Why are HPV vaccines needed?
HPV vaccines are needed because they have the potential to greatly reduce the occurrence of cervical cancer. They also reduce abnormal Pap tests. Cervical cancer is the 7th leading cause of mortality among women in the US, there are around 11,000 cases per year with over 4,000 deaths and well over a million cases of abnormal Pap tests requiring evaluation. Each year, there are also approximately 300,000 cases of genital warts, 7,000 anal cancer cases and over 11,000 HPV-associated oropharyngeal cancers. The vaccine’s role in preventing these cancers is even more important since there are no screening tests available as for cervical cancer.
Who should get vaccinated?
HPV vaccination is recommended for girls and boys ages 11 or 12 years. However, the vaccine can be given to children as young as 9 years. Females who were not vaccinated at the target age can be vaccinated from age 13–26 years, and males up through 21 years of age.
Since most obstetrician-gynecologists do not see 11-12 year olds (the target age to receive the HPV vaccine), to whom should they recommend the vaccine?
The HPV vaccine is recommended for all females 11- 26 years of age, and ACOG endorses this recommendation. It is most effective if given prior to exposure to the HPV virus, but studies demonstrate efficacy even if patients have initiated sexual activity—hence providers should discuss the vaccine with all patients through the age 26. Additionally, providers should counsel mothers to vaccinate children at the targeted age range because the vaccine has the best efficacy, and produces a higher antibody response when given to children 11-12 years of age.
Should HPV DNA testing be done prior to vaccination?
No. Even if a patient is tested and the results are positive, vaccination is still recommended because the chances that a patient has all of vaccine preventable types are quite low.
Should I vaccinate a young woman if she previously had an abnormal Pap test or history of genital warts?
Yes. Even if the patient has one or two HPV types causing the abnormal Pap test or genital warts, studies demonstrated that the patient is very unlikely to have all 4 vaccine types, so the patient would benefit from vaccination.
How are the two available HPV vaccines (bivalent and quadrivalent) different?
Both HPV vaccines provide protection against cervical infections for HPV types 16 and 18, and have been shown to decrease the risk of CIN 2+ and AIS caused by these vaccine types >99%. However, the quadrivalent vaccine also provides protection against HPV types 6 and 11.The vaccines have different components (adjuvants) added to the vaccine to increase the body's immune response to the vaccine. The quadrivalent vaccine is approved for use in males and has been shown to be effective in reducing anal HPV infections.
Do the vaccines provide cross protection to other HPV types not in the vaccines?
There is evidence of some cross protection in both vaccines to other non-vaccine HPV types. However, the degree and duration of the cross protection is not known.
Will a booster dose be needed?
This is still under study, but with all the information we have, it appears a booster dose will not be necessary.
Are all three doses of the HPV vaccine recommended?
Yes. Using reduced number of doses is the subject of ongoing research trials, but thus far reduced dose schedules are not recommended.
Do I need to restart the series if a patient does not get the 2nd or 3rd dose on time?
Even if the time interval for the 2nd or 3rd dose is much longer than recommended, it is not necessary to restart the series. Just proceed with getting the next dose (whether it is the 2nd or the 3rd dose). Do strive to complete all 3 doses, even if the time between doses exceeds what is recommended.
Is HPV vaccine recommended for pregnant women?
HPV vaccines are not recommended for use in pregnancy. However, studies have shown that the vaccine causes no problems for the mothers or the babies born to women who got the HPV vaccine while they were pregnant. The virus contains no live virus particles, so is not infectious.
Can HIV positive girls and boys be vaccinated?
YES! Studies show that HPV vaccination is safe to administer to girls and boys who are HIV positive. HPV vaccine is recommended to all HIV positive girls just as it is for HIV negative girls.
Are there any contraindications to being vaccinated?
If a girl has had a serious allergic reaction to another vaccine or a previous dose of the HPV vaccine, such as anaphylaxis or severe swelling, to avoid serious reactions, she should not receive HPV vaccine.
Are the HPV vaccines safe?
Many studies conducted in developing and developed countries have found both vaccines to be very safe and effective. The vaccine does not contain live viruses so cannot cause an HPV infection.
Both vaccines have been administered to millions of girls and women around the world without serious side effects. Common, mild side effects included pain where the shot was given, fever, headache, and nausea. An increased risk of fainting after vaccination resulted in recommendations that the patient remain seated for 15 minutes after vaccination. As with all vaccines, the safety of these vaccines is monitored very carefully. *
*For more safety information, please visit the CDC:
What are the known side effects of the HPV vaccines?
The most common side effects are pain and redness where the shot is given (in the arm). About 1 person in 10 will get a mild fever (less than100.4˚F). About 1 person in 30 will get itching where they got the shot. About 1 person in 60 will experience a moderate fever (less than or equal to 100.4˚F to less than102.2 ˚F). These symptoms do not last long and go away on their own.
What is an effective way to talk with parents about the vaccine?
Remember that your recommendation is the strongest factors for parents and parents trust physicians opinion above anyone else. Here are some ideas for messages:
Discuss with parents how common HPV is and that the vaccine needs to be given before the onset of sexual activity to get the full effect of the vaccine for their child
Strongly recommend the vaccine the same way you recommend other adolescent vaccines.
Emphasize the fact that we have a vaccine to prevent cervical, vulvar, vaginal and anal cancer and likely oropharyngeal cancers.
Discuss that millions of girls have been vaccinated and that data show no increase risk of adverse events. On the contrary, countries (Australia and Sweden) with high vaccination rates are seeing declines in genital warts and abnormal cytology.
Share that studies of girls age 11 to 12 years have found that HPV vaccination was not linked to increased sexual activity and their antibody response was most robust if vaccinated during this age period.
For more information, please see the following CDC website: http://www.cdc.gov/std/HPV/STDFact-HPV-vaccine-hcp.htm