Update of human papillomavirus vaccination

Abstract

자궁경부암은 2008년 전세계적으로 매년 약 530,000명 의 신환이 발생하고 275,000명이 사망하였으며 국내에서는 2011년 3,780명이 발생하고 1,100명이 사망한 주요 여성암 이다[1]. 자궁경부암의 원인은 잘 알려진 대로 인유두종바 이러스(human papillomavirus, HPV)로서 현재까지 밝혀 진 190종 이상에서 최소한 40여 종이 생식기 감염을 일으 킨다[2]. 이중 자궁경부암 발생과 관련된 15종을 고위험군 으로 분류하고 나머지를 저위험군으로 분류한다. 자궁경부 에 고위험군 HPV가 감염되면 대부분 6개월 이상의 기간이 지나면 대부분 제거가 되지만 그 중 5-10% 정도는 지속 감 염으로 진행하게 된다. 이러한 지속 감염은 점차 진행되어 전암 단계인 상피내종양(cervical intraepithelial neoplasia, CIN)으로 이행할 수 있는데 CIN은 세 등급, 즉 CIN1, CIN2, CIN3를 거쳐 자궁경부암으로 진행하게 된다. 자궁경부암의 99% 이상이 HPV에 의하여 발생한다. HPV는 자궁경부암 Infection with one of 15 types of high-risk human papillomavirus (HPV) is the cause of cervical cancer. Worldwide, 70% of cervical cancer is caused by either HPV type 16 or 18. The current HPV vaccine is composed of virus-like particles (VLPs) of the L1 capsid protein as well as adjuvant. Quadrivalent HPV vaccine contains L1 VLPs from HPV types 6, 11, 16, and 18, and the bivalent vaccine contains HPV 16 and 18 L1 VLPs. HPV vaccines have demonstrated almost 100% efficacy in preventing HPV 16or 18associated cervical intraepithelial neoplasia grade 3 or worse (CIN3+) in large-scale randomized studies. The HPV vaccine was confirmed to be safe by the WHO Global Advisory Committee for Vaccine Safety after reviewing information from clinical trials and post-marketing surveillance of two HPV vaccines. Local injection site reactions were the most commonly observed side effect, and these resolved spontaneously. A three-dose schedule is recommended prior to sexual contact and potential exposure to HPV, but a two-dose schedule is also recommended for adolescent girls aged 9 to 13 years. Recently, cervical cancer screening and HPV vaccination to prevent cervical cancer and HPV-related disease have become major public health issues. The effects of HPV vaccination, such as a rapid decrease in HPV prevalence, genital warts, and cervical precancerous lesions, have been observed in several countries in which HPV vaccination coverage is very high. At this point, cost-effectiveness analysis should be performed in Korea with the view to include HPV vaccination in the national immunization program to increase the coverage of HPV vaccination. In the future, we can eradicate cervical cancer through the universal HPV prophylactic vaccine and therapeutic HPV vaccine, together with cervical cancer screening.