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 is your recommendation, and when should the treatment be administered? What evidence supports your opinion?
Human papillomavirus (HPV) is a very common virus that can lead to various types of cancers. According to the Sarid and Gao article, HPV is now recognized as the virus responsible for causing essentially all cases of cervical cancer in women, with a higher risk associated with certain strains. Today, over 100 types of HPV have been identified (1).
Although developing a vaccine for every strain of HPV would be an incredible advancement in the field of oncology, it is simply unplausible. The process of developing a vaccine for every HPV strain would take a lot of time, and a lot of money. Findings show that the cost of developing a vaccine from preclinical trials through to the end of phase 2a ranges from 31-68 million US dollars, and that is assuming no risk of failure (2). Cancerous cells are constantly (and rapidly) evolving and developing new abilities in order to evade detection. It would be nearly impossible to develop successful vaccines for every strain. The cost of vaccine development for every strain of HPV would also likely come at a great price to the public, therefore rendering it unaccessible to many individuals in general.
There are 12 different HPVs, and four of them, including HPVs 16, 18, 31 and 45 account for about 80% of cervical cancer. The remaining HPV types are also associated with cervical cancer and several have been classified as “probably carcinogenic to humans”, however, the four mentioned above are considered high-risk HPVs. Vaccines currently exist for HPV16 and HPV18, therefore, my recommendation would be to develop a vaccine for the other two high-risk HPVs, HPV31 and HPV45.
Because human papillomavirus is a sexually transmitted infection, the vaccine should be given to individuals before they have sexual contact with others and are exposed to HPV. I would recommend giving the vaccine around age 11 to begin protecting against HPV prior to possible exposure.
Sarid R, Shou-Jiang G. 2011. Viruses and Human Cancer: From Detection to Causality. Cancer Lett 305(2):218-227.
Gouglas D, Le T, Henderson K, Kaloudis A, Danielsen T, Hammersland N, Robinson J, Heaton P, Rottingen J. 2018. Estimating the cost of vaccine development against epidemic infectious diseases: a cost minimisation study. Lancet Glob Health 6:e1386-1396. DOI: 10.1016/S2214-109X(18)30346-2