Abstract
In February 2007, the National Advisory Committee on Immunization (NACI) – the expert committee that provides the Public Health Agency of Canada with advice relating to immunization – recommended that females between nine and 26 years of age be given the human papillomavirus (HPV) vaccine (1). Within one month, the Government of Canada announced in its federal budget that $300 million would be allocated to the provinces for the HPV vaccine (2). Immunization recommendations are not infrequently associated with a certain amount of controversy, and HPV vaccination is no exception (3). A review of HPV disease and its diagnosis, as well as the evidence supporting the vaccination, will help to put the discussion into context.
Highlights
Papillomaviruses are nonenveloped, double-stranded, circular DNA viruses
human papillomavirus (HPV)-16 and HPV-18 account for 70% of cervical cancers [11]
Cervical cancer kills an estimated 250,000 women every year, with more than 80% of the 500,000 new cases occurring in the developing world, where cervical cancer is the foremost cause of cancer-related mortality in women [14]
Summary
Papillomaviruses are nonenveloped, double-stranded, circular DNA viruses. The structural integrity of the capsid proteins is necessary to elicit protective antibodies and has been an important consideration in vaccine development [4]. Epidemiological studies [9], supported by molecular technology, have provided evidence of the causal role of some HPV types in the development of cervical cancer. Whether such a vaccine would be financially feasible and amenable to evaluation through randomized clinical trials (because of small numbers of cancer associated with non-HPV-16 and non-HPV-18 types) is unknown [12].
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