臨床婦人科産科64巻3号

2010年03月発行

今月の臨床 子宮頸がんの予防戦略―ワクチンと検診 HPVワクチン─確実な予防効果

3．HPVワクチンの現状

著者： 吉川裕之¹

所属機関： ¹筑波大学大学院人間総合科学研究科婦人周産期医学

ページ範囲：P.252 - P.255

はじめに

　ヒトパピローマウイルス（human papillomavirus : HPV）では，約15の型（16，18，31，33，35，39，45，51，52，56，58，59，68，69，73，82型など）が，子宮頸がん関連HPVとして知られ，最も高頻度に検出されるのはHPV16であり，次いでHPV18である^1）．子宮頸がんの原因とはならないHPVはlow-risk typesと呼ばれ，尖圭コンジローマや喉頭乳頭種（小児型，成人型）の原因であるHPV6，11型が代表的である．

　HPV感染は最も頻度の高い性感染で，20歳前後の女性のコホート研究では3～5年で40～60％にHPV感染が起こる^2）．HPV感染からみると，子宮頸がん発生は，むしろ例外的なイベントといえる．HPVがん蛋白であるE6/E7の機能とHPV感染細胞に対する細胞免疫が重要な鍵を握っている．HPV感染は子宮頸がん発生の必要条件で，感染を予防することで子宮頸がん征圧が期待できる．

参考文献

1）Munoz N, Bosch FX, de Sanjose S, et al : Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med 348 : 518-527, 2003

2）Markowitz LE, Dunne EF, Saraiya M, et al : Advisory Committee on Immunization Practices（ACIP）. Quadrivalent human papillomavirus vaccine : Recommendations of the Advisory Committee on Immunization Practices（ACIP）. MMWR Recomm. Rep 56（RR-2）: 1-24, 2007

3）Harper DM, Franco EL, Wheeler CM, et al : HPV Vaccine Study group. Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18 : follow-up from a randomised control trial. Lancet 367 : 1247-1255, 2006

4）Garland SM, Hernandez-Avila M, Wheeler CM, et al : Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. Females United to Unilaterally Reduce Endo/Ectocervical Disease（FUTURE）I Investigators. N Engl J Med 356 : 1928-1943, 2007

5）Paavonen J, Jenkins D, Bosch FX, et al : Efficacy of a prophylactic adjuvanted bivalent L1 virus-like-particle vaccine against infection with human papillomavirus types 16 and 18 in young women : an interim analysis of a phase III double-blind, randomised controlled trial. Lancet 369 : 2161-2170, 2007. Erratum in : Lancet 370 : 1414, 2007

6）The FUTUREII Study Group : Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Eng J Med 356 : 1915-1927, 2007

7）Joura EA, Leodolter S, Hernandez-Avila M, et al : Efficacy of a quadrivalent prophylactic human papillomavirus（types 6, 11, 16, and 18）L1 virus-like-particle vaccine against high-grade vulval and vaginal lesions : a combined analysis of three randomised clinical trials. Lancet 369 : 1693-1702, 2007

8）Ault KA ; Future II Study Group : Effect of prophylactic human papillomavirus L1 virus-like-particle vaccine on risk of cervical intraepithelial neoplasia grade 2, grade 3, and adenocarcinoma in situ : a combined analysis of four randomised clinical trials. Lancet 369 : 1861-1868, 2007

9）Konno R, Dobbelaere KO, Godeaux O, et al : Immunogenicity, reactogenicity and safety of human papillomavirus 16/18 AS04-adjuvanted vaccine in Japanese women : interim analysis of a phase II double-blind, randomized controlled trial at Month 7. Int J Gynecol Cancer 19 : 905-911, 2009

10）Miura S, Matsumoto K, Oki A, et al : Do we need a different strategy for HPV screening and vaccination in East Asia? Int J Cancer 119 : 2713-2715, 2006

11）Onuki M, Matsumoto K, Satoh T, et al : Human papillomavirus infections among Japanese women : age-related prevalence and type-specific risk for cervical cancer. Cancer Sciences 100 : 1312-1316, 2009

12）Schiffman M, Castle PE : The promise of global cervical-cancer prevention. N Engl J Med 353 : 2101-2104, 2005

13）Nakagawa S, Yoshikawa H, Onda T, et al : Type of human papillomavirus is related to clinical features of cervical cancer. Cancer 78 : 1935-1941, 1996