Prompt: As a healthcare professional, a colleague asks your opinion as to which HPV strains should be covered in a new treatment. Based on your reading from the Sarid and Gao 2011 article, what would your recommendation be, and when should the treatment be administered? What evidence supports your opinion? Keep in mind a cost/benefit analysis, as the cost of developing a vaccine for each strain can get very pricey!
HPV, which is associated with carcinoma of the cervix, vulva, vagina, penis, anus, oral cavity, oropharynx, and tonsils was discovered in 1983. The current Gardasil vaccine helps to prevent HPV in individuals aged 9-45 caused by 9 strains (6,11,16,18,31,33,45,52, and 58). The CDC recommends that boys and girls at age 11 or 12 should receive the Gardasil vaccination.
If a new vaccine were being created today, I would consider adding strains 16, 18, 31 and 35 due to the fact that these 4 strains account for ~80% of cervical cancer in women. Including cost as a factor for my decision, I would target my treatment at the cancer-causing strains, rather than the prevention of anogenital warts. I think the treatment should be given around or before age 11 or 12 similar to CDC guidelines due to sexual contact being the main route of transmission of anogenital HPV and most children are not sexually active around age 11. I would focus the majority of expense on education and primary prevention of HPV rather than adding more strains to the vaccination. If adolescents have better education on prevention of HPV and safe sexual practices, there would be less need for a vaccine with many strains.