funding: not stated.
assessment of individual trials was based on the Jadad scale
and allocation concealment; all 6 RCTs were of high c Clinical impact ratings: Family/General practice 5/7; Infectious disease 5/7;
methodological quality. Oncology 5/7; Women’s health 6/7
Vaccines against oncogenic types of human papillomavirus (HPV) v placebo or no HPV vaccine to prevent vaccine-type HPV-associated cervical cancer
precursors in young women (modified intention-to-treat population)*
Weighted event rates
Outcomes at 15–60 months Number of trials (n) Vaccine Control RRR (95% CI) NNT (CI)
Grade 2 CIN or worse 5 (36 266) 0.8% 1.5% 48% (37 to 57) 138 (116 to 179)
Any grade CIN 5 (24 613) 0.7% 1.9% 64% (55 to 71) 81 (73 to 95)
Persistent HPV infection at 6 months 3 (14 207) 0.9% 4.0% 77% (72 to 81) 33 (31 to 35)
Persistent HPV infection at 12 months 2 (7774) 0.4% 1.6% 74% (59 to 84) 86 (76 to 108)
External genital lesions 2 (5981) 1.1% 3.5% 69% (56 to 77) 41 (37 to 51)
Serious adverse events 6 (39 609) 2.2% 2.2% 0% (214 to 13) Not significant
*CIN = cervical intraepithelial neoplasia; other abbreviations defined in glossary. Weighted event rates, RRR, NNT, and CI calculated from data in article.
COMMENTARY
he systematic review by Rambout et al is a in real world populations, duration of effect, and the efficacy has not been determined. Vaccination must
T high-quality synthesis of the evidence to date

on the effectiveness of prophylactic HPV
vaccination in preventing persistent HPV infection
optimal age to immunise young women if the vaccine
is publicly funded. Despite these gaps in knowledge,
it is evident from the results of this review that
be accompanied by education on the importance of
continued routine cervical screening and safer sex
practices, regardless of immunisation status. HPV
and precancerous cervical changes in young women. prophylactic HPV vaccination can prevent type- vaccines provide a new and promising strategy for
Infection with HPV is common;1 however, current specific HPV infection and precancerous cervical primary prevention of cervical cancer that should be
primary prevention strategies, such as condom use, lesions in healthy young women (15–26 y of age) accessible to all women who can benefit from them.
can only reduce the risk of transmission.2 The who receive all 3 doses of the vaccine and have not
vaccines included in this review provide highly been previously infected with these strains. Jacqueline Muresan, RN, BScN
effective protection against 2 high-risk HPV types The conclusions of the review by Rambout et al MSc student
(16 and 18), which account for 70% of all cervical are relevant to nurses working in public health and McMaster University
Hamilton, Ontario, Canada
cancers. 1 of the vaccines tested provides additional primary health care. Education should be provided to
coverage against non-oncogenic HPV types 6 and 11, the public about HPV. Nurses can use the results of 1. National Advisory Committee on Immunization.
which have been associated with the development of this review to help parents and young women Statement on human papillomavirus vaccine. Can
external genital disease. understand the risks and benefits of immunisation Commun Dis Rep 2007;33(ACS-2):1–31.
2. Manhart LE, Koutsky LA. Do condoms prevent genital
Questions remain about the long-term effective- and make informed decisions. It is essential that
HPV infection, external genital warts, or cervical
ness of the vaccine in reducing cervical cancer clients understand that the vaccines do not protect neoplasia? A meta-analysis. Sex Transm Dis 2002;29:
incidence and mortality, effectiveness of the vaccine against all strains of HPV and that long-term vaccine 725–35.
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Downloaded from ebn.bmj.com on December 4, 2010 - Published by group.bmj.

Review: vaccines against human

Evid Based Nurs 2008 11: 11

Updated information and services can be found at:

Topic Articles on similar topics can be found in the following collections

To request permissions go to:

To order reprints go to:

To subscribe to BMJ go to:

T high-quality synthesis of the evidence to date

EBN January 2008 Vol 11 No 1 11

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