[Preventive vaccines against papillomavirus and cervix cancer will soon enter clinical practice]

A vaccine may protect against cancers caused by high-risk human papillomaviruses (HPVs). Sexually transmitted high-risk HPV types are almost always found in cervical cancer. Incidents of HPV type 16 and cervical cancer has more than doubled after the 1980's in Finland. HPV L1 capsid protein can be produced in the yeast, after which it assembles into virus-like-particles (VLP) and can be readily used for vaccine production. HPV VLP vaccine is well tolerated and induces ten-fold higher serum antibody levels as compared to natural infection. HPV16 VLP vaccine has shown to be 91% protective effect against HPV16 infections in the first phase III study. Neutralizing HPV antibodies, induced by HPV VLP vaccination, effectively reduce the viral load even though total elimination of the virus may not be needed. It is not known for how long the vaccine induced protection will last. Recruitment of adolescents into population-based phase III vaccination studies should be large to allow reliable cancer registry based evaluation of protective effect against grave dysplasia and cervical cancer.

[Can human papillomavirus testing and vaccination prevent cervical cancer?]

BACKGROUND

Cervical cancer is the third most frequent cancer among women worldwide. Human papillomavirus (HPV) infection is a necessary risk factor and the first step in cervical carcinogenesis.

MATERIAL AND METHODS

This article reviews the current literature concerning the possibility of preventing cervical cancer by HPV testing and vaccination.

RESULTS

HPV testing cannot replace cytology, but will reduce false negative cytology and may improve the screening programme for cervical neoplasia. It has not yet been incorporated in any national cervical cancer screening program, but trials are ongoing in Scandinavia and in the Netherlands. The cost-effectiveness of HPV testing in screening has to be proven and whether it can affect the recommended screening-intervals. Therapeutic and prophylactic vaccines for HPV associated disease are in progress. Evaluating the clinical trials that are ongoing will take several years. Several anti-HPV vaccines are now in clinical trials; Norway will also participate. Therapeutic vaccines against cervical cancer have so far not been successful, but anogenital dysplasias and condylomas may be more susceptible. Prophylactic vaccines against HPV 6, 11, 16 and 18 have been evaluated in clinical phase I and II trials, and phase III trials are in progress.

INTERPRETATION

HPV testing improves the specificity and sensitivity of cervical cytology and it can be used to clarify cases with atypical cells of undetermined significance (ASCUS) and low-grade intraepithelial neoplasia. In the near future it may also be included in the cervical cancer screening programme for women above the age of 30. The first results in clinical vaccine trials are encouraging, and final conclusions about the effectiveness of these vaccines may be achieved in five years' time.

Two fatal cases of adenovirus-related illness in previously healthy young adults--Illinois, 2000

Adenoviruses are common pathogens that often are associated with respiratory and gastrointestinal illness and/or conjunctivitis in young persons. Adenovirus serotypes 4 and 7 have caused outbreaks of self-limited febrile respiratory illness in young adults in basic military training. During the 1950s and 1960s, up to 10% of recruits were infected with adenovirus, and these pathogens were responsible for approximately 90% of pneumonia hospitalizations. Beginning in 1971, all military recruits received oral, live, enteric-coated vaccines that were licensed by the Food and Drug Administration as safe and effective in preventing illness from adenovirus serotypes 4 and 7. In 1996, the sole manufacturer ceased production of adenoviral vaccines and, as supplies dwindled during the next few years, outbreaks of adenoviral respiratory illness reemerged in military settings. Since 1999, approximately 10%-12% of all recruits have become ill with adenovirus infection in basic training, similar to the prevaccine era. This report describes the first two deaths probably associated with adenovirus infection identified in military recruits since the vaccines became unavailable. The military has requested proposals for a new adenovirus vaccine manufacturer; however, these deaths suggest that efforts by policymakers and pharmaceutical companies to reestablish adenoviral vaccine production should be intensified.

[Human papillomavirus as a risk factor in carcinogenesis]

BACKGROUND

The causal link between Human papillomavirus (HPV) and cervical neoplasia has been established through clinical, epidemiological and molecular studies during the last two decades. In 1995, HPV 16 and 18 were classified as human carcinogens.

MATERIALS AND METHODS

This paper discusses the aetiological role of HPV infection in carcinomas of the anogenital region, the respiratory and the upper digestive tract on the basis of a literature search and the author's own research.

RESULTS

Almost all patients with cervical carcinomas and precursor lesions are HPV-positive. HPV is a necessary, but not sufficient factor in carcinogenesis. Several risk factors such as other sexually transmitted diseases, sexual activity, smoking, immunosuppression and diet may be important. High prevalences of HPV-DNA have also been found in carcinomas of other anogenital regions; however, HPV does not seem to be important in prostate carcinogenesis. Recent studies have shown that HPV may be a risk factor in carcinogenesis in the respiratory and upper digestive tract, but its aetiological role has yet to be proved.

INTERPRETATION

Therapeutic and prophylactic vaccination is now being developed. In a few years time they may influence the treatment and prophylaxis of cervical carcinomas, some of the most common cancers among women worldwide.

[The first rotavirus vaccine approved in the USA and Europe]

A new live oral rotavirus vaccine (Rotashield) has now been approved both in the USA and Europe. In large multicentre trials involving over 10,000 children, the vaccine has been shown to have a manifest protective effect, first and foremost against severe rotavirus-induced diarrhoea, but to be associated with certain side effects. The Advisory Committee on Immunisation Practices and the American Academy of Paediatrics are now recommending that Rotashield be included in the child vaccination programme. Use of the vaccine in Europe is likely to vary from one country to another. The issue of general recommendations for its use in Sweden should await the results of cost-benefit analysis and review of experience of the vaccine's use in the USA. In addition, a more comprehensive identification of rotavirus serotypes occurring in Sweden is a prerequisite for adequate assessment of the vaccine's necessity in this country.

[Promising experiments with DNA vaccine against HIV. A complete eradication of the virus is a formidable task]

The past few years have witnessed encouraging progress in experimental HIV vaccination. Several new vaccine candidates have been shown to elicit immune response and provide protection in animals, and the first immunotherapy trials in humans have been reported. Difficulties remain to be overcome, however. No consensus exists regarding trials in humans. Some researchers and clinicians believe that we must await a vaccine demonstrably and reproducibly effective in animals. Immunogenicity alone is considered insufficient to ensure clinical protection. Others consider animal experiments valuable, but believe that actual trials should be made in humans in the target population. Trials are urgently needed in countries with high transmission rates, even if optimal efficacy cannot be guaranteed.

Prevention of varicella: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Centers for Disease Control and Prevention

These recommendations represent the first statement by the Advisory Committee on Immunization Practices (ACIP) on the use of live, attenuated varicella virus vaccine--VARIVAX--manufactured by Merck and Company, Inc. and licensed in March 1995 for use in healthy persons > or = 12 months of age. In addition to presenting information regarding vaccine, this statement updates previous recommendations concerning the use of varicella zoster immune globulin (VZIG) as prophylaxis against varicella (MMWR 1984; 33:84-90, 95-100).

[New vaccines. What can we expect in the coming years?]

There is an urgent need for new vaccines. The biotechnological revolution has created new hope. However, developments are hampered by inadequate basic knowledge about the immunology of infections, and lack of coordination between public and commercial research and development work on vaccines. Recombinant vaccines are an important step forward when combined with new adjuvants, but the authorization of these adjuvants for use in humans has been slow. Recombinant live vectors for vaccine antigens circumvent this problem, but imply some risk in HIV-infected people. Nucleic acid vaccines are met with strong emotional resistance, because of many unanswered questions as to their safety. Mucosal vaccines make quality control simpler, open up for a safer use of live recombinant vectors and simplify delivery of the vaccine. New vaccines marketed in the last decade are surprisingly "old-fashioned". Traditional ways of making vaccines have still not been abandoned.

[Communicable diseases in Norway. Epidemiological status and future challenge for prevention of the most important diseases]

The authors briefly review the incidence of some of the more important communicable diseases in Norway today. Thanks to extensive use of vaccines, effective preventive measures and useful antibiotics, many of these diseases are no longer a threat to public health, as was the rule up to the latter half of this century. However, constant vigilance is needed to sustain this positive situation.