Are the Two Human Papillomavirus Vaccines Really Similar? A Systematic Review of Available Evidence: Efficacy of the Two Vaccines against HPV

Abstract

Background. When the bivalent and the quadrivalent HPV vaccines were marketed they were presented as having comparable efficacy against cervical cancer. Differences between the vaccines are HPV types included and formulation of the adjuvant. Method. A systematic review was conducted to assess the efficacy of the two vaccines against cervical cancer. Outcomes considered were CIN2+, CIN3+, and AIS. Results. Nine reports (38,419 women) were included. At enrolment mean age of women was 20 years, 90% had negative cytology, and 80% were seronegative and/or DNA negative for HPV 16 or 18 (naïve women). In the TVC-naïve, VE against CIN2+ was 58% (95% CI: 35, 72); heterogeneity was detected, VE being 65% (95% CI: 54, 74) for the bivalent and 43% (95% CI: 23, 57) for the quadrivalent. VE against CIN3+ was 78% (95% CI: <0, 97); heterogeneity was substantial, VE being 93% (95% CI: 77, 98) for the bivalent and 43% (95% CI: 12, 63) for the quadrivalent. VE in the TVC was much lower. No sufficient data were available on AIS. Conclusions. In naïve girls bivalent vaccine shows higher efficacy, even if the number of events detected is low. In women already infected the benefit of the vaccination seems negligible.

Efficacy of intralesional immunotherapy for the treatment of warts: A review of the literature

“…Common warts and plantar warts are predominantly caused by HPV types 1 and 2, while roughly 90% of genital warts are caused by types 6 and 11 (8,9). Currently available primary preventions include the bivalent vaccine, Cervarix TM , which contains types 16 and 18, and Gardasil TM 9, which contains types 6,11,16,18,31,33,45,52, and 58. HPV vaccines have led to a significant reduction in the incidence of genital warts and cervical neoplasias; however, they do not target genotypes specific to other cutaneous sites (10,11).…”

Cervical cancer screening in the era of HPV vaccination: A review of shifting paradigms in cytopathology

“…92 Some studies have shown cross-protection with the bivalent vaccine against low-risk serotypes with changes in incidence of condylomata acuminata although other studies have shown no impact. [93][94][95][96] Durability of seropositivity following HPV vaccination is yet to be established.…”

“…Studies have also demonstrated cross‐protection to serotypes not included in the bivalent and quadrivalent vaccines associated to the development of cross‐reactive T‐cells and detectable serologic levels of specific antibodies to other low and high risk HPV types, as well as decreased detection of HPV prevalence in HPV types 31, 33, and 45 not included in the bivalent and quadrivalent vaccines . Some studies have shown cross‐protection with the bivalent vaccine against low‐risk serotypes with changes in incidence of condylomata acuminata although other studies have shown no impact . Durability of seropositivity following HPV vaccination is yet to be established.…”

Cost-effectiveness of two-dose human papillomavirus vaccination in Singapore

“…(9, 10) Cost of screening (SGD [15][16][17][18][19][20][21][22][23][24] is paid out of pocket, except for low-income citizens aged above 40 years, who have been fully subsidised since 2014. (11) Opportunistic screening is sometimes also provided for free through charitable organisations.…”

“…(20) On the other hand, 4vHPV provides protection against HPV-6 and HPV-11 infections, thereby reducing the risk of genital warts. (4) Recent studies have suggested that AS04-HPV-16/18v also provides moderate cross-protection against persistent infection by HPV-6 and HPV-11.…”