Highlights of this issue

HPV vaccination by the numbers

Brisson and colleagues estimate that the number needed to vaccinate against human papillomavirus (HPV) infection would be 8 to prevent an episode of genital warts and 324 to prevent a case of cervical cancer. This assumes the vaccine offers lifelong protection, has an efficacy of 95% and is given at 12 years of age. The numbers increase dramatically if vaccine protection wanes at 3% per year and the efficacy is 70%. The authors conclude that the benefits are highly dependent on the duration of vaccine protection and that long-term surveillance of vaccine efficacy will be essential.

See page 464

Efficacy of HPV vaccines: systematic review

In a systematic review, Rambout and colleagues analyze the available evidence from randomized controlled trials of the efficacy of prophylactic HPV vaccination. Their study shows that it is highly efficacious in preventing vaccine type-specific HPV infection and cervical disease. However, the authors identify a number of study-design limitations and knowledge gaps.

See page 469

Self-collected specimens for HPV testing

Ogilvie and colleagues investigate the feasibility of self-collection of specimens for HPV testing among women who may not make full use of cytology screening programs (e.g., women who are homeless or involved in the sex trade) and are thus at increased risk of cervical cancer. Over 50% of the women contacted by outreach nurses agreed to provide a self-collected specimen, and the nurses were able to recontact over 80% of those with positive test results. Women in the study group were less likely than women in the general population to have undergone cervical cancer screening. The authors' findings suggest that self-collection may be feasible for women who do not receive routine cervical cancer screening.

See page 480

HPV vaccines: questions and cautions

Lippman and colleagues argue against widespread implementation of vaccine programs. They suggest that there is no epidemic or urgency to implement a mass vaccination program. They call for more education about the realities of cervical cancer, HPV infection and HPV vaccines, better screening and more independent research.

See page 484

Practice

Lagacé-Wiens and Harding describe a case of coinfection of Strongyloides stercoralis and human T-lymphotropic virus 1 and urge physicians to be aware of the signs of this potentially deadly interaction (page 451).

In Clinical Vistas, Schattner and colleagues caution against the use of phosphate solutions before colonoscopy in patients at risk of hyperphosphatemia (page 454).

In this Public Health column, Dawar and colleagues review the epidemiology and disease outcomes of HPV infection and describe the clinical trials of 2 HPV vaccines. Also in this section, a patient information sheet about HPV is provided (pages 456 and 462).