Role of HPV Vaccination in the Prevention of Cervical Cancer Distributed Throughout Bosnia and Herzegovina

Human papilloma virus (HPV) is an envelopeless, epitheliotropic virus that carries double-stranded, circular DNA that belongs to the Papillomaviridiae virus family. It represents one of the most commonly sexually transmitted diseases (STD) in the world with higher prevalence in low developed socio-economic countries. Infection occurs as a result of sexual intercourse and epithelial micro-trauma of the vagina and cervix, where HPV reaches the epithelial basal membrane and starts its replication process. HPV is often divided into high-risk and low-risk HPV type groups based on differences in their viral genome structure. High-risk HPV types such as HPV-16 and HPV-18 are responsible for almost 70% of cases involving cervical caricnoma. Currently, the licensed HPV vaccines are developed based on virus-like particles (VLP) of the major papillomavirus capsid protein L1. VLP-containing vaccines do not consist protein base and do not contain viral genome therefore this vaccine form is non-infectious and non-oncogenic. This form makes them safer rather then attenuated vaccines. Gardasil 9 vaccine, licensed by the FDA in 2014, offers protection against HPV6, 11, 16, 18, 31, 33, 45, 53, and 58 therefore increasing the protection rate of cervical carcinoma to 90%. Currently available Gardasil 9 HPV vaccine in Bosnia and Herzegovina represents the most modern vaccine in combat with HPV infection and HPV-related complications. The total number of doses given from the beginning of the HPV immunization program sponsored by the Institute for Public Health of FBiH started in 2023 extending into late 2025 shows tendency of a double positive response of the target age and sex groups to the immunization program.