The substantially lower attack rates in seropositives are an important consideration that should not be ignored in these discussions. Therapeutic efficacy of the vaccines was not specifically evaluated in the end of study publications, in large measure because there was no evidence for it in interim analyses. Although the clinical trials were primarily designed to evaluate immunoprophylaxis, the fact that women who had prevalent cervicovaginal infection or low grade disease were not excluded at entry provided a cohort to evaluate therapeutic efficacy. In the CVT, time to clearance

of prevalent infection was evaluated. There was no difference in the rate of clearance of vaccine or non-vaccine MEK activity Selleck Dorsomorphin types in Cervarix® vaccinees and control [37]. For example, 48.9% and 49.8% of HPV16/18 infections were cleared after 12 months in vaccine recipients and controls, respectively. The therapeutic activity of Gardasil® was evaluated in FUTURE II [15]. No significant difference in the rate of progression of HPV16/18 infection to CIN2+ was observed in VLP vaccinees versus controls,

11.1% and 11.9%, respectively. Thus the VLP vaccines do not appear to alter the course of established cervicovaginal HPV infection or disease. Both vaccines exhibited excellent safety profiles in the clinical trials. Mild to moderate injection-site symptoms, headache and fatigue were the most common adverse events in Cervarix® and Gardasil® vaccinees and controls. Injection-site pain ranged from 83.0–93.4%

in vaccine groups and from 75.5–87.25% in control groups [14], [15], [38] and [39]. Headache and fatigue was reported in 50-60% of participants in both groups. These solicited symptoms were transient and resolved spontaneously and did not increase with number of doses. Symptoms were not notably different in women with evidence of prevalent or past infection [32] and [35]. In a randomized control trial directly comparing the two vaccines, injection-site pain was somewhat higher with Cervarix® than with Gardasil®; 92.9% (95% CI: 90.4–95.0) and 71.6% (95% to CI: 67.5–75.4) respectively [40]. Grade 3 severity was reported in 17.4% (95% CI: 14.2–20.9) and 3.4% (95% CI: 2.0–5.4) in Cervarix® and Gardasil® groups respectively. However, compliance rates with the three-dose schedule were similarly high (>84%). The inclusion of the immune stimulating component MPL in the Cervarix® adjuvant might account for somewhat higher reactogenicity of the vaccine [38]. For both Cervarix® and Gardasil®, vaccine and control groups experienced similar rates of serious adverse events (SAEs) (Table 8). The numbers of SAEs judged to be possibly related to vaccine injection was low for both vaccines and similar to the numbers in the control groups (Table 8). Pregnancy outcomes have received special attention, given the target ages of catch up vaccination programs.