Prophylactic HPV vaccination for women over 18 years of age.

Cervical screening has resulted in a major reduction in the incidence and mortality of cervical cancer in the UK and other developed countries. Nevertheless approximately 2700 women present with cervical cancer in the UK each year with mortality in excess of 1000 cases. Prophylactic HPV vaccination against HPV 16 and 18 has been shown to be highly effective in preventing HPV related malignancy in clinical trials. Newly introduced HPV vaccination programmes in the UK and elsewhere are ultimately likely to result in a further significant reduction in the incidence and mortality of cervical cancer. These vaccination programmes will be most effective in early adolescence when prevalence of HPV infection is low. Consequently, vaccination programmes in the UK have been initially targeted at 12 to 13-year olds. In Australia favourable estimates of cost effectiveness have supported funding of a 'catch-up' programme to 26 years. In the UK the catch up programme has for the present been restricted to 18 years for cost effectiveness reasons. In addition the value of HPV vaccination beyond 26 years has not yet been fully clarified. Nevertheless women up to 45 years of age have been shown to exhibit strong immune responses to the bivalent HPV vaccine which might be expected to reduce the risk of HPV re-infection and address the second peak of HPV related malignancy in later life, evident over 45 years of age. Early data from randomised trials testing the quadrivalent HPV vaccine in women over 25 years has suggested high vaccine efficacy comparable to younger women. This paper will explore the evidence supporting HPV vaccination in HPV naïve and HPV exposed sexually active women up to 26 years and beyond this age group.