Public health paradoxes and the epidemiological impact of an HPV vaccine

Background: our understanding of human papilloma virus (HPV) and cervical cancer has improved dramatically, with a vaccine against the viral infection being a real possibility in the near future. Aims: the goal of an HPV vaccine would be to reduce the prevalence of infection and hence the risk of cervical abnormalities. However, questions arise as to how this would interact with an existing intervention, screening, which reduces the progress of cervical abnormalities to serious disease. Furthermore, will a vaccine against one genotype influence the other types within a population and will the patterns of infection and disease remain the same if the vaccine alters the timing and type of HPVs experienced within a population? What would a vaccine that only worked in one sex achieve and how widespread would the use of such a vaccine have to be? Conclusion: the above-given questions can be addressed within a theoretical framework that describes the transmission dynamics of human papilloma virus. (C) 2000 Elsevier Science B.V. All rights reserved.