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Preventing cervical cancer by vaccination has become a reality, complementing highly successful screening programmes. One vaccine against human papillomavirus (HPV) is already licensed (Gardasil®, Sanofi Pasteur), and approval for a second (Cervarix®, GSK) is expected shortly. Trials indicate over 90% efficacy in preventing persistent infection with vaccine types (HPV-16 and 18).1 2 In several countries, including the United States, Canada, Australia, Austria, Italy, Germany and France, HPV vaccination has now been universally recommended. Other countries, including the UK, are considering recommendations for its use.
The clinical benefit of HPV vaccines is incontrovertible, and excellent safety profiles have been established. As HPV is a sexually transmitted infection, however, some groups are anxious that vaccination may encourage earlier sexual activity.3 Further, uncertainty about the programme’s optimal delivery setting remains.3
However, precedents exist. First, with rubella, against which many countries vaccinated adolescent schoolgirls to protect during later pregnancy, and more recently with hepatitis B (HepB), against which some countries, including Italy, Spain and France, have had universal …