A New Strategy for Elimination of Human Paplloma Virus-related Disease after Human Papillomavirus Vaccines Introduction

Abstract

Human papillomavirus (HPV) infections are the most common sexually transmitted diseases in male and female. The most common HPV types include HPV 6/11/16/18/31/33/45/52/58. Bivalent (bHPV), quadrivalent (qHPV), and nonavalent (nHPV) vaccines, have been developed worldwide to protect against HPV infections. This paper describes the worldwide trends in HPV infections after HPV vaccination and shows the progressive changes in national HPV vaccination programs toward gender-neutral vaccination (GNV). This review article is based on original and review articles on the HPV-associated disease burden and nationwide vaccination trends. In Korea, epidemiology studies have shown a decline in the incidence of cervical cancer from 16.3% (in 1999) to 9.1% (in 2015). Interestingly, based on the 2019 annual report from Korean Center for Disease Control, the incidence of anogenital warts increased in both sexes during 2014-2018 and was 2.6 times higher in male than female in 2018. These results indicate the good efficacy of HPV vaccinations against both diseases in female. Other studies suggest that GNV would almost eliminate the risks of HPV-associated diseases in most countries, compared to female-only vaccination. HPV vaccine coverage remains lower in male in Korea despite the vaccine efficacy in both sexes and the worldwide GNV trend. Scaling up HPV vaccination in both sexes should be encouraged. Furthermore, removing the HPV-attributable burden through nHPV vaccination could be considered, showing that HPV 31, 33, 45, 52, 58, which are not covered by bHPV and qHPV, are as prevalent as HPV 6, 11, 16, 18.