Why are HPV vaccines needed?
HPV vaccines are needed because they greatly reduce the occurrence of cervical, vaginal, vulvar and anal cancer. They also reduce abnormal Pap tests. Approximately 79 million people in the United States have been infected with HPV and 14 million new infections occur every year, leading to around 11,000 cases of cervical cancer per year and over 4,000 deaths. Each year, there are also approximately 300,000 cases of genital warts, 7,000 anal cancer cases and over 12,000 HPV-associated oropharyngeal cancers. The vaccine’s role in preventing oral and anal 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 and males who were not vaccinated at the target age of 11-12 years can be vaccinated from age 13–26 years. It is important to protect children from HPV before they are exposed. The CDC recommends that 11 and 12 year olds receive the HPV vaccine because statistics show that one in three 9th graders and two in three 12th graders have engaged in sexual intercourse. Studies have also shown a more robust immune response when given at younger ages.
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 age 26. Additionally, providers should counsel mothers to vaccinate children at the targeted age range because the vaccine is most effective before the onset of sexual activity and produces a higher antibody response when given to children 11-12 years of age. Many parents think that the HPV vaccine is only needed for their daughters. Encourage the parents of males to have their sons vaccinated in order to stop the spread of HPV viruses, and to prevent anal, oropharyngeal and penile cancers.
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 vaccine preventable HPV types are extremely unlikely.
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 extremely unlikely to have been exposed to all HPV vaccine types, so the patient would benefit from vaccination.
How are the three available HPV vaccines (2-valent, 4-valent, and 9-valent) different?
All three HPV vaccines protect against HPV 16 and 18, types that cause about 66% of cervical cancers and the majority of other HPV-attributable cancers in the United States. The 9-valent HPV vaccine targets five additional cancer causing types (31, 33, 45, 52, and 58), which account for about 15% of cervical cancers. The 4-valent and 9-valent HPV vaccines also protect against HPV 6 and 11, types that cause genital warts.
If a patient receives the 4-valent HPV vaccine for their first dose, do I need to complete the series with 4-valent, or can I complete the series with the 2-valent or 9-valent?
If vaccination providers do not know or do not have available the HPV vaccine product previously administered, or are in settings transitioning to 9-valent HPV, any available HPV vaccine product may be used to continue or complete the series for females for protection against HPV 16 and 18; 9-valent HPV or 4-valent HPV may be used to continue or complete the series for males.
Do the vaccines provide cross protection against other HPV types not in the vaccines?
There is evidence of some cross protection in all three vaccines to 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 all the available information suggests a booster dose will not be necessary.
Are two doses of HPV vaccine acceptable?
No. Although the WHO recommends a 2-dose schedule in girls under 15, the ACIP and ACOG recommend the full 3-dose schedule for all age groups.
Do I need to restart the series if a patient does not get the 2nd or 3rd dose on time?
No. 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?
No. 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?
Anyone who has ever had a life-threatening allergic reaction to any component of HPV vaccine, or to a previous dose of HPV vaccine, should not get the vaccine. Providers should assess patients for severe allergies, including an allergy to yeast. People with a moderate or severe illness should wait until their illness improves.
Are the HPV vaccines safe?
Many studies conducted in developing and developed countries have found all three vaccines to be very safe and effective. The vaccine does not contain live viruses so cannot cause an HPV infection. HPV vaccines have been administered to millions of girls and women around the world without serious side effects. In the past eight years since the vaccine was licensed, serious side effects have been exceedingly rare (less than 0.0003% of patients). Frequently reported non-serious side effects include headache, nausea, dizziness, pain and redness, and low grade fever. Studies have shown that the 9-valent HPV vaccine results in increased fever and pain and redness at the injection site. Ob-gyns should counsel patients to expect discomfort following vaccination and that such discomfort is not a cause for concern. The HPV vaccine was licensed by the Food and Drug Administration (FDA) in 2006 and the CDC continues to closely monitor the vaccine and its safety. *
*For more safety information, please visit the CDC: http://www.cdc.gov/vaccinesafety/Vaccines/HPV/hpv_faqs.html
What are effective messages for parents when talking about the vaccine?
It is required by law for you to give your patients a Vaccine Information Statement upon receiving an immunization. Vaccine Information Statement forms can be found in multiple languages at www.immunize.org/vis/.
For more information, please see the following resources:
American College of Obstetricians and Gynecologists Immunization for Women
Centers for Disease Control and Prevention HPV Vaccine Resources for Healthcare Professionals