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As we write, the Food and Drug Administration (USA) has approved the use of the 9-valent human papilloma virus (HPV) vaccine. Questions remain, however, about who to vaccinate. Should we be vaccinating boys/men, and how old is too old to be vaccinated? Skinner et al1 go some way to answering the second question with their interim analysis. The VIVIANE study is a multicentre double-blinded randomised controlled trial looking at the efficacy of the bivalent HPV 16/18 vaccine in women >25 years. (The PATRICIA study previously looked at this vaccine in women <25 years).2 In total, 15% of women included in the trial had prior exposure to HPV, and primary endpoints were persistent HPV 16/18 infection at 6 months or CIN1 or greater associated with these subtypes. Vaccine efficacy was 81.1% for the total group and 86.4% for those who were seropositive for HPV but negative for HPV DNA at baseline, after 40.3-month follow-up. The vaccine appears to be more efficacious in the group aged 26–35 years than in …
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