Public Health Implications of Human Papilloma Virus Vaccination: With Reference to the German Situation

Abstract

Background: Cervical cancer constitutes a major burden of disease with nearly 500,000 new cases each year, 83% of which are seen in the developing world. More than 6500 cases of invasive cervical cancer are diagnosed in Germany annually with the mean age at diagnosis being 52 years. It constitutes 3.4% of all cancers in women, yet it accounts for 25% of cancers in the 25 –35 year age group. Human Papillomavirus (HPV) infection which is the most common sexually transmitted infection has been proposed as the first ever necessary cause of a human cancer associated with more than 99.7% of cervical cancers. Of the more than 130 genotypes identified 15 types have been labelled as high risk types. In view of the promising research results of prophylactic HPV VLP vaccines, this review aims to explore the public health potential which the introduction of such a prophylactic vaccine could have in the German context and to identify the influencing factors. Discussion: Impact of HPV vaccination on cervical cancer incidence at population level will depend on the length of induced immunity, number and interval of booster doses required, vaccine coverage of population at risk, societal acceptance and costs involved. If results from the large scale trials are similar to the phase II trials and model calculations hold true, given a high vaccine coverage a HPV vaccination would have a profound effect in reducing the burden of cervical disease in Germany.