病気を科学する （婦人科がん2oo9） 子宮頸癌と HP䠨予防ワクチン

2009ᖳ5᭮21᪝
⑋Ẵ䜘⛁Ꮥ䛟䜑
䟺፦ெ⛁䛒䜙䠄䠂䠂䠋䟻
Ꮔᐋ㢍⒬䛮
䠚䠢䠨஢㜭䝳䜳䝅䝷
䚭ᶋὶᕰ❟ኬᏕ㜻ᒌ⑋㝌䚭໩Ꮥ⒢Ἢ䜿䝷䝃䞀㛏
⏐፦ெ⛁
䚭䚭䚭䚭䚭䚭䚭䚭䚭䚭䚭䚭䚭䚭䚭䚭䚭䚭䚭䚭ᐋᇖᝃᏄ
Ꮔᐋ㢍⒬䛴␷Ꮥ
Ꮔᐋ㢍⒬
ୠ⏲୯䛭䛵⣑䠄ฦ㛣䛱䠃ெ䛴ዥᛮ䛒Ꮔᐋ㢍⒬䛱䜎䛩䛬Ṓஷ䛝䛬䛊䜑
᪝ᮇ䛭䛵䠃᪝䛱⣑䠉ெ䛴ዥᛮ䛒Ꮔᐋ㢍⒬䛱䜎䛩䛬Ṓஷ䛝䛬䛊䜑
໪䜦䝥䝮䜯㻃+ 䝬䞀䝱䝇䝕
䜦䜼䜦
75,000
266,000
36,000
143,000
䜦䝙䝮䜯
䝭䝊䝷䜦䝥䝮䜯
79,000
72,000
62,000
33,000
Ꮔᐋ㢍⒬䛴ᖳ㛣᩺ぞᝀ⩽ᩐ: ~ 500,000
Ꮔᐋ㢍⒬䛱䜎䜑ᖳ㛣Ṓஷ⩽ᩐ: ~ 270,000
Estimates from GLOBOCAN 2002
Ꮔᐋ㢍⒬䛴⨧ᝀ⋙䛮Ṓஷ⋙䟺᪝ᮇெዥᛮ䟻
ெཾ10୒ᑊ
䟺ெ䟻
ᖳ㛣⣑8,000ெ䛒⨧ᝀ䛝⣑2,400ெ䛒Ṓஷ㻍
30ṋ௥ᚃ༖䛴
഼䛓┊䜐ୠ௥䛱
䝘䞀䜳
24
22
20
18
16
14
12
10
8
6
4
2
0
⨧ᝀ⋙
0-
4
510 9
-1
15 4
-1
20 9
-2
25 4
-2
30 9
-3
35 4
-3
40 9
-4
45 4
-4
50 9
-5
55 4
-5
60 9
-6
65 4
-6
70 9
-7
75 4
-7
80 9
-8
4
85
-
Ṓஷ⋙
ᖳ㱃
⨧ᝀ⋙䠌2001ᖳ䝋䟿䝃䚮Ṓஷ⋙2005ᖳ䝋䟿䝃
ᅗ❟䛒䜙䜿䝷䝃䞀䛒䜙ᑊ➿᝗ሒ䜿䝷䝃䞀
*ཉ⏍ຘ഼⛁Ꮥ◂✪㈕⿭ຐ㔘㻃➠3ḗᑊ䛒䜙⥪ྙᡋ␆◂✪஥ᴏ㻃䛒䜙⨧ᝀ·Ṓஷິྡྷ䛴ᐁឺᢍᥩ䛴◂✪
ᖲᠺ18ᖳᗐ㻃⥪ᣋ·ฦᢰ◂✪ሒ࿈᭡(୹௴◂✪⩽㻃♵∏ỜཪᏏ), 2007ᖳ4᭮ප㛜
Ꮔᐋ㢍㒂ᾈ₮⒬ᝀ⩽䛴ᖳ㱃ื㐅⾔᭿ฦᕱ䛴ን໩䠌
1982ᖳ䛐䜎䛹2004ᖳ䛴Ẓ㍉
30~40௥䛭Ꮔᐋ
ᦤฝᡥ⾙䜘さ䛟
䜑䠛䠴᭿䛒ኣ䛊
ሒ
࿈
ౚ
ᩐ
500
500
400
400
300
300
200
% 200
$
# 㐅 100
"b ⾔
"a ᭿
100
0
!29 30!39 40!49 50!59 60!69 70!79 80!
0
%
$
# 㐅
"b ⾔
"a
᭿
!29 30!39 40!49 50!59 60!69 70!79 80!
ᖳ㱃
ᖳ㱃
䟺1982ᖳ⑍ౚ䟻
䟺2004ᖳ⑍ౚ䟻
ᒷᆊ๙䠌⮣፦⏐䠀61(6), 780-785, 2007
᪝ᮇ⏐⛁፦ெ⛁Ꮥఌ䝿፦ெ⛁⭐⑾ጟဤఌሒ࿈䠌1982ᖳ䛐䜎䛹2004ᖳᝀ⩽ᖳሒ
᪝ᮇ䛱䛐䛗䜑20-29ṋ䛴ዥᛮ10୒ெᙔ䛥䜐䛴
྘⛸⒬䛴Ⓠ⑍⋙䛴᥆⛛
!"#$%&"#&'()*+),'-&./0'12%3
,
:
@
!A
BA
CD
E
FGHI
JKL
MN
JKOHI
JKO
<.=&'>&/'4**?***
9
8
7
6
5
)
4
*
4,97
4,:*
4,:7
4,,*
4,,7
)***
;&./
䟼䠃䚭୕⓮හ⒬䜘ྱ䜆
ᅗ❟䛒䜙䜿䝷䝃䞀䛒䜙ᑊ➿᝗ሒ䜿䝷䝃䞀䚮ெཾິឺ⤣ゝ䟺ཉ⏍ຘ഼┤ኬ⮟ᏻᡛ⤣ゝ᝗ሒ㒂䟻䚭
㼋㼗㼗㼓㻝㻒㻒㼊㼄㼑㼍㼒㼋㼒㻑㼑㼆㼆㻑㼊㼒㻑㼍㼓㻒㼓㼕㼒㼉㼈㼖㼖㼌㼒㼑㼄㼏㻒㼖㼗㼄㼗㼌㼖㼗㼌㼆㼖㻒㼖㼗㼄㼗㼌㼖㼗㼌㼆㼖㻑㼋㼗㼐㼏
᪝ᮇ䛱䛐䛗䜑30-39ṋ䛴ዥᛮ10୒ெᙔ䛥䜐䛴
྘⛸⒬䛴Ⓠ⑍⋙䛴᥆⛛
!"#$%&"#&'()*+),'-&./0'12%3
74
7*
?
!@
A@
BC
D
EFGH
IJK
LM
IJNGH
IJN
;.<&'=&/'5**>***
)4
)*
64
6*
54
5*
4
*
5,84
5,9*
5,94
5,,*
5,,4
6***
:&./
䟼䠃䚭୕⓮හ⒬䜘ྱ䜆
ᅗ❟䛒䜙䜿䝷䝃䞀䛒䜙ᑊ➿᝗ሒ䜿䝷䝃䞀䚮ெཾິឺ⤣ゝ䟺ཉ⏍ຘ഼┤ኬ⮟ᏻᡛ⤣ゝ᝗ሒ㒂䟻䚭
㼋㼗㼗㼓㻝㻒㻒㼊㼄㼑㼍㼒㼋㼒㻑㼑㼆㼆㻑㼊㼒㻑㼍㼓㻒㼓㼕㼒㼉㼈㼖㼖㼌㼒㼑㼄㼏㻒㼖㼗㼄㼗㼌㼖㼗㼌㼆㼖㻒㼖㼗㼄㼗㼌㼖㼗㼌㼆㼖㻑㼋㼗㼐㼏
Ꮔᐋ㢍⒬䛴⨧ᝀ䛮Ṓஷ
ⱕᖳ໩䛒ၡ㢗䟺䝖䝌䝕䝘䝱䞀䝢䜪䜨
䝯䜽䛴វ᯹ᶭఌ䛴ቌຊ䟻
ᏄᐋῺᏋᡥ⾙䛒ྊ⬗䛰᪡᭿䛒䜙䛭
䛴Ⓠぜ䛮஢㜭䟺᳠チ䚮䝳䜳䝅䝷䟻䛒㔔
さㄚ㢗
Ꮔᐋ㢍䛒䜙䛮
䝖䝌䝕䝘䝱䞀䝢䜪䜨䝯䜽
䝓䝭䝯䝌䝿䝈䜦䝿䝓䜪䝀䝷༡ኃ䛒2008ᖳ䝒䞀䝝䝯⏍⌦Ꮥ䝿༈Ꮥ㈳䜘ུ㈳
䚸Ꮔᐋ㢍䛒䜙䜘ᘤ䛓㉫䛙䛟䝖䝌䝕䝘䝱䞀䝢䜪䜨䝯䜽䟺HPV䟻䛴Ⓠぜ䚹䛒㧏䛕フ౮
 ዥᛮ≁᭯䛴⒬䛴୯䛭2␊┘䛱ኣ䛊Ꮔᐋ㢍⒬䛴୹さཋᅄ䛒䚮≁ᏽ䛴䝃䜨䝛䛴䝖䝌䝕䝘䝱䞀䝢䜪䜨
䝯䜽䟺HPV䟻䛭䛈䜑䛮䛟䜑䜪䜨䝯䜽ㄕ䜘᪡䛕䛑䜏၌䛎䜑䚯
 1983ᖳ䛱Ꮔᐋ㢍⒬⤄⧂䛑䜏HPV 16ᆵ䛐䜎䛹18ᆵ䜘ฦ㞫䛝䚮ᙴ䛴Ꮥㄕ䛒❟ッ䛛䜒䛥䚯
 䛙䛴ᇱ♇◂✪䛴ᠺᯕ䛵Ꮔᐋ㢍⒬䛴἖⒢䚮䛣䛝䛬஢㜭䝳䜳䝅䝷䛴㛜Ⓠ䛾䛮◂✪䛴㐠䜘ᢽ䛊䛥䚯
 ெ㢦䜘⬛䛑䛟⮬ṒⓏ䛰⑋Ẵ䛴ཋᅄ䜘≁ᏽ䛝䚮Ꮔᐋ㢍⒬஢㜭䝳䜳䝅䝷䛴㐠䜘ᗀ䛘䛥䚯
䝓䝭䝯䝌䝿䝈䜦䝿䝓䜪䝀䝷༡ኃ䟺72ṋ䟻
1936ᖳ3᭮⏍䜄䜒䚯≺䝋䝩䝇䜿䝯䝍䝯䝙ኬ䛰䛯䜘⤊䛬䝜䝯
䝤䝟䝯䝈༝ఌഘୖ䛴䝍䜨䝈⒬◂✪䜿䝷䝃䞀䟺DKFZ䟻ᡜ㛏䜘
20ᖳ㛣ຸ䜇䚮2003ᖳ䛴ᏽᖳ㏝ᏻᚃ䜈䝍䜨䝈⮤↓⛁Ꮥ⩽䜦
䜯䝋䝣䞀䝿䝰䜮䝡䝯䝋䜧䝎䛴๧ఌ㛏䛣䛴௙䛴さ⫃䛱䛈䜑䚯
1975ᖳ䚭䜷䝇䝟㈳ུ㈳
1980ᖳ䚭ᑞᅽ䜷䝷䜼䝱䞀䝢䛑䜏HPV 6䝿11ᆵ䜘ฦ㞫*1
1983ᖳ䚭Ꮔᐋ㢍䛒䜙⤄⧂䛑䜏HPV 16*2䝿18*3ᆵ䜘ฦ㞫
*1 Proc.Natl.Acad.Sci.USA 80,560-563(1983)
*2 Proc.Natl.Acad.Sci.USA 80,3812-38151983)
*3 EMBO Journal 3,5,1151-1157(1984)
䝖䝌䝕䝘䝱䞀䝢䜪䜨䝯䜽䟺㻫㻳㻹䟻
L1䝃䝷䝕䜳
஫㔖మ
L2 䝃䝷䝕䜳
䛐䜎䛹ᰶ
⎌≟
DNA
 HPV䛵䝕䝘䝱䞀䝢䜪䜨䝯䜽ᒌ䛴䜪
䜨䝯䜽䛭䛈䜑䚯㻃1
 HPV䛵䜬䝷䝝䝱䞀䝚䜘᭯䛛䛰䛊⌣
≟䛴አ⓮䟺䜯䝛䜻䝍䟻හ䛱஦ᮇ㙈
DNA䜘ᣚ䛪Ẓ㍉Ⓩᑚᆵ䛴䜪䜨䝯
䜽䛭䛈䜑䚯㻃1,2
 䝖䝌䛱វ᯹䛟䜑ᆵ䛵100⛸㢦௧୕
䛒≁ᏽ䛛䜒䛬䛐䜐䚮30䡐40⛸㢦䛴
ᆵ䛒ᛮⓏ᥃り䛱䜎䛩䛬វ᯹䛟䜑䚯
 䛙䜒䜏䛴䛌䛧䚮⣑15⛸㢦䛒Ⓠ⒬ᛮ
䛭䛈䜐䚮Ꮔᐋ㢍⒬䜘ᘤ䛓㉫䛙䛟ྊ
⬗ᛮ䛒䛈䜑䚯㻃3,4
1. De Villiers E-M. Virology 2004; 324: 17-27; 2. Munoz N et al. Int J Cancer 2004; 111: 278–85, 2. Howley PM, Lowy DR. In: Knipe DM, Howley PM, eds.
Philadelphia, Pa: Lippincott-Raven; 2001:2197–2229. , 3. Schiffman M, Castle PE. Arch Pathol Lab Med. 2003;127:930–934. 4. Wiley DJ, Douglas J, Beutner
K, et al. Clin Infect Dis. 2002;35(suppl 2):S210–S224.
HPV䜶䝒䝤䛴ᵋᠺ*1
⣵⬂ቌṢཀྵ䛹⣵⬂࿔᭿㐅⾔䛱
ᑊ䛟䜑፳௒ཀྵ䛹㜴ᐐ1,3
LCR
PAL
E7
7904/1
7000
L1
୹さ䜯䝛䜻䝍1
E6
P97
P670
1000
HPV16
2000
5000
L2
๧䜯䝛䜻䝍3
4000
ඞ␷ᅂ㑂2
䜪䜨䝯䜽DNA
々⿿1,3
3000
䜪䜨䝯䜽䝿䜶䝒䝤ቌᖕ䛱
ᑊ䛟䜑ᐞ୙ᅄᏄ1
PAE
E5
E1
6000
E4
E2
䜪䜨䝯䜽㌹෕ᅄᏄ1,3
* ▦༰䛵᪡᭿䛮ᚃ᭿䜘♟䛟䚯E = ᪡᭿㡷ᇡ; L = ᚃ᭿㡷ᇡ; LCR = long control region; PAE = ᪡᭿䝡䝮䜦䝋䝏
䝯໩㒂న; PAL = ᚃ᭿䝡䝮䜦䝋䝏䝯໩㒂న䚯
1. Doorbar J. Clin Sci. 2006;110:525–541. 2. Ashrafi GH, Brown DR, Fife KH, Campo MS. Virus Res.
2006;120:208–211. 3. Frazer IH. Nature Rev. 2004;4:46–54.
2
HPVฦ㢦䛴⣌⤣Ⓠ⏍
䊗
A
a
䊘
b
䊙
B
a
䊚
b
HPV1
HPV25
HPV20
HPV14
HPV21
HPV5
HPV47
HPV8
HPV2
HPV57
HPV6
HPV11
HPV13
HPV44
HPV43
HPV42
HPV16
HPV35
HPV31
HPV52
HPV33
HPV58
HPV51
HPV56
HPV18
HPV45
HPV39
ME180
⓮⭭␴㉍
␴㉍≟⾪⓮Ⓠ⫩␏ᖏ⑍
⓮⭭䠁⢋⭯
⢋⭯䝱䞀䝮䜽䜳
⢋⭯䝓䜨䝮䜽䜳
Swygart C: Br J Biomed Sci. 54, 299-303, 1997
HPVវ᯹ཀྵ䛹ቌṢ䝭䜨䝙䜹䜨䜳䝯
␏∸ཧ䛵᚜ᑚ
᧷㐛ഭ䛑䜏౴ථ
䛝䛥䜪䜨䝯䜽
វ᯹ᛮ䝗䝮䜮䝷䛴ᨲฝ
䝗䝮䜮䝷䛴⤄䜅❟䛬
䜪䜨䝯䜽DNA䛴々⿿
䜪䜨䝯䜽
វ᯹
Doorbar J. J Clin Virol. 2005; 32S; S7-S15 䜎䜐ᨭን
ᚃ᭿㻃HPV ⺦Ⓣ㈻
䟺㻃L1ཀྵ䛹L2䟻
⏐⏍
᪡᭿㻃HPV ⺦Ⓣ㈻
䟺E1䚮E2䚮E5䚮
E6䚮ཀྵ䛹E7䟻
⏐⏍
⏍Ṣჹ䛱䛐䛗䜑HPVវ᯹䛴⮤↓⤊㐛1,2
⣵⬂ᛮ
ඞ␷ᚺ➽
᭩ิ䛴
⑋ን
វ
᯹
₧ఄ
L1ᢘమ䛴
⾉ΰ㌹ᥦ
ᣚ⤾Ⓩ䛰
⮣ᗃⓏ
ᐰよ
ὩⓆ䛰
ቌṢ
• ఩䝮䜽䜳HPV䛵㧏䝮䜽䜳HPV䜎䜐䜈᪡䛕ᾐ
኶䛟䜑䚯
• HPV 16ᆵវ᯹䛵ᖲᆍ12䡐18䝺᭮㛣ᣚ
⤾䛟䜑䚯
វ᯹䛴ᣚ⤾
ཧ䛵
්Ⓠ
Ⓠ䛒䜙䛮㛭౿
1. Stanley M, Lowy DR, Frazer I. Vaccine. 2006;24(suppl 1):S16–S22. 2. Association of Reproductive Health
Professionals. Available at: http://www.arhp.org/healthcareproviders/cme/onlinecme/hpvcp/infection.cfm.
Accessed April 7, 2007.
7
Ⓠ⒬ᛮ㻫㻳㻹䛴វ᯹䛮Ꮔᐋ㢍㒂⑋ን䛴Ⓠ⏍
Ⓠ⒬ᛮHPV䛱វ᯹䛝䛬䜈⒬໩䛟䜑䛴䛵䛚䛕䜕䛠䛑
ୌ⯙ዥᛮ䛴30~50䟸䛵⏍ᾥ䛱ୌᗐ䛵វ᯹䛟䜑䛮䜈ゕ䜕䜒䜑
Ꮔᐋ㢍⒬45୒ெ
㧏ᗐ␏ᙟᠺ
䟺䠅䟸䟻
㍇~୯➴ᗐ␏ᙟᠺ
䟺䠃䠂䟸䟻⮤↓἖⒭䜈
᭿ᙽ䛭䛓䜑䚯
Ⓠ⒬ᛮHPVᣚ⤾វ᯹⩽䛴
⣑0.15䟸䛱┞ᙔ
CIN 3
1,000୒ெ
CIN 1/2
3,000୒ெ
␏ᙟᠺ䛴ṹ㝭䛭䛴Ⓠぜ
䛮㐲ว䛰⟮⌦䛱䜎䜐䚮Ꮔ
ᐋ㢍⒬䛵஢㜭ྊ⬗䛰⑄
ᝀ䛮䛊䛎䜑䚯
Ⓠ⒬ᛮHPVវ᯹
3൦ெ
Ꮔᐋ㢍⒬䛴ୠ⏲䛭䛴ᖳ㛣⨧ᝀᝀ⩽᥆ᏽ㻃䟺WHO䟻
ᕖྞ䚭ᩏ䜁䛑໩Ꮥ⒢Ἢ䛴㡷ᇡ䠀22(10), 1521-1528, 2006
᪝ᮇெ䛴ୌ⯙ዥᛮ䛱䛐䛗䜑HPV䛴᳠ฝ⋙㻃䟺ᖳ௥ื䟻
50%
45.2%
40%
30%
"
#
$ 20%
23.1%
9.0%
10%
6.3%
4.8%
4.9%
5.8%
5.3%
50!
60!
70!
80!
0%
10!
(n)* 126
20!
1533
2649
30!
1728
40!
1409
536
156
19
%&'
ᑊ㇗䠌2003ᖳ10᭮䡐2004ᖳ5᭮䛱▴ᕖ┬䛱ᅹప䛝䛥ୌ⯙ዥᛮ8,156ౚ
᳠ฝᑊ㇗䛴HPVᆵ䠌䡼䡤䢊䡯䡪䡲䡤䡾䢑䟺16/18/31/33/35/39/45/51/52/56/58/59/66/6/69䟻䛐䜎䛹䢍䡢䢊䡯䡪䡲䡤䡾䢑
䟺6/11/34/40/42/43/44)䠀䝓䜨䝚䝮䝇䝍䜱䝧䝛䝅䝧䞀Ἢ䛱䜎䜐ᑛ䛰䛕䛮䜈1䛪䛴ᆵ䛒᳠ฝ䛛䜒䛥ሔྙ䜘
HPV(+)䛮䛝䛥䚯
Inoue M et al.: Int J Gynecol Cancer. 16, 1007-1013, 2006
᮶ா㒌ㄢᰕ䠌୯Ꮥ䡐㧏ᰧ⏍ዥᏄ䛴ิஹ⤊㥺⋙
䟺䟸䟻
50.0
45.0
"#$%
40.0
35.0
30.0
"&$%
25.0
20.0
15.0
"'$%
10.0
(#$%
5.0
(&$%
0.0
('$%
1987 ! 1990 ! 1993 ! 1996 ! 1999 ! 2002 ! 2005 !
Ἰ㻌䚭㻛7䡐㻓2ᖳ䜄䛭䛵䚮㧏㻖䛴ิஹ⤊㥺⩽⣴✒⩽⋙䚯㻓5ᖳ䛵྘Ꮥᖳ䛱䛐䛗䜑ิஹ⤊㥺⩽⋙䚯
㒌ᛮ◂䚭‘05ᖳඡ❲䝿⏍ᚈ䛴ᛮណㆉᛮ⾔ິㄢᰕୌ㒂ᨭን
䟺᮶ா㒌ᖺᑚ୯㧏ᚨᛮᩅ⫩◂✪ఌ䟺㒌ᛮ◂䟻䛒䚮ୌஐඳୌᖳ௧ᮮ䚮䠅ᖳẎ䛱㒌හ྘ᰧ⛸䚮྘Ꮥᖳ䛴⏠ዥ500ெ௧୕䛴ඡ❲䝿⏍ᚈ
䜘ᑊ㇗䛱䛝䛬ᐁ᪃䛝䛬䛓䛥ᛮណㆉ䝿ᛮ⾔ິ䛴ᐁឺㄢᰕ䟻
Ꮔᐋ㢍㒂⭐⑾䛭᳠ฝ䛛䜒䜑HPVᆵ
16ᆵ䚮18ᆵ䛒≁䛱㔔さ
⭚䛒䜙
䠚䠢䠨ᆵ
⭚ᡝᖲ୕⓮䛒䜙
11
16
18
31
33
39
51
52
58
Ίᅹ
ᆵ୘᪺
㝔ᛮ
ᡝᖲ୕⓮䛒䜙
୕⓮හ䛒䜙
㧏ᗐ␏ᙟᠺ
୯ᗐ␏ᙟᠺ
㍇ᗐ␏ᙟᠺ
0%
20%
40%
60%
80%
100%
ΰỀᩝ୏㻃⥽䠌䝕䝘䝱䟿䝢䜪䜨䝯䜽䛱䜎䜑⭐⑾䠀170-172, 2000䠌ᩝකᇸ, ᮶ா
Ꮔᐋ䛒䜙᳠チ䛴ၡ㢗Ⅴ
Ꮔᐋ䛒䜙᳠チ䛴䜰䜨䝍䝭䜨䝷
ᨭᏽ䟺2004ᖳ䟻
Ꮔᐋ䛒䜙᳠チᑊ㇗⩽ᖳ㱃䛴
20ᡧ௧୕䛾䛴ᘤ䛓ୖ䛘䛱䛪䛊䛬
ᶋὶᕰ❟ኬᏕ㜻ᒌ⑋㝌⏐፦ெ⛁ิチᝀ⩽
䛴ヾ▩⋙䛵䜕䛠䛑10䟸䚭䟺10/100䟻
᭩᩺䛴㢍䛒䜙᳠チུチ⋙䛱䛪䛊䛬
䟺ཉຘ┤䠌ᖲᠺ17ᖳᗐᇱᮇ᳠チㄢᰕ䝿䛒䜙᳠チ䛴ᐁ᪃≟Ἓ䟻
పẰᇱᮇ᳠チ䚭ධᅗᏄᐋ䛒䜙᳠チུチ⋙䚭18.9䟸
ᅗẰ⏍Ὡᇱᮇㄢᰕ䟺௴ណ᳠チྱ䜆䟻䚭ུチ⋙䚭21.3䟸
䝝䜽䝌䚭䠇
ᒜᙟ┬䚭䠅䠋䠀䠊䟸
໪ᾇ㐠䚭䠅䠆䠀䠄䟸
㟯᲻┬䚭䠅䠅䠀䠈䟸
㟴ᒱ┬䚭䠅䠂䠀䠈䟸
⚗ᓞ┬䚭䠄䠋䠀䠈䟸
ᨳᗋ䛴┘ᵾ䛵䠇䠂䟸
䝳䞀䜽䝌䚭䠇
ᇳ⋚┬䚭䚭䠉䠀䠉䟸
᮶ா㒌䚭䠃䠂䠀䠉䟸
㛏㔕┬䚭䠃䠄䠀䠉䟸
ඹᗔ┬䚭䠃䠅䠀䠂䟸
ா㒌ᗋ䚭䠃䠅䠀䠆䟸
䛯䛌䛝䛥䜏ྊ⬗䛱䛰䜑
䛴䛭䛝䜍䛌䛑䠑䠑
඙㐅ᅗࡡᏄᐋ࠿ࢆ᳠チུチ⋙
㻕㻕㻈
᪝ᮇ
⡷ᅗ
䜨䜲䝮䜽
䝙䝭䝷䜽
䝍䜨䝈
䝋䝷䝢䞀䜳
䜮䝭䝷䝄
䝙䜧䝷䝭䝷䝍
䜮䞀䜽䝌䝭䝮䜦
㻓
㻕㻓
㻗㻓
㻙㻓
㻛㻓
㻔㻓㻓
᳠チུチ⋙䟺䟸䟻
௑㔕䚭Ⰳ䠌ᇳ⋚┬⏐፦ெ⛁༈ఌሒ䠀38, 58-61, 2006
ิᅂᏄᐋ䛒䜙ུチ⩽䛴
㧏䛊⣵⬂チ␏ᖏⓆぜ⋙
䟺♼ዄᕖ┬Ꮔᐋ䛒䜙㌬᳠チ䟻
ิチさ්⢥᳠⋙ 䚭්チさ්⢥᳠⋙
䚭䚭䚭㻕㻓㻓㻖㻃ᖳ
㻔㻑㻖㻚㻈
㻓㻑㻙㻗㻈
䚭䚭䚭㻕㻓㻓㻘㻃ᖳ
㻔㻑㻖㻘㻈
㻓㻑㻘㻘㻈
ิᅂུチ⩽䛴⣵⬂チ␏ᖏⓆぜ⋙䛵්チ⩽
䛴2ಶ௧୕䠀
ᮅུチ⩽䛾䛴ུチ໅ዜ䛒䟾Ꮔᐋ㢍⒬䛱䜎䜑
Ṓஷ⋙΅ᑛ䛴Key䠀
䛒䜙ᑊ➿ᇱᮇἪ䟺ᖲᠺ䠃䠋ᖳ䠆᭮䠃᪝䜎䜐᪃⾔䟻
䛮㏻ິ䛝䛥ᨳ➿Ⓩ䜽䝌䝭䝊䜼䞀
䟺ᇱᮇ⌦ᛍ䟻
ᅗẰ䛴㈈ຸ䚭䚭ᅗẰ䛵䟾႖↦䟾㣏⏍Ὡ䟾㐘ິ䛣䛴௙䛴
⏍Ὡ⩞ៈ䛒೸ᗛ䛱ཀྵ䜂䛟ᙫ㡢➴䛒䜙䛱㛭䛟䜑ḿ䛝䛊
▩ㆉ䜘ᣚ䛧䟾䛒䜙䛴஢㜭䛱ᚪさ䛰Ἰណ䜘ᡮ䛌䜎䛌䛱ຑ
䜇䜑䛮䛮䜈䛱䟾ᚪさ䛱ᚺ䛞䟾䛒䜙᳠チ䜘ུ䛗䜑䜎䛌ຑ䜇
䛰䛗䜒䛶䛰䜏䛰䛊䠀
༈ᖅ➴䛴㈈ຸ䚭༈ᖅ䛣䛴௙䛴༈⒢㛭౿⩽䛵䟾ᅗཀྵ䛹
ᆀ᪁පභᅆమ䛒ㅦ䛠䜑䛒䜙ᑊ➿䛱༝ງ䛝䟾䛒䜙䛴஢㜭
䛱ᐞ୙䛟䜑䜎䛌ຑ䜇䜑䛮䛮䜈䛱䟾䛒䜙ᝀ⩽䛴⨠䛑䜒䛬䛊
䜑≟Ἓ䜘῕䛕ヾㆉ䛝䟾Ⰳ㈻䛑䛪㐲ว䛰䛒䜙༈⒢䜘⾔䛌䜎
䛌ຑ䜇䛰䛗䜒䛶䛰䜏䛰䛊䠀
ᆀᇡ༈⒢්⏍ྱ䜆㏛ຊᬊẴᑊ➿䚮10᪝Ửᏽ䛾
䟺4᭮9᪝20᫤27ฦ㒼ಘ ༈⒢௒㆜CB䝏䝩䞀䜽䟻
䚭ᨳᗋ䝿୙ඨ䛵4᭮8᪝䚮ᆀᇡ༈⒢්⏍䛴䛥䜇䚮༈⒢ᅥ༟
న䛭䛴༈⒢ᶭ⬗䛴ᙁ໩䜊༈ᖅ䛴☔ಕ䛰䛯䛴ཱི䜐⤄䜅䛾䛴
ᨥᥴ䛰䛯┊䜐㎲䜙䛦㏛ຊᬊẴᑊ➿䜘䜄䛮䜇䛥䚯10᪝䛴㛮
㆗䛭ḿᘟỬᏽ䛛䜒䜑䚯
䟺୯␆ 䟻
䚭 䜄䛥䚮Ꮔ⫩䛬䝿ᩅ⫩ᨥᥴ䛭䛵䚮Ꮔᐋ䛒䜙䛮஘䛒䜙
䛴᳠チᩩ䛱䛪䛊䛬⮤ᕤㇿᢰ䜘ඞ㝎䛟䜑䛮䛝䛥䚯
䠚䠢䠨䝳䜳䝅䝷ヾྊ㎾䛝䛴䝏䝩䞀䜽䛰䛯䛮䛮䜈䛱䝢䜽䝥䝋䜧䜦䛴
ཱི䜐᡽䛊䛒ኬ䛓䛕䛰䜒䛶䚮ᅗẰ䛴ណㆉ䛒ን䜕䜑ྊ⬗ᛮ䜈䟵䟵
Ꮔᐋ㢍⒬䛴チ᩷䛮἖⒢
Ꮔᐋ㢍䛒䜙䛴ึᏽ
䞀ᐁ㝷䛴἖⒢䜄䛭䛴Ὦ䜒䞀
⣵⬂チ䛱䜎䜑䜽䜳䝮䞀䝏䝷䜴䟺᳠チ䟾
୘ḿฝ⾉䟾ᛮஹ᫤ฝ⾉䟾ዲ፦᳠チ
㼈㼗㼆䟻䊲␏ᖏᡜぜ䟺㼆㼏㼄㼖㼖䊙௧୕䟻
⢥ᰕ䠌හチ䟾䜷䝯䝡䜽䜷䞀䝛䟾≲䛊⤄
⧂チ䟾㻦㻷䟾㻰㻵㻬䟾⭐⑾䝢䞀䜯䞀
⮣ᗃ⑋᭿䛱䜎䜐಴ื໩䛝䛥἖⒢䛾
ิ᭿Ꮔᐋ㢍⒬䛴䜁䛮䜙䛯䛵↋⑍≟䟵
子宮頸部擦過細胞診（綿
棒）
Ꮔᐋ㢍䛒䜙䛴チ᩷
䞀⣵⬂チ䛮⮣ᗃ⑋᭿䛴㐢䛊䞀
⣵⬂チ䚭䟺䜳䝭䜽ฦ㢦䟻
⮣ᗃ⑋᭿䚭䟺㐅⾔᭿ฦ㢦䟻
䜳䝭䜽I 䚭ḿᖏ
I᭿㻃䚭Ꮔᐋ䛱㝀ᑻ
䜳䝭䜽II 䚭ⅎ⑍䛰䛯Ⰳᛮን໩
䚭䚭䚭䟺Ia䜄䛭䛒᪡᭿䛒䜙䟻
䜳䝭䜽IIIa䚭㍇䡐୯➴ᗐ␏ᙟᠺ
II ᭿䚭Ꮔᐋአ䛾㍇ᗐᾈ₮
䚭䚭䚭䜘᝷ᏽ
䚭䚭䚭䚭䟺Ꮔᐋഎ⤄⧂䟾⭈䟻
䜳䝭䜽III䠴䚭㧏ᗐ␏ᙟᠺ䜘᝷ᏽ
III᭿䚭Ꮔᐋአ䛾㧏ᗐᾈ₮
䜳䝭䜽IV䚭୕⓮හ䛒䜙䜘᝷ᏽ
IV᭿䚭⭜⬌䝿├⭘⢋⭯ᾈ
₮䟾
䜳䝭䜽V䚭ᾈ₮䛒䜙䜘᝷ᏽ
䚭䚭䚭䚭㐪㝰㌹⛛
Ꮔᐋ㢍䛒䜙䛴ᵾ‵Ⓩ἖⒢
㸥᭿ ࠈළ㗱ว㝎⾙
ϨF᭿ࠈ㸝ළวᚃ㸞ཋ์ࡢᏄᐋධᦤ⾙㸣ᣪඡ
ࠈࠈࠈࠈᕵ᭻࠵ࡿࡣළ㗱ว㝎⾙ᚃࡡࣆ࢚࣭ࣞࡵ⩻
៎㸣
ϨG᭿ࠈᗀỏᏄᐋධᦤ⾙
ϩ᭿ ࠈᗀỏࡱࡒࡢᨲᑏ⥲⒢Ἢ
Ϫ᭿ ࠈᨲᑏ⥲⒢Ἢ㸝໩Ꮥ⒢Ἢ㸞㸣
ࠈࠈࠈࠈࠈᢘ⒬๠ᢖ୙ᚃᡥ⾙ࢅ⾔࠹ࡆ࡛ࡵ࠵ࡾ㸣
ϫ᭿ ࠈᨲᑏ⥲⒢Ἢ㸝໩Ꮥ⒢Ἢ㸞
⿭㸞⡷ᅗ࡚ࡢ㸡㐅⾔࠿ࢆࡡᨲᑏ⥲἖⒢ࡢ໩Ꮥ⒢Ἢ࡛
ࡡె⏕࠿᭯⏕࡚࠵ࡾ࡛ᖳ࡞໅࿈㸣
ዲ፦䛴Ꮔᐋ㢍㒂⣵⬂チ䛴㔔さᛮ
䞀㧏䛊␏ᖏ᳠ฝ㢎ᗐ䞀
㢍⒬䛴⣑䠅䟸䛵ዲፈ୯䛱チ᩷䠀
ዲ፦䛴⣵⬂チ␏ᖏ᳠ฝ㢎ᗐ䠌䠃䡐1.5%
100ெ䛱1ெ௧୕䛴㢎ᗐ䛭⣵⬂チ␏ᖏ䛒ぜ䛪䛑䜑䟵
䟺♼ዄᕖ┬2005ᖳᗐ䛴ิᅂ㌬᳠チ⣵⬂チ␏ᖏ᳠ฝ㢎ᗐ䠌1.35%䟻
ዲፈ୯䛴㧏ᗐ␏ᙟᠺⓆぜ⋙䠌䚭⣑0.2䟸
ዲፈ୯䛴୕⓮හ⒬Ⓠぜ⋙䠌䚭⣑0.1䟸
ዲፈ୯䛴ᾈ₮⒬Ⓠぜ⋙䠌䚭0.05䟸
ዲፈ୯䛴㢍⒬Ⓠぜ⋙䠌ᮇ㑝䛭0.45%䛴ሒ࿈䜈䟵
䚭ᠺெୌ⯙ዥᛮ䛴Ꮔᐋ㢍䛒䜙᳠チུチ
⋙䛒ᴗ䜇䛬఩䛊ᮇ㑝䛱䛐䛊䛬䟾ዲፈิ
᭿䛴㢍㒂⣵⬂チ䛵䟾䚭ⱕᖳዥᛮ䛴Ꮔᐋ
䛒䜙᳠チdebut䛴ᶭఌ䟾␏ᙟᠺ䛐䜎䛹
Ꮔᐋ㢍⒬Ⓠぜ䛴ዉᶭ䛮䛝䛬䛵ᴗ䜇䛬㔔
さ䛭䛈䜑䠀
ᬄ፡໩䛱ఔ䛊䟾Ꮔᐋ㢍⒬ྙెዲፈ䜘チ⒢
䛟䜑ᶭఌ䛵௑ᚃ䜄䛟䜄䛟ቌຊ䛟䜑䛮஢᝷䠀
ዲፈ୯䛴㢍㒂⣵⬂チ␏ᖏ⩽䛴ཱི䜐᡽䛊䛴
䜷䝷䜿䝷䜹䜽䚭(Ꮔᐋ㢍⒬἖⒢䜰䜨䝍䝭䜨䝷䜎䜐䟻
ዲ፦ิ᭿䛴⣵⬂チ␏ᖏclass IIIa௧୕
䜷䝯䝡䜽䜷䝘䞀ୖ⏍᳠
୕⓮හ⒬(0᭿)䜄䛭
䛴チ᩷
ฦፎᚃ䛱≟ឺ䛱ᚺ䛞䛥
἖⒢䜄䛥䛵⤊㐛ふᐳ
Ia᭿௧୕䛒␪䜕䜒䜑ሔྙ
䛵ළ㗱ว㝎⾙䛱䛬チ᩷
⑋᭿䛮ዲፈ㐄ᩐ䛱ᚺ䛞
䛥ᑊᚺ
Ꮔᐋ㢍⒬஢㜭䝳䜳䝅䝷
ୠ⏲䛱䛐䛗䜑Ꮔᐋ㢍⒬Ⓠ⑍⋙䛮
HPV16/18䛴ཋᅄ䛮䛰䜑๪ྙ
Globocan,2002, 䚭䚭N Engl J Med 356(19), 1908-1910, 2007
ୠ⏲Ⓩ䛱䛵䚮HPV 16 䛮18䛭Ꮔᐋ㢍
⒬䛴ཋᅄ㻃䛴70䟸䜘༥䜇䜑
16
GSK HPV 16/18 VACCINE
+ 18
53.5%
17.2%
+ 45
+ 31
6.7%
+ 33
2.9%
+ 52
+ 58
2.6%
+ 35
2.3%
+ 59
2.2%
+ 58
1.4%
+ 51
+ 39
1.3%
+ 68
1.2%
+ 73
1.0%
+ 82
0.7%
+ Other
0.6%
+X
0
10
20
30
40
50
60
70
Proportion of cervical cancers associated with HPV types
80
90
100
0.5%
0.3%
1.2%
4.4%
Muñoz N et al. Int J Cancer 2004; 111: 278–85
᪝ᮇ䛱䛐䛗䜑Ꮔᐋ㢍⒬䛱㛭㏻䛟䜑
Ⓠ⒬ᛮHPV䛴㐿ఎᏄᆵ
44.8%
44.8%
16
58.8%
14.0%
18
52
65.8%
7.0%
72.5%
6.7%
58
33
HPV genotype
16䟽18ᆵ
䛵⣑6๪
78.8%
6.3%
84%
5.2%
31
2.3%
35
1.0%
51
56
0.9%
68
0.7%
59
0.6%
53
0.5%
0.9%
Others
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ᾈ₮⒬⣵⬂䛑䜏ฦ㞫䛛䜒䛥HPV䝃䜨䝛ืฦᕱ
Miura S et al.: Int.J.Cancer. 119, 2713-2715, 2006
㎾䛊ᑑᮮ䛱ᮇ㑝䛭䜈2⛸㢦䛴Ꮔᐋ㢍⒬஢㜭䝳
䜳䝅䝷䛒ヾྊ䛛䜒䜑ぜ㏳䛝
サーバリクス（グラクソ・スミスク
ライン）
 1接種分の用量
0.5ml
 アジュバント（免疫増強剤）
AS04 䟺GSK≺⮤㛜Ⓠ䟻
䚭- Al(OH)3
500μg
䚭- MPL
50μg
2౮䝳䜳䝅䝷
 L1-HPV16
 L1-HPV18
 ⺦ⓉⓆ⌟⣌䚭㻃
 ᥃⛸䜽䜵䜼䝩䞀䝯
20μg
20μg
ガーダシル（メルク−万有）
 1接種分の用量
0.5ml
 䜦䜼䝩䝔䝷䝌䟺ඞ␷ቌᙁ๠䟻
䜦䝯䝣䝏䜪䝤ሲ
225μg
4౮䝳䜳䝅䝷
 L1-HPV6
 L1-HPV11
 L1-HPV16
 L1-HPV18
20μg
40μg
40μg
20μg
 ⺦ⓉⓆ⌟⣌
㓕ẍ
 ᥃⛸䜽䜵䜼䝩䞀䝯
0䚮2䚮6䝺᭮
䝔䜱䝩䝱䜪䜨䝯䜽Hi-5⣵⬂
0䚮1䚮6䝺᭮
 EU䚮䜮䞀䜽䝌䝭䝮䜦䛰䛯64䜯ᅗ䛭ᢆヾ䜘ཱིᚋ
 ⡷ᅗ䚮EU䛰䛯90䜯ᅗ䛭ᢆヾ䜘ཱིᚋ
྘ᅗ䛱䛐䛗䜑Ꮔᐋ㢍䛒䜙஢㜭䝳䜳䝅䝷䟺᥆ዜ䛮ප㈕ㇿᢰ䛴≟Ἓ䟻䊗
2008ᖳ11᭮⌟ᅹ
ඁ඙ᑊ㇗
䜱䝧䝇䝅䜦䝇䝛᥃⛸ᑊ㇗
ප㈕ㇿᢰ≟Ἓ
㻔㻕䡐㻔㻖ṋዥᏄ
㻔㻖䡐㻔㻛ṋዥᏄᏕ⏍䚮㻔㻜䡐㻕㻙ṋ䛴ዥᛮ
ධ㢘ප㈕ㇿᢰ
Ꮥᰧ䛭䛴᥃⛸
䟺㻕ᖳ㛣䛴䜱䝧䝷䝞䞀䝷䟻
䟺㻔㻕䡐㻕㻙ṋ䟻
ප㈕ㇿᢰ䛈䜐䟼
㻔㻔䡐㻔㻕ṋዥᏄ
㻜䡐㻔㻓ṋዥᏄ䟺༈ᖅ䛒ᚪさ䛮ึ᩷䛝䛥
ሔྙ䟻䚮㻔㻖䡐㻕㻙ṋ䛴ዥᛮ䟺᪜䛱ᛮஹῦ
䛴⤊㥺䛒䛈䜑ዥᛮ䚮䝕䝇䝛䝊䜽䝌䛭␏
ᖏ䛒ヾ䜇䜏䜒䛥ዥᛮ䚮Ⓠ⒬ᛮ㻫㻳㻹䛱
វ᯹䛝䛬䛊䜑ዥᛮ䜈ྱ䜆䟻
ᑊ㇗䝳䜳䝅䝷
ᖳ㱃
䜮䞀䜽䝌䝭
䝮䜦
䜦䝥䝮䜯
䟺᥃⛸ᑊ㇗䛱ᑊ䛝䚮䝊
䜱䜹䜽䚮䝔䞀䜼䝏䜦ᕗ
䛰䛯䛊䛕䛪䛑䛴ᕗ䟻
䜹䞀䝔䝮䜳䜽㻑
䝿䜰䞀䝄䜻䝯
䜰䞀䝄䜻䝯
䜹䞀䝔䝮䜳䜽䛵ᢆヾ
⏞ㄫ୯
ධ㢘ප㈕ㇿᢰ
䜨䜲䝮䜽
㻔㻕䡐㻔㻖ṋዥᏄ
㻔㻛ṋ䜄䛭䟺㻕ᖳ㛣䛴䜱䝧䝷䝞䞀䝷䟻
䜹䞀䝔䝮䜳䜽
䟺㻔㻕䡐㻔㻛ṋ䟻
ᆀ᪁⮤἖మ䛱䜎䛩䛬㐢䛌
ᆀ᪁⮤἖మ䛱䜎䛩䛬㐢䛌
䜨䝃䝮䜦
㻔㻕ṋዥᏄ
ධ㢘ප㈕ㇿᢰ䟺㻔㻕ṋ䟻
䟺䜁䛮䜙䛯䛒㻔㻖ṋ䟻
㻔㻘䡐㻕㻖ṋ
䝙䝭䝷䜽
㻔㻗ṋዥᏄ
䟺ᛮஹῦ๑䛑ิஹ䛑䜏㻔ᖳ௧හ䛴ዥᛮ䟻
ᅗẰ༈⒢ಕ㝜䛭㻙㻘䟸
䜯䝔䞀䛛䜒䜑
䟺䜹䞀䝔䝮䜳䜽䠌㻔㻘⮤
἖మ䚮䜰䞀䝄䜻䝯䠌㻔㻓
⮤἖మ䟻
䜹䞀䝔䝮䜳䜽
䝿䜰䞀䝄䜻䝯
䟺㻔㻗ṋ䡐㻕㻖ṋ䟻
ධ㢘ප㈕ㇿᢰ
䜽䝞䜨䝷
䠃䠆ṋዥᏄ
䛰䛝
ᆀ᪁⮤἖మ䛱䜎䛩䛬㐢䛌
䟺㻔㻗ṋ䟻
྘ᅗ䛱䛐䛗䜑Ꮔᐋ㢍䛒䜙஢㜭䝳䜳䝅䝷䟺᥆ዜ䛮ප㈕ㇿᢰ䛴≟Ἓ䟻䊘
2008ᖳ11᭮⌟ᅹ
ඁ඙ᑊ㇗
ᖳ㱃
䝒䝯䜪䜫䞀
㻔㻔䡐㻔㻕ṋ
ዥᏄ
䜱䝧䝇䝅䜦䝇䝛᥃⛸ᑊ㇗
ප㈕ㇿᢰ≟Ἓ
ධ㢘ප㈕ㇿᢰ
㻔㻖䡐㻔㻙ṋዥᏄ
䛀㻔㻔䡐㻔㻙ṋ䟻
ᑊ㇗䝳䜳䝅䝷
㆗ㄵ୯
䟺䜹䞀䝔䝮䜳䜽䝿
䜰䞀䝄䜻䝯䟻
༈⒢ಕ㝜䛑䜏ධ㢘
ർ㑇䛛䜒䜑
䝍䜨䝈
㻔㻕䡐㻔㻚ṋ
ዥᏄ
䛰䛝
䚭䟺㻔㻕ṋ䡐㻔㻚ṋ䟻
䜹䞀䝔䝮䜳䜽䝿䜰䞀
䝄䜻䝯
䟺㻕㻓㻓㻚ᖳ䛱โᗐን᭞䟻
ධ㢘ප㈕ㇿᢰ
䜮䝭䝷䝄
㻔㻕ṋዥᏄ
㻔㻖ṋ䡐㻔㻙ṋ
䜹䞀䝔䝮䜳䜽
䟺㻔㻕䟿㻔㻙ṋ䟻
ධ㢘ප㈕ㇿᢰ
䝋䝷䝢䞀䜳
㻔㻕ṋዥᏄ
㻔㻖㻐㻔㻘ṋዥᏄ
䜰䞀䝄䜻䝯
䟺㻔㻕㻐㻔㻘ṋ䟻
19䜯ᅗ䛭ප㈕ㇿᢰ䟺ථᮈ䚮ಕ㝜䚮ୌ㒂ർ㑇䛰䛯䟻䛒䛛䜒䛬䛊䜑䚯
䟼䜦䝥䝮䜯䛭䛵䚮Ằ㛣ಕ㝜䛒㈕⏕ㇿᢰ䜘䛟䜑ሔྙ䜈ኣ䛊䚯䚭11ṋ䡐12ṋ䛴఩ᡜᚋ⩽ᒒ䛵Ꮔ౩䛥䜇䛴
䝳䜳䝅䝷䝛䝱䜴䝭䝤䟺Vaccine For Children䟻䛭ධ㢘ප㈕ㇿᢰ䛛䜒䜑䟺ධᑊ㇗⩽䛴⣑45䟸䟻
log (EU/mL)
Ꮔᐋ㢍⒬஢㜭䝳䜳䝅䝷᥃⛸ᚃ䛴ᢘమ౮᥆⛛
䟺䠄౮䝳䜳䝅䝷䠌䜹䞀䝔䝮䜳䜽䟻
㻫㻳㻹㻐㻔㻙
㻔㻓㻓㻓㻓
HPV 001/007モ㥺
䝳䜳䝅䝷
䝛䝭䜿䝠㻃
㻔㻓㻓㻓
11ಶ௧
୕䛴ᢘ
మ౮
㻔㻓㻓
⮤↓វ᯹㻃
㻔㻓
㻔
㻓
㻚
㻔㻕
㻫㻳㻹㻓㻓㻔モ㥺
㻔㻛
䠭25-32䠯 䠭33-38䠯 䠭39-44䠯 䠭45-50䠯 䠭51-56䠯 䠭57-62䠯 䠭63-68䠯 䠭69-74䠯 䠭75-76䠯
ふᐳ᭿㛣䟺᭮䟻
㻫㻳㻹㻓㻓㻚モ㥺
Susan JK et al.: Drugs. 68(3), 359-372, 2008
Presentation on the 10th of March at SGO, 2008
Ꮔᐋ㢍⒬஢㜭䝳䜳䝅䝷᥃⛸ᚃ䛴ᢘమ౮᥆⛛
䟺㻃䠄౮䝳䜳䝅䝷䠌䜹䞀䝔䝮䜳䜽䟻
HPV 001/007モ㥺
log (EU/mL)
㻫㻳㻹㻐㻔㻛
㻔㻓㻓㻓㻓
䝳䜳䝅䝷
䝛䝭䜿䝠㻃
㻔㻓㻓㻓
11ಶ௧୕
䛴ᢘమ౮
㻔㻓㻓
⮤↓វ᯹㻃
㻔㻓
㻔
㻓
㻚
㻔㻕
㻫㻳㻹㻓㻓㻔モ㥺
㻔㻛
䠭25-32䠯 䠭33-38䠯 䠭39-44䠯 䠭45-50䠯 䠭51-56䠯 䠭57-62䠯 䠭63-68䠯 䠭69-74䠯 䠭75-76䠯
ふᐳ᭿㛣䟺᭮䟻
㻫㻳㻹㻓㻓㻚モ㥺
Susan JK et al.: Drugs. 68(3), 359-372, 2008
Presentation on the 10th of March at SGO, 2008
㻫㻳㻹㻔㻙㻒㻔㻛䛱㛭㏻䛟䜑វ᯹䝿⑋ን஢㜭ຝᯕ
HPV 001/007モ㥺
6.4ᖳ㛣䛱䛐䛗䜑᳠ゞ
䟺䠄౮䝳䜳䝅䝷䠌䜹䞀䝔䝮䜳䜽䟻
フ౮㡧┘㻍
䝳䜳䝅䝷⩄
䟺n=401䟻
䝛䝭䜿䝠⩄
䟺n=372䟻
䝳䜳䝅䝷䛴᭯ຝᛮ
n
n
%
95% CI
ୌ᫤វ᯹
4
70
95
87.4 - 98.7
6䝺᭮ᣚ⤾វ᯹
0
34
100
90.0 - 100
12䝺᭮ᣚ⤾វ᯹
0
20
100
81.8 - 100
CIN1+ 䟺㍇ᗐ␏ᙟᠺ䟻
0
15
100
73.4 - 100
CIN2+ 䟺୯➴ᗐ␏ᙟᠺ䟻
0
9
100
51.3 - 100
*ATP analysis for virologic endpoints; ITT analysis for cytologic and CIN endpoints
Presentation on the 10th of March at SGO, 2008
HPVฦ㢦䛴⣌⤣Ⓠ⏍
䊗
A
a
䊘
b
䊙
B
a
䊚
b
HPV1
HPV25
HPV20
HPV14
HPV21
HPV5
HPV47
HPV8
HPV2
HPV57
HPV6
HPV11
HPV13
HPV44
HPV43
HPV42
HPV16
HPV35
HPV31
HPV52
HPV33
HPV58
HPV51
HPV56
HPV18
HPV45
HPV39
ME180
⓮⭭␴㉍
␴㉍≟⾪⓮Ⓠ⫩␏ᖏ⑍
⓮⭭䠁⢋⭯
⢋⭯䝱䞀䝮䜽䜳
⢋⭯䝓䜨䝮䜽䜳
Swygart C: Br J Biomed Sci. 54, 299-303, 1997
㻫㻳㻹㻗㻘䛮㻖㻔䛴វ᯹䛱ᑊ䛟䜑䜳䝱䜽䝛䝱䝊䜳䜻䝫䝷ຝᯕ
HPV 001/007モ㥺
6.4ᖳ㛣䛱䛐䛗䜑᳠ゞ
HPV-45
HPV-31
Vaccine
Control
Vaccine efficacy 78% [39, 93]
Vaccine
Control
Vaccine efficacy 60% [20, 81]
Presentation on the 10th of March at SGO, 2008
䝳䜳䝅䝷᥃⛸ᚃ㻚᪝௧හ䛱Ⓠ⌟䛝䛥୹䛰᭯ᐐ஥㇗
HPV 001モ㥺䟺䠄౮䝳䜳䝅䝷䠌䜹䞀䝔䝮䜳䜽䟻
䜯䝊䜸䝮䟿
Ἰᑏ㒂న䛴⑍≟
ධ㌗⑍≟
䝳䜳䝅䝷⩄
n=531
䝛䝭䜿䝠⩄
n=538
%
%
⑂䚭⑚
93.4
87.2
<0.001
⭐䚭⬵
34.3
21.0
<0.001
Ⓠ䚭㉝
35.6
24.3
<0.001
್ᛨវ
58.0
53.7
0.175
⫮⭘⑍≟
33.5
32.0
0.602
㢄䚭⑚
62.3
61.2
0.706
䛣䛌⑓វ
24.5
20.3
0.106
Ⓠ䚭⑀
11.3
10.0
0.552
Ⓠ䚭⇍
16.6
13.6
0.172
⑍䚭≟
p-value
ATP analysis
䚭䚭䚭䚭䚭䚭䚭Harper D et al. Lancet. 2004; 364: 1757-65
HPV012モ㥺10 – 14ṋ䛮15 – 25ṋ䛴ඞ␷ཋᛮ䛴Ẓ㍉
䟺䠄౮䝳䜳䝅䝷䠌䜹䞀䝔䝮䜳䜽䟻
７ヶ月後の免疫原性: 抗体価と抗体陽転率
100000
HPV-16
100 % SC
100 % SC
GMT log (EU/ml)
10000
1000
100
10
1
10-14 y
Adapted from Pedersen et al. J Adolesent Health 2007; 40: 564–571
15-25 y
SC:Seropositivity defined as titer ≥ 8 EU/ml
HPV012モ㥺10 – 14ṋ䛮15 – 25ṋ䛴ඞ␷ཋᛮ䛴Ẓ㍉
䟺䠄౮䝳䜳䝅䝷䠌䜹䞀䝔䝮䜳䜽䟻
７ヶ月後の免疫原性: 抗体価と抗体陽転率
100000
HPV-18
100 % SC
GMT log (EU/ml)
10000
100 % SC
1000
100
10
1
10-14 y
Adapted from Pedersen et al. J Adolesent Health 2007; 40: 564–571
15-25 y
SC:Seropositivity defined as titer ≥ 8 EU/ml
㻫㻳㻹㻓㻔㻗モ㥺
ᖳ㱃⩄ืᢘమ౮䛴Ẓ㍉䟺䠄౮䝳䜳䝅䝷䠌䜹䞀䝔䝮䜳䜽䟻
15-25 歳
26-35 歳
10000
36-45 歳
46-55 歳
GMT (EU/ml) (log)
1000
100
100% 100% 100% 100%
100%
100% 100% 100%
自然感染
10
1
HPV-16
HPV-18
ATP cohort, Seronegative at entry, month 7 results
Schwarz TF J Clin Oncol 2006; 24(18S): 1008
䜰䞀䝄䜻䝯® [4౮䝖䝌䝕䝘䝱䞀䝢䜪䜨䝯䜽 (6, 11, 16, 18ᆵ) ⤄ᥦ䛎ỷ㜾䝳䜳䝅䝷]
┘䚭Ⓩ
FUTURE I1
•
䜰䞀䝄䜻䝯®䛴3ᅂ᥃⛸䛒䚮䝛䝭䜿䝠䛮Ẓ㍉䛝䛬䚮HPV 6ᆵ䚮11ᆵ䚮16ᆵ
ཀྵ䛹18ᆵ䛱㛭㏻䛝䛥ୖオ䛴Ⓠ⏍⋙䜘఩ୖ䛛䛡䜑䛙䛮䠌
– ᛮჹ࿔㎰㒂␴㉍䚮VIN / VaIN1-3䚮䜄䛥䛵⒬
– CIN1-3䚮㻤IS䚮䜄䛥䛵⒬
FUTURE II2
•
䜰䞀䝄䜻䝯®䛴3ᅂ᥃⛸䛒䚮䝛䝭䜿䝠䛮Ẓ㍉䛝䛬䚮HPV 16ᆵ䚮18ᆵ䛱㛭㏻
䛝䛥ୖオⓆ⏍⋙䜘఩ୖ䛛䛡䜑䛙䛮䠌
– CIN 2䚮CIN 3䚮AIS䚮䜄䛥䛵ᾈ₮ᛮ⒬
VIN = አ㝔୕⓮හ⭐⑾㻃(vulvar intraepithelial neoplasia䟻
VaIN = ⭴୕⓮හ⭐⑾㻃(vaginal intraepithelial neoplasia䟻
CIN = Ꮔᐋ㢍㒂୕⓮හ⭐⑾㻃(cervical intraepithelial neoplasia䟻
AIS = ୕⓮හ⭚⒬㻃(adenocarcinoma in situ)
1. Garland SM et al. New Engl J Med. 2007;356:1928–1943. 2. The
FUTURE II Study Group. New Engl J Med. 2007;356:1915–1927.
䜰䞀䝄䜻䝯® [4౮䝖䝌䝕䝘䝱䞀䝢䜪䜨䝯䜽 (6, 11, 16, 18ᆵ) ⤄ᥦ䛎ỷ㜾䝳䜳䝅䝷]
FUTUREモ㥺䛴ぞᶅ䛮ᆀᇡ
FUTURE I1
(N = 5,455)
FUTURE II2
(N = 12,167)
16ṋ䡐24ṋ
15ṋ䡐26ṋ
521 (10%)
1,597 (29%)
2,215 (41%)
1,122 (20%)
181 (1%)
916 (8%)
3,193 (26%)
7,877 (65%)
䜮䞀䜽䝌䝭䝮䜦䚮䜮䞀䜽䝌䝮䜦䚮䝚䝭䜼
䝯䚮䜯䝎䝄䚮䜷䝱䝷䝗䜦䚮䝅䜫䜷භ࿰
ᅗ䚮䝍䜨䝈䚮㤮῿䚮䜨䝃䝮䜦䚮䝥䜱䜻䜷䚮
䝏䝩䞀䜼䞀䝭䝷䝍䚮䝞䝯䞀䚮䝛䜬䝯䝌䝮
䜷䚮䝱䜻䜦䚮䝃䜨䚮ⱝᅗ䚮⡷ᅗ
䝚䝭䜼䝯䚮䜷䝱䝷䝗䜦䚮䝋䝷䝢䞀䜳䚮
䝙䜧䝷䝭䝷䝍䚮䝙䝭䝷䜽䚮䜦䜨䜽䝭䝷䝍䚮
䝥䜱䜻䜷䚮䝒䝯䜪䜫䜨䚮䝞䝯䞀䚮䝡䞀䝭
䝷䝍䚮䜻䝷䜰䝡䞀䝯䚮䜽䝞䜨䝷䚮䜽
䜪䜫䞀䝋䝷䚮⡷ᅗ
2002ᖳ1᭮䡐2003ᖳ3᭮
2002ᖳ6᭮䡐2003ᖳ5᭮
ふᐳ᭿㛣
4 ᖳ㛣
4 ᖳ㛣
ิᅂ᥃⛸ᚃ䛑䜏䛴
ᖲᆍふᐳ᭿㛣
3 ᖳ㛣
3 ᖳ㛣
ᖳ㱃
ᆀᇡ:
䜦䜼䜦䝿䝕䜻䝙䜧䝇䜳
໪⡷
䝭䝊䝷䜦䝥䝮䜯
䝬䞀䝱䝇䝕
ཤຊᅗ
⤄ථ䜒᭿㛣
1. Garland SM et al. New Engl J Med. 2007;356:1928–1943. 2. The
FUTURE II Study Group. New Engl J Med. 2007;356:1915–1927.
52
䜰䞀䝄䜻䝯® [4౮䝖䝌䝕䝘䝱䞀䝢䜪䜨䝯䜽 (6, 11, 16, 18ᆵ) ⤄ᥦ䛎ỷ㜾䝳䜳䝅䝷]
஢㜭ຝᯕ: HPV 6/11/16/18ᆵ䛱㛭㏻䛟
䜑CIN䛱ᑊ䛝100%䛴᭯ຝᛮ
FUTURE I
⑋ን
䜰䞀䝄䜻䝯®*
(n=2,241)
プラセボ*
(n=2,258) ஢㜭ຝᯕ
CI
HPV 6/11/16/18ᆵ䛱
㛭㏻䛝䛥CIN
0
65
100%
94–100
CIN 1
0
49
100%
92–100
CIN 2
0
21
100%
81–100
CIN 3
0
17
100%
76–100
AIS
0
6
100%
15–100
CI = ಘ㢏༇㛣
CIN = Ꮔᐋ㢍㒂୕⓮හ⭐⑾
AIS = Ꮔᐋ㢍㒂୕⓮හ⭚⒬
Garland SM et al. New Engl J Med. 2007;356:1928–1943.
䜰䞀䝄䜻䝯® [4౮䝖䝌䝕䝘䝱䞀䝢䜪䜨䝯䜽 (6, 11, 16, 18ᆵ) ⤄ᥦ䛎ỷ㜾䝳䜳䝅䝷]
஢㜭ຝᯕ: HPV 6/11/16/18ᆵ䛱㛭㏻䛟
䜑CIN䛱ᑊ䛝100%䛴᭯ຝᛮ
FUTURE I
HPVᆵ
n
HPV 6/11/16/18
CIN
n
CI
䝛䝭䜿䝠* ஢㜭ຝᯕ
65
100%
94–100
2,241
䜰䞀䝄䜻䝯®*
0
2,258
HPV 6 㛭㏻
1,961
0
1,975
12
100%
64–100
HPV 11 㛭㏻
1,961
0
1,975
4
100%
<0–100
HPV 16 㛭㏻
1,888
0
1,847
39
100%
90–100
HPV 18 㛭㏻
2,102
0
2,120
16
100%
74–100
CIN = Ꮔᐋ㢍㒂୕⓮හ⭐⑾
Garland SM et al. New Engl J Med. 2007;356:1928–1943.
䜰䞀䝄䜻䝯® [4౮䝖䝌䝕䝘䝱䞀䝢䜪䜨䝯䜽 (6, 11, 16, 18ᆵ) ⤄ᥦ䛎ỷ㜾䝳䜳䝅䝷]
஢㜭ຝᯕ: HPV 6/11/16/18ᆵ䛱㛭㏻䛟䜑
VIN/VaINཀྵ䛹ᛮჹ␴㉍䛱ᑊ䛝100%䛴᭯ຝᛮ
FUTURE I
⑋ን
HPV 6/11/16/18 VIN/VaIN,
䜰䞀䝄䜻䝯®*
(n=2,261)
䝛䝭䜿䝠* ஢㜭ຝ
(n=2,279)
ᯕ
CI
0
60
100% 94–100
ᛮჹ␴㉍
0
48
100% 92–100
VIN 1 or VaIN 1
0
9
100% 49–100
VIN 2/3 or VaIN 2/3
0
9
100% 49–100
ᛮჹ␴㉍
VIN = አ㝔୕⓮හ⭐⑾
VaIN = ⭴୕⓮හ⭐⑾
Garland SM et al. New Engl J Med. 2007;356:1928–1943.
䜰䞀䝄䜻䝯® [4౮䝖䝌䝕䝘䝱䞀䝢䜪䜨䝯䜽 (6, 11, 16, 18ᆵ) ⤄ᥦ䛎ỷ㜾䝳䜳䝅䝷]
Ꮽධᛮ
FUTURE I1
䟺䟸䟻
FUTURE II2
䜰䞀䝄䜻䝯®
(n=2,673)
䝛䝭䜿䝠
(n=2,672)
䜰䞀䝄䜻䝯®
(n=6,019)
䝛䝭䜿䝠
(n=6,03
1)
86.8
77.4
84.4
77.9
85.3
75.4
83.0
75.8
ධ㌗ᛮ䛴๧ཬᚺ
65.3
63.7
61.4
60.0
㔔⠔䛰๧ཬᚺ
1.8
1.7
0.7
0.9
䝳䜳䝅䝷䛱㛭㏻䛝䛥๧ཬᚺ
<0.1
0.0
<0.1
<0.1
㔔⠔䛰๧ཬᚺ䛱䜎䜑୯Ḿౚ
0.1
0.1
0.1
0.1
䝳䜳䝅䝷䛱䜎䜑㔔⠔䛰๧ཬᚺ
䛱䜎䜑୯Ḿౚ
0.0
0.0
0.0
<0.1
0.1
0.1
0.1
0.1
Ἰᑏ㒂న䛴๧ཬᚺ
⑂⑚
Ṓஷ䛱䜎䜑୯Ḿౚ
䟺ᅄᯕ㛭౿䛰䛝䟻
1. Garland SM et al. New Engl J Med. 2007;356:1928–1943.
2. The FUTURE II Study Group. New Engl J Med. 2007;356:1915–1927.
ACIP䚭䟺Advisory Committee on Immunization
Pactices䟻 Recommendation
䟺䜄䛮䜇䟻Ꮔᐋ㢍⒬䛵᪡᭿Ⓠぜ䛮஢㜭䛒ྊ⬗
HPV䝳䜳䝅䝷
HPV䛴វ᯹஢㜭
×
ḿᖏ䛰⣵⬂
HPV䛒វ᯹䛝䛥≟ឺ
䛙䛴≟ឺ䛭ぜ䛪䛗䜒
䛶䚮⒬䛱䛰䜏䛰䛊
␏ᙟᠺ䟺⒬䛱䛰䜑๑䛴≟ឺ䟻
᪡᭿Ⓠぜ䛱䛵᳠チ
䛒ຝᯕⓏ䟵
⒬⣵⬂
䟺䜄䛮䜇䟻Ꮔᐋ㢍䛒䜙䛴䠋䠋䟸䛵HPV 䛴វ
᯹䛒ཋᅄ䛭䛈䜑䛙䛮䛴▩ㆉ䛴ၤⓆ
ᛮஹ⤊㥺䛴䛈䜑ḿᖏዥᛮ䛴䠃䠂䟿䠅䠂䟸䛵ಕ
᭯䛝䛬䛊䜑䛈䜐䛻䜒䛥䜪䜨䝯䜽䛭䛈䜑䠀
≁ᏽ䛴䝃䜨䝛䛴䜅䛒⒬໩䛱㛭୙䠀
វ᯹䛴㻜๪䛵⮤↓἖⒭䠀ᣚ⤾វ᯹䛴㻔䇩㻖๪䛒
␏ᙟᠺ䛾䠀䛛䜏䛱䛣䛴㻔๪௧ୖ䛒Ꮔᐋ㢍⒬䛾
䛮㐅ᒈ䠀ඞ␷ງ䜈㛭୙䠀
20ṋྋ䛑䜏䛴㢍䛒䜙᳠チ䛴㔔さᛮ䠀
䟺䜄䛮䜇䟻୯Ꮥ䝿㧏ᰧ䛱䛐䛊䛬䟾HPVវ᯹䛮Ꮔᐋ㢍⒬䛴㛭
㏻䛒ዥᛮ䛴ᖏㆉ䛮䛝䛬ヾㆉ䛛䜒䜑䜎䛌䛰ᩅ⫩䛴ᐁ⌟
ᩝ㒂⛁Ꮥ┤䛾䛴഼䛓䛑䛗䠀
ᩅ⫩㛭౿⩽䛴HPVវ᯹䛮Ꮔᐋ㢍⒬䛱䛪䛊䛬
䛴ḿ☔䛰⌦よ䠀
Ꮥ᭿ᮆモ㥺ၡ㢗䛴䝨䝢䛮䛰䜑!!
Ꮔᐋ䛒䜙᳠チ䛴⌦よ䟾HPVវ᯹஢㜭䝳䜳
䝅䝷䛴௑ᚃ䛴ᬉཀྵ䛮䜈ᐠ᥃䛱㛭㏻
(䜄䛮䜇)䚭ᮇ㑝䛭Ꮔᐋ㢍⒬஢㜭䝳䜳䝅䝷䜘
ᬉཀྵ䛛䛡䜑䛥䜇䛴ኬ䛓䛰䝓䞀䝍䝯
ば⮤㌗䛒HPV䛮Ꮔᐋ㢍⒬䛴㛭㏻ᛮ䜘▩䜏䛠䚮
ኣ䛕䛴ẍば䛵Ꮔᐋ䛒䜙᳠チ䜘ུ䛗䛬䛊䛰䛊䚯
ẍ䜈ፃ䜈⨧ᝀ䛟䜑䛑䜈䛝䜒䛰䛊⑄ᝀ䛭䛈䜑䛮䛊䛌
ヾㆉ䛴Ḗዯ䚯
ᩝ㒂⛁Ꮥ┤䟺▩ㆉ䛴ᬉཀྵ䚮ᛮᩅ⫩䟻䚮ཉ⏍ຘ഼
┤䛴᥆ዜ䛒䛯䛴⛤ᗐᚋ䜏䜒䜑䛑䠑
㧏㢘䛴䝳䜳䝅䝷䛱පⓏຐᠺ䛒ᚋ䜏䜒䜑䛴䛑䠑
᥃⛸䛴୹మ䛵⏐፦ெ⛁༈䠑ᑚඡ⛁༈䠑
䝳䜳䝅䝷᥃⛸䜘ུ䛗䛬䜈Ꮔᐋ䛒䜙᳠チ䛒ᚪさ䚯