In contrast to the extensive data on anogenital infection (Table 11), there are no data to date on vaccine

efficacy against oropharyngeal HPV infections. This deficit is an important consideration, since the incidence of HPV-associated oropharyngeal cancer (mostly attributable to HPV16) appears to be increasing dramatically, at least in industrialized countries [87]. It is uncertain whether a trial to specifically evaluate oropharyngeal efficacy will be conducted. The premalignant precursors of oropharyngeal cancer cannot be routinely identified, making it difficult to contemplate a trial with intraepithelial neoplasia as a surrogate endpoint [88]. Current routine HPV DNA sampling methods appear to have relatively low sensitivity for detecting oropharyngeal infections, making trials using persistent infection endpoints difficult as well. Finally, approval FRAX597 of a trial with a placebo-controlled trial might be difficult, given that the vaccines are approved for other indications in the prospective study populations. Regarding other oral lesions, it would helpful to establish a surveillance system for recurrent respiratory papillomatosis, since its frequency in infants of

Gardasil®-vaccinated women is likely to decrease. In conclusion, the profiles of the HPV VLP vaccines established in the randomized clinical trials illustrate their potential as high value public health interventions and strongly support their wide spread implementation to prevent anogenital HPV infections and their associated neoplasia. The primary focus must now be on implementation issues to maximize the rapid, effective and cost-efficient Afatinib price delivery of the vaccines to those individuals that are most likely to benefit from them. The work was partially supported by public grants from the the European Commission (7th Framework Programme grant HEALTH-F3-2010-242061, PREHDICT), from the Instituto de Salud

Carlos III (Spanish Government) (grants FIS PI10/02995, RCESP C03/09, RTICESP C03/10, RTIC RD06/0020/0095 and CIBERESP) and from the Agència de Gestió d’Ajuts Universitaris i de Recerca – Generalitat de Catalunya (Catalonian Government) (grants AGAUR 2005SGR00695 and AGAUR 2009SGR126), who had no role in data collection, analysis or interpretation of results. Disclosed potential Libraries conflicts of interest JTS: Named inventor on U.S. government-owned HPV vaccine-related patents that are licensed to Merck & Co., GlaxoSmithKline, Sanofi Pasteur and Shantha Biotechnics and is entitled to limited royalties as specified by federal law. XC: Institutional support: HPV vaccine trials and epidemiological studies sponsored by GlaxoSmithKline, Merck and Sanofi Pasteur MSD. Screening and HPV testing trials partially supported by Qiagen. Personal support: Travel grants to scientific meetings and honorarium for consultancy are occasionally granted by either GlaxoSmithKline, Merck, Sanofi Pasteur MSD.