GPs may be asked to give HPV boosters

By Lilian Anekwe

A GP-led catch-up and booster campaign may be needed for HPV vaccination in older women, according to research by the Health Protection Agency.

The research, which formed the basis of the Government's decision to back the introduction of the HPV vaccine, shows more women aged 14 to 23 are infected with HPV than expected, and that serological evidence of protection declines with age .

The Joint Committee for Vaccination and Immunisation is expected to recommend a school-based vaccination campaign for 11- to 12-year-old girls from the beginning of the 2008 school year.

Data from 1,483 women aged 10 to 29 appear to support the age cut-off decision, as the team report that less than 5% of the sampled women under the age of 14 had previous exposure to any HPV serotype.

Dr Andrew Vyse, from the immunisation department at the HPA's centre for infections, told delegates at the Health Protection 2007 conference that the prevalence of prior infection increased sharply between age 14 and 23, then ‘either stabilised or declined'.

Dr Vyse said: ‘There's strong evidence from our data that prevalence [of HPV antibodies] initially increases with age. An important question is how well population screened [for cervical cancer] represent the age cohort regarding HPV infection.'

He added: ‘Our data suggests the vaccination programme really needs to be targeted at girls before the age of 14. This was the main piece of evidence that the JCVI used to inform their decision to begin a vaccination programme for girls aged 12.

‘The implications are that seropositivity wanes over time. If this is the case it may have implications for the vaccination programme – women may need a booster.'

Professor Andy Hall, chair of the JCVI, said the research had ‘important implications for any possible future catch-up campaign, as clearly older girls and women particularly would not be vaccinated at school. There may be a role for GPs in future.'

Dr Syed Ahmed, a consultant in public health medicine at NHS Greater Glasgow Clyde and a JCVI committee member, said: ‘When we start to vaccinate young girls the JCVI will closely monitor seroprevalence data to see if some sort of catch-up campaign is necessary.

‘What we don't know is if a booster will offer better protection over and above the natural immune memory response. But we know we need to consider it.'

June 07 - JCVI recommendation for vaccine campaign in girls aged 12-13
October - JCVI likely to recommend school-based programme from 2008
2008 onwards - JCVI consideration of catch-up and booster campaign