La vacunación frente al virus del papiloma humano (VPH) puede prevenir las infecciones y las enfermedades asociadas al VPH.[53]Joura EA, Giuliano AR, Iversen OE, et al. A 9-valent HPV vaccine against infection and intraepithelial neoplasia in women. N Engl J Med. 2015 Feb 19;372(8):711-23.
http://www.nejm.org/doi/full/10.1056/NEJMoa1405044#t=article
http://www.ncbi.nlm.nih.gov/pubmed/25693011?tool=bestpractice.com
[54]Centers for Disease Control and Prevention. Supplemental information and guidance for vaccination providers regarding use of 9-valent HPV vaccine. Nov 2016 [internet publication].
http://www.cdc.gov/hpv/downloads/9vHPV-guidance.pdf
[55]Munoz N, Manalastas R Jr, Pitisuttithum P, et al. Safety, immunogenicity, and efficacy of quadrivalent human papillomavirus (types 6, 11, 16, 18) recombinant vaccine in women aged 24-45 years: a randomised, double-blind trial. Lancet. 2009 Jun 6;373(9679):1949-57.
http://www.ncbi.nlm.nih.gov/pubmed/19493565?tool=bestpractice.com
[56]Koutsky LA, Ault KA, Wheeler CM, et al. A controlled trial of a human papillomavirus type 16 vaccine. N Engl J Med. 2002 Nov 21;347(21):1645-51.
http://www.ncbi.nlm.nih.gov/pubmed/12444178?tool=bestpractice.com
[57]Harper DM, Franco EL, Wheeler C, et al. Efficacy of a bivalent L1 virus-like particle vaccine in prevention of infection with human papillomavirus types 16 and 18 in young women: a randomised controlled trial. Lancet. 2004 Nov 13-19;364(9447):1757-65.
http://www.ncbi.nlm.nih.gov/pubmed/15541448?tool=bestpractice.com
[58]Arbyn M, Xu L, Simoens C, et al. Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors. Cochrane Database Syst Rev. 2018 May 9;(5):CD009069.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009069.pub3/full
http://www.ncbi.nlm.nih.gov/pubmed/29740819?tool=bestpractice.com
[59]Brisson M, Kim JJ, Canfell K, et al. Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet. 2020 Feb 22;395(10224):575-90.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30068-4/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/32007141?tool=bestpractice.com
[60]Marth C, Landoni F, Mahner S, et al. Cervical cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017 Jul 1;28(suppl 4):iv72-83.
https://www.annalsofoncology.org/article/S0923-7534(19)42148-0/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/28881916?tool=bestpractice.com
[ 
]
What are the advantages and disadvantages of the prophylactic human papillomavirus (HPV) vaccination in 15‐ to 26‐year‐old women?/cca.html?targetUrl=https://www.cochranelibrary.com/cca/doi/10.1002/cca.4171/fullMostrarme la respuesta Los estudios realizados en países con programas establecidos de vacunación contra el VPH informan una incidencia sustancialmente reducida de cáncer de cuello uterino.[16]Lei J, Ploner A, Elfström KM, et al. HPV vaccination and the risk of invasive cervical cancer. N Engl J Med. 2020 Oct 1;383(14):1340-48.
https://www.nejm.org/doi/10.1056/NEJMoa1917338?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
http://www.ncbi.nlm.nih.gov/pubmed/32997908?tool=bestpractice.com
[17]Kjaer SK, Dehlendorff C, Belmonte F, et al. Real-world effectiveness of human papillomavirus vaccination against cervical cancer. J Natl Cancer Inst. 2021 Oct 1;113(10):1329-35.
https://academic.oup.com/jnci/article/113/10/1329/6227603
http://www.ncbi.nlm.nih.gov/pubmed/33876216?tool=bestpractice.com
[18]Guo F, Cofie LE, Berenson AB. Cervical cancer incidence in young U.S. females after human papillomavirus vaccine introduction. Am J Prev Med. 2018 Aug;55(2):197-204.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6054889
http://www.ncbi.nlm.nih.gov/pubmed/29859731?tool=bestpractice.com
[19]Falcaro M, Castañon A, Ndlela B, et al. The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study. Lancet. 2021 Dec 4;398(10316):2084-92.
http://www.ncbi.nlm.nih.gov/pubmed/34741816?tool=bestpractice.com
Los estudios destacan la importancia de la vacunación temprana para reducir el riesgo. Vacunar a los niños en el mismo calendario puede contribuir a la protección indirecta de las mujeres no vacunadas y aumentar la inmunidad en la población en general.[21]Rahangdale L, Mungo C, O'Connor S, et al. Human papillomavirus vaccination and cervical cancer risk. BMJ. 2022 Dec 15;379:e070115.
https://www.bmj.com/content/379/bmj-2022-070115.long
http://www.ncbi.nlm.nih.gov/pubmed/36521855?tool=bestpractice.com
La mayoría de los cánceres asociados con el VPH son causados por los tipos 16 o 18 del VPH (aproximadamente el 70%), contra los cuales se dirigen las vacunas contra el VPH.[26]Muñoz N, Bosch FX, de Sanjosé S, et al. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med. 2003 Feb 6;348(6):518-27.
http://www.nejm.org/doi/full/10.1056/NEJMoa021641#t=article
http://www.ncbi.nlm.nih.gov/pubmed/12571259?tool=bestpractice.com
[61]Braaten KP, Laufer MR. Human papillomavirus (HPV), HPV-related disease, and the HPV vaccine. Rev Obstet Gynecol. 2008 Winter;1(1):2-10.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2492590
http://www.ncbi.nlm.nih.gov/pubmed/18701931?tool=bestpractice.com
Las vacunas contra el VPH se caracterizan por su valencia:[62]Restrepo J, Herrera T, Samakoses R, et al. Ten-year follow-up of 9-valent human papillomavirus vaccine: immunogenicity, effectiveness, and safety. Pediatrics. 2023 Oct 1;152(4):e2022060993.
https://publications.aap.org/pediatrics/article/152/4/e2022060993/193886/Ten-Year-Follow-up-of-9-Valent-Human
http://www.ncbi.nlm.nih.gov/pubmed/37667847?tool=bestpractice.com
Bivalente (protege contra los tipos 16 y 18 del VPH)
Tetravalente (protege contra los tipos 6, 11, 16 y 18 del VPH)
9-valente (protege contra los tipos 6, 11, 16, 18, 31, 33, 45, 52 y 58 del VPH)
Las vacunas contra el VPH están autorizadas para su uso en esquemas de dos o tres dosis; sin embargo, la evidencia de estudios a largo plazo sugiere que una dosis única ofrece una protección comparable a dos dosis.[63]Kreimer AR, Sampson JN, Porras C, et al. Evaluation of durability of a single dose of the bivalent HPV vaccine: the CVT trial. J Natl Cancer Inst. 2020 Oct 1;112(10):1038-46.
https://publications.aap.org/pediatrics/article/152/4/e2022060993/193886/Ten-Year-Follow-up-of-9-Valent-Human
http://www.ncbi.nlm.nih.gov/pubmed/32091594?tool=bestpractice.com
[64]Basu P, Malvi SG, Joshi S, et al. Vaccine efficacy against persistent human papillomavirus (HPV) 16/18 infection at 10 years after one, two, and three doses of quadrivalent HPV vaccine in girls in India: a multicentre, prospective, cohort study. Lancet Oncol. 2021 Nov;22(11):1518-29.
https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(21)00453-8/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/34634254?tool=bestpractice.com
[65]Barnabas RV, Brown ER, Onono MA, et al. Efficacy of single-dose HPV vaccination among young African women. NEJM Evid. 2022 Jun;1(5):EVIDoa2100056.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9172784
http://www.ncbi.nlm.nih.gov/pubmed/35693874?tool=bestpractice.com
La Organización Mundial de la Salud recomienda un esquema de una o dos dosis para niñas de 9 a 20 años y un esquema de dos dosis para mujeres mayores de 21 años.[66]World Health Organization. Human papillomavirus vaccines: WHO position paper, December 2022 [internet publication].
https://www.who.int/publications/i/item/who-wer9750-645-672
Calendario de vacunación del Reino Unido
En el Reino Unido, se recomienda la vacunación contra el VPH a todos los adolescentes (niños y niñas) de 12-13 años.[67]UK Health Security Agency. Human papillomavirus (HPV): the green book, chapter 18a. Jun 2023 [internet publication].
https://www.gov.uk/government/publications/human-papillomavirus-hpv-the-green-book-chapter-18a
Se recomienda una sola dosis de la vacuna 9-valente.[68]UK Health Security Agency. HPV vaccination guidance for healthcare practitioners (version 6). Jun 2023 [internet publication].
https://www.gov.uk/government/publications/hpv-universal-vaccination-guidance-for-health-professionals/hpv-vaccination-guidance-for-healthcare-practitioners
UKHSA: routine childhood immunisations
Opens in new window
Las personas elegibles en el programa nacional del Reino Unido pueden vacunarse hasta los 25 años, incluidos aquellos que llegan al Reino Unido desde el extranjero y no han sido vacunados.
Se debe ofrecer un esquema de 3 dosis con dosis a los 0, 1 y 4-6 meses a las personas con VIH y a aquellas de las que se sabe que están inmunocomprometidas en el momento de la inmunización.[68]UK Health Security Agency. HPV vaccination guidance for healthcare practitioners (version 6). Jun 2023 [internet publication].
https://www.gov.uk/government/publications/hpv-universal-vaccination-guidance-for-health-professionals/hpv-vaccination-guidance-for-healthcare-practitioners
Calendario de vacunación de los EE. UU.
En Estados Unidos, la vacunación contra el VPH con la vacuna 9-valente se recomienda de forma rutinaria a la edad de 11-12 años (pero puede comenzar a los 9 años).[69]Saslow D, Andrews KS, Manassaram-Baptiste D, et al. Human papillomavirus vaccination 2020 guideline update: American Cancer Society guideline adaptation. CA Cancer J Clin. 2020 Jul;70(4):274-80.
https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21616
http://www.ncbi.nlm.nih.gov/pubmed/32639044?tool=bestpractice.com
[70]Centers for Disease Control and Prevention. Child and adolescent immunization schedule by age. Nov 2024 [internet publication].
https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent-age.html
El calendario recomendado es:[70]Centers for Disease Control and Prevention. Child and adolescent immunization schedule by age. Nov 2024 [internet publication].
https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent-age.html
Dos inyecciones intramusculares a los 0 y 6-12 meses cuando la vacunación se inicia antes de los 15 años, o
Tres inyecciones intramusculares a los 0, 1-2 y 6 meses cuando la vacunación se inicia a los 15 años o más tarde.
Las personas con VIH u otras afecciones de inmunocompromiso deben recibir tres dosis de la vacuna contra el VPH, incluso si la vacunación se inicia entre los 9 y los 14 años, porque su respuesta a la vacunación puede verse atenuada.[71]National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, and Infectious Diseases Society of America. Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV. 2024 [internet publication].
https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-oi/guidelines-adult-adolescent-oi.pdf
Los niños con antecedentes de abuso o agresión sexual deben recibir la vacuna contra el VPH lo antes posible (a partir de los 9 años).[72]American College of Obstetricians and Gynecologists' Committee on Adolescent Health Care, American College of Obstetricians and Gynecologists' Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group. Human papillomavirus vaccination: ACOG committee opinion, number 809. Obstet Gynecol. 2020 Aug;136(2):e15-21.
https://journals.lww.com/greenjournal/fulltext/2020/08000/human_papillomavirus_vaccination__acog_committee.48.aspx
http://www.ncbi.nlm.nih.gov/pubmed/32732766?tool=bestpractice.com
Se recomienda la vacunación de recuperación para las personas de hasta 26 años de edad (y se puede considerar con la toma de decisiones compartida para las personas de 27 años o más) que no se vacunaron adecuadamente cuando eran más jóvenes.[70]Centers for Disease Control and Prevention. Child and adolescent immunization schedule by age. Nov 2024 [internet publication].
https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent-age.html
No se recomienda la vacunación contra el VPH durante el embarazo (aunque no es necesaria ninguna intervención si la vacuna se administra inadvertidamente durante el embarazo).[69]Saslow D, Andrews KS, Manassaram-Baptiste D, et al. Human papillomavirus vaccination 2020 guideline update: American Cancer Society guideline adaptation. CA Cancer J Clin. 2020 Jul;70(4):274-80.
https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21616
http://www.ncbi.nlm.nih.gov/pubmed/32639044?tool=bestpractice.com
[72]American College of Obstetricians and Gynecologists' Committee on Adolescent Health Care, American College of Obstetricians and Gynecologists' Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group. Human papillomavirus vaccination: ACOG committee opinion, number 809. Obstet Gynecol. 2020 Aug;136(2):e15-21.
https://journals.lww.com/greenjournal/fulltext/2020/08000/human_papillomavirus_vaccination__acog_committee.48.aspx
http://www.ncbi.nlm.nih.gov/pubmed/32732766?tool=bestpractice.com
[73]Centers for Disease Control and Prevention. Adult immunization schedule by age. Nov 2024 [internet publication].
https://www.cdc.gov/vaccines/hcp/imz-schedules/adult-age.html
El American College of Obstetricians and Gynecologists (ACOG) recomienda la vacunación contra el VPH en mujeres que están en periodo de lactancia materna de 26 años o menos que no hayan sido vacunadas previamente.[72]American College of Obstetricians and Gynecologists' Committee on Adolescent Health Care, American College of Obstetricians and Gynecologists' Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group. Human papillomavirus vaccination: ACOG committee opinion, number 809. Obstet Gynecol. 2020 Aug;136(2):e15-21.
https://journals.lww.com/greenjournal/fulltext/2020/08000/human_papillomavirus_vaccination__acog_committee.48.aspx
http://www.ncbi.nlm.nih.gov/pubmed/32732766?tool=bestpractice.com
Se pueden encontrar más detalles sobre los calendarios de vacunación actuales de EE. UU., incluidas las vacunas de recuperación y las poblaciones de pacientes especiales, en los últimos calendarios de vacunación del ACIP para niños y adultos.[70]Centers for Disease Control and Prevention. Child and adolescent immunization schedule by age. Nov 2024 [internet publication].
https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent-age.html
[73]Centers for Disease Control and Prevention. Adult immunization schedule by age. Nov 2024 [internet publication].
https://www.cdc.gov/vaccines/hcp/imz-schedules/adult-age.html
Anticonceptivos de barrera y dispositivos intrauterinos
El VPH se transmite por contacto sexual piel con piel; por lo tanto, una salud sexual segura y una anticoncepción de barrera eficaz pueden desempeñar un papel en la prevención primaria.[74]Parazzini F, Negri E, La Vecchia C, et al. Barrier methods of contraception and the risk of cervical neoplasia. Contraception. 1989 Nov;40(5):519-30.
http://www.ncbi.nlm.nih.gov/pubmed/2692961?tool=bestpractice.com
Sin embargo, el problema es complejo.[75]Erbelding EJ, Zenilman JM. Toward better control of sexually transmitted diseases. N Engl J Med. 2005 Feb 17;352(7):720-1.
http://www.ncbi.nlm.nih.gov/pubmed/15716568?tool=bestpractice.com
[76]Bulkmans NW, Berkhof J, Rozendaal L, et al. Human papillomavirus DNA testing for the detection of cervical intraepithelial neoplasia grade 3 and cancer: 5-year follow-up of a randomised controlled implementation trial. Lancet. 2007 Nov 24;370(9601):1764-72.
http://www.ncbi.nlm.nih.gov/pubmed/17919718?tool=bestpractice.com
El uso de un dispositivo intrauterino puede reducir el riesgo de cáncer de cuello uterino.[77]Cortessis VK, Barrett M, Brown Wade N, et al. Intrauterine device use and cervical cancer risk: a systematic review and meta-analysis. Obstet Gynecol. 2017 Dec;130(6):1226-36.
http://www.ncbi.nlm.nih.gov/pubmed/29112647?tool=bestpractice.com
[78]Spotnitz ME, Natarajan K, Ryan PB, et al. Relative risk of cervical neoplasms among copper and levonorgestrel-releasing intrauterine system users. Obstet Gynecol. 2020 Feb;135(2):319-27.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7012337
http://www.ncbi.nlm.nih.gov/pubmed/31923062?tool=bestpractice.com
[79]Minalt N, Caldwell A, Yedlicka GM, et al. Association between intrauterine device use and endometrial, cervical, and ovarian cancer: an expert review. Am J Obstet Gynecol. 2023 Aug;229(2):93-100.
http://www.ncbi.nlm.nih.gov/pubmed/37001577?tool=bestpractice.com