The wealth of numbers presented obscures the fact that HPV DNA is demonstrable in only a minority of women infected with HPV, one to two years after infection. According to international studies, around 70% of women acquire HPV infection over a lifetime. Seroprevalence data on HPV infection and HPV DNA for Germany are lacking (1); an unquantifiable but small minority of girls and women in Germany suffers from persistent HPV infection, which does not necessarily lead to cervical carcinoma.
A systematic review finds no evidence that the incidence or mortality from cervical carcinoma are reduced by HPV vaccines (2). NNTs for the estimation of efficacy of the vaccine show the following: were vaccine protection to be lifelong, 324 girls would need to be vaccinated to prevent one carcinoma. If vaccine protection lasted 30 years, the number would rise to 9080 (3). These are hypothetical numbers, in the face of unknown duration of efficacy. The first author, who works for the manufacturer of gardasil, cannot be accused of presenting unfavourable results.
The efficacy of the vaccine is currently unknown, and may be extremely modest or absent. HPV vaccination certainly cannot replace screening, albeit this is in need of improvement. Could not available resources be spent better in a society which prioritizes prevention than to confront minors with measures and advice whose effects are as yet unpredictable? Young men, meanwhile, are spared from any confrontation with sexually transmitted diseases: we now have a vaccination for the female sex. Medicalization strategies remain fashionable, apparently, even for minors. What will be the next "innovation"?
Footnotes
Conflict of interest statement
The author is a member of an advisory working group for the information portal "Women’s health and health promotion," on behalf of the Federal Health Education Association (Bundeszentrale für gesundheitliche Aufklärung - BZgA).
References
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