Текущие проблемы и будущие направления вакцинации против вируса папилломы человека (ВПЧ)

Рак шейки матки, вызываемый вирусом папилломы человека (ВПЧ) 16 и 18 типов, является одним из самых распространенных злокачественных новообразований у женщин. Другие высокоонкогенные типы вируса способствуют возникновению рака влагалища, вульвы, пениса, анального канала, злокачественных новообразований головы и шеи. Низкоонкогенные типы ВПЧ, такие как 6 и 11, могут быть причиной аногенитальных бородавок и папилломатоза верхних дыхательных путей. Эти заболевания возможно предотвратить с помощью вакцинации до инфицирования вирусом. Цель работы: систематизация актуальных данных по профилактике ВПЧ-ассоциированных заболеваний с помощью вакцинации. В настоящее время в мире зарегистрированы три вакцины против вируса папилломы человека — Церварикс®, Гардасил® и Гардасил®9. Обширные клинические и пострегистрационные исследования свидетельствуют о безопасности и высокой эффективности данных вакцин (до 100%) в отношении возникновения интраэпителиальных неоплазий шейки матки, вульвы и влагалища при введении их пациенткам, не инфицированным данными типами вируса ранее. Однако существует ряд нерешенных вопросов, стимулирующих проведение дальнейших клинических исследований по поиску универсальной вакцины. Прежде всего эффективность указанных вакцин ограничена включенными типами ВПЧ. Только в 2011 г. был поднят вопрос о необходимости вакцинации лиц мужского пола. Также периодически происходит пересмотр рекомендаций по кратности вакцинации вследствие появления новых результатов исследований иммуногенности вакцины. Снижение кратности иммунизации особенно актуально для развивающихся стран с ограниченными финансовыми ресурсами и высокой заболеваемостью раком шейки матки. Таким образом, для достижения элиминации ВПЧ во всем мире необходимо проведение глобальных программ вакцинации, в том числе оптимальных по доступности и кратности вакцинации для развивающихся стран, увеличение охвата вакцинацией по возрасту и полу, а также расширение программ скрининга в области онкологии.

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