Reviewer ’s repo rt 
 
Title: HPV Vaccine in the Treatment of Usual type Vul val and Vaginal Intraepithelial 
Neoplasia: A Systematic Review  
 
Version: 1 Date: 19 Nov 2018  
 
Reviewer: Bo Hansen  
 
Reviewer's report:  
 
The ma nuscript has improved, but I still have some comments:  
 
1. Abstract, conclusions: Please specify that your review concerns HPV vaccines (just "vaccine" 
is imprecise)  
 
 
2. The citation for the VaIN incidence does not appear to be a primary reference, i.e. a paper that 
in fact has assessed it? If not - please cite a primary source. Since incidences also may vary 
geographically, consider to mention where the study was condu cted 
 
 
3. Your review of clinical referrals that has been moved from the discussion to the introduction: 
Is there a reference for these findings? If yes, please give it. If not, please shorten it to make it 
more general. This is not the place to present new data 
 
 
4. "HPV subtype" - I think you mean "HPV type". The subtype terminology should be reserved 
for variants of types (e.g. HPV68a and HPV68b are subtypes of HPV68). If you do not refer to 
subtypes, please change to "types" throughout the manuscript.  
 
 
5. Similar to point 1: Throughout the discussion, qualify "vaccine" and "vaccination" with 
"experimental HPV" - since your statements only refer to these vaccines  
 
 
6. I still think your discussion needs more work. I think it should start with an overall assessm ent 
of your findings, i.e. that you found very few studies of low quality etc. In my view, this is an 
essential starting point from which to discuss potential clinical and molecular responses. Your 
review shows that any discussion regarding treatment effec ts need to be very cautious - and I still 
do not think your discussion gets this point across clearly enough in the first two sections. I am 
not against discussing clinical and molecular responses - my point concerns your emphasis  
 
 
7. "Strengths and limitat ions" - this heading is commonly used to discuss strengths and 
limitations of the study at hand - and not of the literature reviewed. Hence, I think it is a 
misleading heading for the text that follows. If you want to keep the heading, you should instead 
highlight the strengths and limitations of your study, e.g. things like the quality of your literature 
search, the lack of meta -analyses etc.  
 
 
8. Although English is not my mother tongue and I am thus not so well qualified to comment on 
your language, I thin k the language can be improved. Some examples from the conclusions that 
do not sound optimal to me:  
 
"Women with VIN/VaIN are having to live with ..."  
 
"Vaccines may have potential in this aspect."  
 
"This review found the evidence for the use of therapeutic HPV vaccination is of low quality...."  
 
Hence, I suggest more proof reading throughout the manuscript.  
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the autho rs. 
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the edito rs. 
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following quest ions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial com peting interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare I have no competing interests  
 
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