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Zinsou JF, Diemert DJ, Dejon-Agobé JC, Adégbité BR, Honkpehedji YJ, Vodonou KG, Bikangui R, Edoa JR, Massinga Loembe M, Li G, Yazdanbakhsh M, Bottazzi ME, van Leeuwen R, Kremsner PG, Hotez PJ, Bethony JM, Grobusch MP, Adegnika AA. Safety and immunogenicity of the co-administered Na-APR-1 and Na-GST-1 hookworm vaccines in school-aged children in Gabon: a randomised, controlled, observer-blind, phase 1, dose-escalation trial. THE LANCET. INFECTIOUS DISEASES 2024; 24:760-774. [PMID: 38513684 DOI: 10.1016/s1473-3099(24)00104-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND A human hookworm vaccine is being developed to protect children against iron deficiency and anaemia associated with chronic infection with hookworms. Necator americanus aspartic protease-1 (Na-APR-1) and N americanus glutathione S-transferase-1 (Na-GST-1) are components of the blood digestion pathway critical to hookworm survival in the host. Recombinant Na-GST-1 and catalytically inactive Na-APR-1 (Na-APR-1[M74]) adsorbed to Alhydrogel were safe and immunogenic when delivered separately or co-administered to adults in phase 1 trials in non-endemic and endemic areas. We aimed to investigate the safety and immunogenicity of these antigens in healthy children in a hookworm-endemic area. METHODS This was a randomised, controlled, observer-blind, phase 1, dose-escalation trial, conducted in a clinical research centre, in 60 children aged six to ten years in Lambaréné, a hookworm-endemic region of Gabon. Healthy children (determined by clinical examination and safety laboratory testing) were randomised 4:1 to receive co-administered Na-GST-1 on Alhydrogel plus Na-APR-1(M74) on Alhydrogel and glucopyranosyl lipid A in aqueous formulation (GLA-AF), or co-administered ENGERIX-B hepatitis B vaccine (HBV) and saline placebo, injected into the deltoid of each arm. Allocation to vaccine groups was observer-masked. In each vaccine group, children were randomised 1:1 to receive intramuscular injections into each deltoid on two vaccine schedules, one at months 0, 2, and 4 or at months 0, 2, and 6. 10 μg, 30 μg, and 100 μg of each antigen were administered in the first, second, and third cohorts, respectively. The intention-to-treat population was used for safety analyses; while for immunogenicity analyses, the per-protocol population was used (children who received all scheduled vaccinations). The primary outcome was to evaluate the vaccines' safety and reactogenicity in healthy children aged between six and ten years. The secondary outcome was to measure antigen-specific serum IgG antibody levels at pre-vaccination and post-vaccination timepoints by qualified ELISAs. The trial is registered with ClinicalTrials.gov, NCT02839161, and is completed. FINDINGS Between Jan 23 and Oct 3, 2017, 137 children were screened, of whom 76 were eligible for this trial. 60 children were recruited, and allocated to either 10 μg of the co-administered antigens (n=8 for each injection schedule), 30 μg (n=8 for each schedule), 100 μg (n=8 for each schedule), or HBV and placebo (n=6 for each schedule) in three sequential cohorts. Co-administration of the vaccines was well tolerated; the most frequent solicited adverse events were mild-to-moderate injection-site pain, observed in up to 12 (75%) of 16 participants per vaccine group, and mild headache (12 [25%] of 48) and fever (11 [23%] of 48). No vaccine-related serious adverse events were observed. Significant anti-Na-APR-1(M74) and anti-Na-GST-1 IgG levels were induced in a dose-dependent manner, with peaks seen 14 days after the third vaccinations, regardless of dose (for Na-APR-1[M74], geometric mean levels [GML]=2295·97 arbitrary units [AU] and 726·89 AU, while for Na-GST-1, GMLs=331·2 AU and 21·4 AU for the month 0, 2, and 6 and month 0, 2, and 4 schedules, respectively). The month 0, 2, and 6 schedule induced significantly higher IgG responses to both antigens (p=0·01 and p=0·04 for Na-APR-1[M74] and Na-GST-1, respectively). INTERPRETATION Co-administration of recombinant Na-APR-1(M74) and Na-GST-1 to school-aged Gabonese children was well tolerated and induced significant IgG responses. These results justify further evaluation of this antigen combination in proof-of-concept controlled-infection and efficacy studies in hookworm-endemic areas. FUNDING European Union Seventh Framework Programme.
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Affiliation(s)
- Jeannot F Zinsou
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany; Fondation pour la Recherche Scientifique (FORS), Cotonou, Benin
| | - David J Diemert
- Department of Medicine, School of Medicine and Health Sciences, The George Washington University, Washington DC, USA; Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington DC, USA.
| | | | - Bayodé R Adégbité
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Yabo Josiane Honkpehedji
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Fondation pour la Recherche Scientifique (FORS), Cotonou, Benin; Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Kafui G Vodonou
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
| | - Rodrigue Bikangui
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
| | - Jean Ronald Edoa
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
| | | | - Guangzhao Li
- Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington DC, USA
| | - Maria Yazdanbakhsh
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Maria Elena Bottazzi
- Departments of Pediatrics, Division of Pediatric Tropical Medicine, and Molecular Virology and Microbiology, Texas Children's Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Remko van Leeuwen
- Amsterdam Institute for Global Development (AIGHD), Amsterdam, Netherlands
| | - Peter G Kremsner
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany
| | - Peter J Hotez
- Departments of Pediatrics, Division of Pediatric Tropical Medicine, and Molecular Virology and Microbiology, Texas Children's Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey M Bethony
- Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington DC, USA
| | - Martin P Grobusch
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands; Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Ayola A Adegnika
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany; Fondation pour la Recherche Scientifique (FORS), Cotonou, Benin; Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
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Hernández-Silva CD, Ramírez de Arellano A, Pereira-Suárez AL, Ramírez-López IG. HPV and Cervical Cancer: Molecular and Immunological Aspects, Epidemiology and Effect of Vaccination in Latin American Women. Viruses 2024; 16:327. [PMID: 38543693 PMCID: PMC10974876 DOI: 10.3390/v16030327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/31/2024] [Accepted: 02/03/2024] [Indexed: 05/23/2024] Open
Abstract
Cervical cancer is primarily caused by Human Papillomavirus (HPV) infection and remains a significant public health concern, particularly in Latin American regions. This comprehensive narrative review addresses the relationship between Human Papillomavirus (HPV) and cervical cancer, focusing on Latin American women. It explores molecular and immunological aspects of HPV infection, its role in cervical cancer development, and the epidemiology in this region, highlighting the prevalence and diversity of HPV genotypes. The impact of vaccination initiatives on cervical cancer rates in Latin America is critically evaluated. The advent of HPV vaccines has presented a significant tool in combating the burden of this malignancy, with notable successes observed in various countries, the latter due to their impact on immune responses. The review synthesizes current knowledge, emphasizes the importance of continued research and strategies for cervical cancer prevention, and underscores the need for ongoing efforts in this field.
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Affiliation(s)
- Christian David Hernández-Silva
- Departamento de Microbiología y Patología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico; (C.D.H.-S.); (A.L.P.-S.)
| | - Adrián Ramírez de Arellano
- Instituto de Investigación en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico;
| | - Ana Laura Pereira-Suárez
- Departamento de Microbiología y Patología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico; (C.D.H.-S.); (A.L.P.-S.)
- Instituto de Investigación en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico;
| | - Inocencia Guadalupe Ramírez-López
- Departamento de Ciencias de La Salud, CUValles, Universidad de Guadalajara, Guadalajara-Ameca Rd Km. 45.5, Ameca 46600, Jalisco, Mexico
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Escoffery C, Petagna C, Agnone C, Perez S, Saber LB, Ryan G, Dhir M, Sekar S, Yeager KA, Biddell CB, Madhivanan P, Lee S, English AS, Savas L, Daly E, Vu T, Fernandez ME. A systematic review of interventions to promote HPV vaccination globally. BMC Public Health 2023; 23:1262. [PMID: 37386430 PMCID: PMC10308645 DOI: 10.1186/s12889-023-15876-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 05/11/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Despite the human papillomavirus (HPV) vaccine being a safe, effective cancer prevention method, its uptake is suboptimal in the United States (U.S.). Previous research has found a variety of intervention strategies (environmental and behavioral) to increase its uptake. The purpose of the study is to systematically review the literature on interventions that promote HPV vaccination from 2015 to 2020. METHODS We updated a systematic review of interventions to promote HPV vaccine uptake globally. We ran keyword searches in six bibliographic databases. Target audience, design, level of intervention, components and outcomes were abstracted from the full-text articles in Excel databases. RESULTS Of the 79 articles, most were conducted in the U.S. (72.2%) and in clinical (40.5%) or school settings (32.9%), and were directed at a single level (76.3%) of the socio-ecological model. Related to the intervention type, most were informational (n = 25, 31.6%) or patient-targeted decision support (n = 23, 29.1%). About 24% were multi-level interventions, with 16 (88.9%) combining two levels. Twenty-seven (33.8%) reported using theory in intervention development. Of those reporting HPV vaccine outcomes, post-intervention vaccine initiation ranged from 5% to 99.2%, while series completion ranged from 6.8% to 93.0%. Facilitators to implementation were the use of patient navigators and user-friendly resources, while barriers included costs, time to implement and difficulties of integrating interventions into the organizational workflow. CONCLUSIONS There is a strong need to expand the implementation of HPV-vaccine promotion interventions beyond education alone and at a single level of intervention. Development and evaluation of effective strategies and multi-level interventions may increase the uptake of the HPV vaccine among adolescents and young adults.
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Affiliation(s)
- Cam Escoffery
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA.
| | - Courtney Petagna
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA
| | - Christine Agnone
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA
| | - Stephen Perez
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA
| | - Lindsay B Saber
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA
| | - Grace Ryan
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Meena Dhir
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA
| | - Swathi Sekar
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Caitlin B Biddell
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, Durham, NC, USA
| | - Purnima Madhivanan
- Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA
| | - Stephanie Lee
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Amanda S English
- Institute for Health Disparities, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Lara Savas
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Eliza Daly
- Prevention Research Center, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Thuy Vu
- Health Promotion Research Center, School of Public Health, University of Washington, Seattle, WA, USA
| | - Maria E Fernandez
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
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Fan J, Jin S, Gilmartin L, Toth I, Hussein WM, Stephenson RJ. Advances in Infectious Disease Vaccine Adjuvants. Vaccines (Basel) 2022; 10:1120. [PMID: 35891284 PMCID: PMC9316175 DOI: 10.3390/vaccines10071120] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 02/01/2023] Open
Abstract
Vaccines are one of the most significant medical interventions in the fight against infectious diseases. Since their discovery by Edward Jenner in 1796, vaccines have reduced the worldwide transmission to eradication levels of infectious diseases, including smallpox, diphtheria, hepatitis, malaria, and influenza. However, the complexity of developing safe and effective vaccines remains a barrier for combating many more infectious diseases. Immune stimulants (or adjuvants) are an indispensable factor in vaccine development, especially for inactivated and subunit-based vaccines due to their decreased immunogenicity compared to whole pathogen vaccines. Adjuvants are widely diverse in structure; however, their overall function in vaccine constructs is the same: to enhance and/or prolong an immunological response. The potential for adverse effects as a result of adjuvant use, though, must be acknowledged and carefully managed. Understanding the specific mechanisms of adjuvant efficacy and safety is a key prerequisite for adjuvant use in vaccination. Therefore, rigorous pre-clinical and clinical research into adjuvant development is essential. Overall, the incorporation of adjuvants allows for greater opportunities in advancing vaccine development and the importance of immune stimulants drives the emergence of novel and more effective adjuvants. This article highlights recent advances in vaccine adjuvant development and provides detailed data from pre-clinical and clinical studies specific to infectious diseases. Future perspectives into vaccine adjuvant development are also highlighted.
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Affiliation(s)
- Jingyi Fan
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia; (J.F.); (S.J.); (L.G.); (I.T.); (W.M.H.)
| | - Shengbin Jin
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia; (J.F.); (S.J.); (L.G.); (I.T.); (W.M.H.)
| | - Lachlan Gilmartin
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia; (J.F.); (S.J.); (L.G.); (I.T.); (W.M.H.)
| | - Istvan Toth
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia; (J.F.); (S.J.); (L.G.); (I.T.); (W.M.H.)
- Institute for Molecular Bioscience, The University of Queensland, St. Lucia, QLD 4072, Australia
- School of Pharmacy, The University of Queensland, Woolloongabba, QLD 4102, Australia
| | - Waleed M. Hussein
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia; (J.F.); (S.J.); (L.G.); (I.T.); (W.M.H.)
| | - Rachel J. Stephenson
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia; (J.F.); (S.J.); (L.G.); (I.T.); (W.M.H.)
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Mehta A, Markman B, Rodriguez-Cintron W. Don’t jump down my throat: gender gap in HPV vaccinations risk long term cancer threats. Expert Rev Vaccines 2022; 21:1045-1053. [DOI: 10.1080/14760584.2022.2075850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Armaan Mehta
- George Washington University School of Public Health and Health Services, Virginia, United States
| | - Bethany Markman
- George Washington University School of Public Health and Health Services, Virginia, United States
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Kuter BJ, Garland SM, Giuliano AR, Stanley MA. Current and future vaccine clinical research with the licensed 2-, 4-, and 9-valent VLP HPV vaccines: What's ongoing, what's needed? Prev Med 2021; 144:106321. [PMID: 33678229 DOI: 10.1016/j.ypmed.2020.106321] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/26/2020] [Accepted: 11/03/2020] [Indexed: 01/28/2023]
Abstract
Prophylactic HPV vaccination has been a great public health success. For >20 years, clinical trials were conducted with the 2-, 4-, and/or 9-valent vaccines in young-adult females, mid-adult women, males, and adolescents. In all studies, the vaccines were highly efficacious, immunogenic, and well tolerated. Following vaccine licensure and utilization in national vaccine programs globally (real-world settings primarily in high income countries), numerous studies demonstrated that the vaccines continue to have an excellent safety profile and have dramatically reduced the incidence of genital warts, HPV vaccine-type prevalence, and precancerous lesions. Thirty-eight clinical trials with the currently licensed HPV vaccines are ongoing. Key questions being addressed in new trials include: efficacy against persistent infection and immunogenicity of a 1-dose regimen; efficacy of 3 doses in 20-45-year-old females; use in postpartum women and immunocompromised individuals (HIV, liver and kidney transplants); dose sparing via intradermal administration; use in combination with a PD1 monoclonal antibody in patients with cervical cancer; impact on recurrent disease in women undergoing cervical conization; persistence of protection; and use to prevent oropharyngeal cancer. Additional clinical research that should be conducted includes: long-term follow-up, particularly of 1- and 2-dose regimens; further evaluation of flexible 2-dose regimens; immunogenicity of 1- or 2-dose regimens in persons ≥15 years old and immunocompromised populations; safety and immunogenicity of 1 or 2 doses in children <9 years old; assessment of the vaccine in the prevention of transmission; interchangeability with newer HPV vaccines; additional concomitant use studies; and prevention of penile cancer and recurrent respiratory papillomatosis.
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Affiliation(s)
- Barbara J Kuter
- Children's Hospital of Philadelphia, Philadelphia, PA, United States of America.
| | - Suzanne M Garland
- The University of Melbourne, The Royal Women's Hospital, and Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States of America
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Cheng L, Wang Y, Du J. Human Papillomavirus Vaccines: An Updated Review. Vaccines (Basel) 2020; 8:vaccines8030391. [PMID: 32708759 PMCID: PMC7565290 DOI: 10.3390/vaccines8030391] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 12/17/2022] Open
Abstract
Human papillomavirus (HPV) vaccines, which were introduced in many countries in the past decade, have shown promising results in decreasing HPV infection and related diseases, such as warts and precancerous lesions. In this review, we present the updated information about current HPV vaccines, focusing on vaccine coverage and efficacy. In addition, pan-gender vaccination and current clinical trials are also discussed. Currently, more efforts should be put into increasing the vaccine’s coverage, especially in low- and middle-income countries. Provision of education on HPV and vaccination is one of the most important methods to achieve this. Vaccines that target HPV types not included in current vaccines are the next stage in vaccine development. In the future, all HPV-related cancers, such as head and neck cancer, and anal cancer, should be tracked and evaluated, especially in countries that have introduced pan-gender vaccination programs. Therapeutic vaccines, in combination with other cancer treatments, should continue to be investigated.
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