The first generation of prophylactic HPV vaccines has provided an excellent and robust protection against infection and disease with HPV 16 and 18. These two types account for approximately 70% of HPV related invasive cancer and 50% of precancer, hence a medical need remained. A prophylactic effect beyond the HPV types included in the vaccines would be beneficial and marketing activities suggested a major difference between the first generation vaccines.
Available data of the effect on non vaccine types will be analysed. The effect of mixed infections and co-infections with the vaccine types will be demonstrated. Available data on the duration of cross protection will be reviewed.
After correction for co-infectins with vaccine types the prophylactic effect against non- vaccine types appears to be moderate and to wane after some years. The ninevalent HPV vaccine demonstrated no efficacy beyond the vaccine types.
Type specific protection with the HPV vaccine types against disease and infection appears to be superior to cross protective effects. With the ninevalent vaccine the broadest protection with a robust duration can be expected. An analyses of the total efficacy irrespective of the HPV type reflects the incidence of infections with various types in the study population and cannot be generalized for the real world populations.