Human papillomavirus vaccination for the prevention of cervical neoplasia: is it appropriate to vaccinate women older than 26?

Human papiilomaviruses (HPVs) are the major cause of cervical cancer. Cervical cancer mortality has been reduced in Australia because of effective screening programs, but there are still about 800 new cases and 300 deaths per year. Worldwide, mortality and morbidity are high. Australia was the first country to introduce fully funded immunisation with a quadrivalent HPV vaccine for girls aged 12 and 13 in schools. A 2-year catch-up program covers all women to the age of 26 years. Age stratification of HPV prevalence showed the highest rates in women under 25 years of age, a decrease in women from 30 years of age and a second smaller peak in those over 45 years. Recently, a bivalent HPV vaccine has been licensed for use in women aged up to 45 years. Older women have robust immune responses to the bivalent HPV vaccine, and so should derive benefit from the vaccine if exposed to HPV type 16 or 18 in the future. It is likely that this vaccine will need to be purchased by women in the older age group (27-45 years).