HPV-Impfung bei Kindern, Jugendlichen und jungen Erwachsenen

ZUSAMMENFASSUNG

Neben gutartigen Kondylomen zählen Krebsvorstufen von Zervix, Vulva, Vagina, Anus und Penis sowie die entsprechenden Karzinome zu den HPV-bedingten Erkrankungen. In den letzten Jahrzehnten haben HPV-assoziierte Oropharynxkarzinome zugenommen, vor allem bei Männern. Insgesamt werden 4–5 % aller Krebserkrankungen durch HPV verursacht. In allen HPV-bedingten Karzinomen ist HPV16 der häufigste HPV-Typ. Kondylome und die rezidivierende Larynxpapillomatose (RLP) werden durch HPV6 und 11 ausgelöst. Die meisten HPV-assoziierten Erkrankungen können durch prophylaktische HPV-Impfung verhindert werden, wobei ein junges Impfalter bzw. HPV-Naivität entscheidend sind. In Ländern mit hohen HPV-Impfraten bei Kindern und Jugendlichen nehmen nicht nur Kondylome, sondern auch das Zervixkarzinom und seine Vorstufen drastisch ab. In Australien und den USA wird ein deutlicher Rückgang der juvenilen RLP beobachtet, weil geimpfte Mütter vor HPV6/11 geschützt sind. Metaanalysen kommen zu dem Schluss, dass die Off-Label-HPV-Impfung als adjuvante Therapie bei RLP einen Nutzen haben könnte, aber weitere Studien notwendig sind. Die WHO strebt die Elimination des Zervixkarzinoms an. Dazu müssen bei Mädchen bis zum 15. Lebensjahr HPV-Impfraten von 90 % in allen Ländern erreicht werden. Da in Deutschland die HPV-Impfquote bei 15-jährigen Mädchen nur bei 54 % liegt (Jungen 26,5 %), sind weitere Anstrengungen zur Erhöhung der Impfraten notwendig.

ABSTRACT

HPV-induced diseases comprise benign genital warts, precancerous lesions of the cervix, vulva, vagina, anus, and penis as well as the corresponding carcinomas. In recent decades, HPV-associated oropharyngeal cancer has increased, especially in men. Overall, 4–5 % of all human cancers are caused by HPV. In all HPV-related cancers, HPV16 is the most common HPV-type. Genital warts and recurrent respiratory papillomatosis (RRP) are caused by HPV6 and 11. Most HPV-associated diseases are preventable by prophylactic HPV vaccination, with young age at vaccination respectively HPV naivety being critical. In countries with high HPV vaccination rates in children and adolescents, both genital warts and cervical cancer and its precursors have decreased dramatically. In Australia and the United States, a significant decline in juvenile-onset RRP has been observed since vaccinated mothers are protected from HPV6/11. Meta-analyses conclude that off-label HPV vaccination may be a beneficial adjuvant treatment for RRP, but further studies are needed. WHO aims to eliminate cervical cancer. This will require HPV vaccination rates of 90 % in girls by the age of 15 in all countries. Since the HPV vaccination rate in 15-year-old girls in Germany is only 54 % (boys 26.5 %), further efforts to increase vaccination rates are needed.

Schlüsselwörter

Humane Papillomviren (HPV) - Impfung - Prophylaxe

Keywords

Human papillomavirus (HPV) - vaccination - prophylaxis

Publikationsverlauf

Artikel online veröffentlicht:
12. Juni 2023

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