HPV vaccination: Are we overlooking additional opportunities to control HPV infection and transmission?

Abstract

Human papillomavirus virus-like particles (HPV VLPs) have distinctive immunogenic properties that generate a durable antibody response, producing high-quality neutralizing antibodies. By vaccination, i.e., intramuscular injection of these HPV VLPs, the viral survival strategy of avoiding exposure to the systemic immune system is completely overruled, and large amounts of vaccine-induced systemic antibodies are generated. These systemic circulating antibodies are easily transuded to the genital mucosa and are detectable in female genital secretions. It is well accepted that these antibodies interact with the virions presented by an infected partner and inhibit infection. However, much less attention has been paid to the role of anti-HPV vaccine-induced antibodies in an HPV-infected individual where infectious virions are encountered by neutralizing antibodies in mucosal secretions. There is a clear need to further investigate and document this role. Indeed, if HPV vaccination of HPV-infected women has an effect on HPV transmission, auto-inoculation, and relapse after treatment, this may influence how we model, assess, and implement HPV vaccination programmes.

Alterations of HPV-Related Biomarkers after Prophylactic HPV Vaccination. A Prospective Pilot Observational Study in Greek Women

“…The importance of HPV vaccination of previously HPV-infected women is also substantiated in a recent publication by Vorsters et al, who consider this practice safe and generating a high-level immune response [12]. The authors contend that even in women with a productive infection, vaccination will lead to a potentially neutralizing amount of transudated anti-HPV antibodies in their cervicovaginal secretions with several benefits: first, vaccination could prevent infectious virions from a productive infection spreading from sites with low potential for malignant progression to the cervical transformation zone with a higher potential for progression.…”

Australia’s Role in Pneumococcal and Human Papillomavirus Vaccine Evaluation in Asia-Pacific

“…Another alternate strategy is to vaccinate those that are at the highest risk of HPV infection and cervical cancer, such as those with high numbers of sexual partners, in addition to cervical cancer screening. While HPV vaccines are prophylactic and do not clear existing lesions [ 106 ], it is increasingly being recognised that there are still important benefits for vaccinating HPV-infected women [ 107 ], particularly in settings where cervical cancer screening is limited (i.e., LLMICs and remote settings). These benefits include reducing transmission, protecting against vaccine-type HPV that the individual is not infected with, as well as reducing the risks of clinical disease relapse after treatment.…”

Human papillomavirus vaccination: Good clinical practice recommendations from the Federation of Obstetric and Gynecological Societies of India

“…Continued protection and persistent antibody levels have been observed through a minimum of 10 years following vaccination among female participants against highgrade cervical, vaginal and vulvar neoplasia. 34 FOGSI GCPR does not recommend a booster dose for the HPV vaccine.…”

“…Protection against nonprevalent HPV types included in vaccine is activated similar to that in HPV-naive women. 34 The Federation of Obstetric and Gynecological Societies of India recommends that women with abnormal screening tests and/or precancerous lesions may receive the vaccine up to age 45 years, but it should be emphasized that the vaccine will not have any therapeutic effect on existing HPV infection, associated precancerous lesion, and cancer or anogenital warts.…”