The Green Book Human Papillomavirus Chapter 18a
The Green Book HPV Chapter 18a includes detailed information about HPV, the history and epidemiology of the disease and the vaccination programme.
Healthcare practitioners should familiarise themselves with this Green Book chapter before offering or advising on HPV vaccination and refer to relevant parts of the chapter for information on the following:
- history and epidemiology of the disease
- the HPV vaccination
The HPV vaccine is recommended for:
- all adolescents in school Year 8
- MSM up to and including 45 years of age attending Specialist Sexual Health Services and/or HIV clinics regardless of risk, sexual behaviour or disease status
Girls remain eligible to receive the vaccine up to their 25th birthday, and boys in the eligible cohort remain eligible to receive the vaccine until their 25th birthday. Older boys have not been offered the vaccine as they are already benefitting greatly from the indirect protection provided by the HPV vaccination programme to date.
MSM older than 45 years are not eligible for HPV vaccination under the national NHS England procured service.
Although the universal adolescent HPV programme will be delivered as a school-based programme, eligible individuals who are home-schooled, or schooled outside of mainstream schooling should also be offered the vaccine.
Hpv Vaccine For The Treatment Of Head And Neck Cancer
On June 12, 2020, the FDA approved an expanded indication for Gardasil 9 for the prevention of oropharyngeal and other head and neck cancers caused by HPV types 16, 18, 31, 33, 45, 52, and 58. The oropharyngeal and head and neck cancer indication is approved under accelerated approval based on effectiveness in preventing HPV-related anogenital disease. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial, which is currently underway.
What Types Of Hpv Vaccines Are There
Three HPV vaccines9-valent HPV vaccine , quadrivalent HPV vaccine , and bivalent HPV vaccine have been licensed by the U.S. Food and Drug Administration . All three HPV vaccines protect against HPV types 16 and 18 that cause most HPV cancers.
Gardasil-9 , a nine-valent HPV vaccine that protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58, is the only HPV vaccine currently distributed in the U.S.
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How Well Do These Vaccines Work
HPV vaccination works extremely well. HPV vaccine has the potential to prevent more than 90% of HPV-attributable cancers.
- Since HPV vaccination was first recommended in 2006, there has been a significant reduction in HPV infections.
- Fewer teens and young adults are getting genital warts.
- HPV vaccine has also reduced the number of cases of precancers of the cervix in young women.
With more than 12 years of data, we know that HPV vaccine offers long-lasting protection against HPV infection and HPV disease.
- HPV vaccination does not lose the ability to protect against new HPV infections over time.
Merck Vaccine Patient Assistance Program
The pharmaceutical company that manufactures Gardasil-9 offers a vaccine assistance program to cover the cost of the vaccine itself. To qualify, you must:
- Be between 19 and 45 years of age
- Have no health insurance
- Live in the United States
- Have an annual income at or less than 400% of the Federal Poverty Level .
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Why Is Hpv Vaccination Important
The combination of HPV vaccination and cervical screening can provide the greatest protection against cervical cancer. Also, HPV vaccination reduces the risk of developing cancers caused by HPV at sites other than the cervix.
Not only does vaccination protect vaccinated individuals against infection by the HPV types targeted by the vaccine that is used , but vaccination can also reduce the prevalence of the vaccine-targeted HPV types in the population, thereby reducing infection in individuals who are not vaccinated . For example, in Australia, where a high proportion of girls are vaccinated with Gardasil, the incidence of genital warts went down during the first 4 years of the vaccination program among young maleswho were not being vaccinated at the timeas well as among young females .
Further evidence that large-scale HPV vaccination confers protection for unvaccinated individuals comes from a 2019 meta-analysis of girls-only HPV vaccination programs in 14 high-income countries that included 60 million vaccinated people . That analysis showed that, up to 8 years after the start of vaccination, diagnoses of anogenital warts decreased by 31% among women aged 2529 years, by 48% among boys aged 1519 years, and by 32% among men aged 2024 years, compared with the period before vaccination began.
Does Bcbs Cover Rabies Vaccine
Blue Chip for Medicare Products
Correspondingly, what vaccines are covered by Blue Cross Blue Shield?
Yes! CareFirst’s Blue Cross Blue Shield health plans cover HPV vaccines for both children and adults, the varicella vaccine, which protects against shingles, and the pneumococcal vaccine, which helps protect against pneumonia.
Similarly, does Blue Cross Blue Shield PPO cover shingles vaccine? It protects your overall health: The vaccine protects you against contracting shingles and protects others from contracting chickenpox from you. It’s covered under most plans: Most Blue Cross commercial plans cover the vaccine for no copay during your annual check-up or at a pharmacy.
Secondly, does Blue Shield cover travel vaccinations?
Our plans for retirees will cover travel immunizations including, hepatitis A, hepatitis B, Japanese encephalitis, meningitis, polio, rabies, typhoid and yellow fever. These immunizations can be administered at your doctor’s office and may be available at some pharmacies.
Is MMR vaccine covered by insurance?
The measles vaccine is covered at no cost-share for members on plans that follow UnitedHealthcare’s standard preventive benefits. Members should review their plan documents or call the number on their health plan ID card to understand what their benefits include.
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Study Shows Hpv Vaccine Works
The FDAs approval for expanded vaccine use was based on a study of women 27 through 45 years of age. They were vaccinated with the previous Gardasil, which covered four HPV strains, and they were followed for an average of three and a half years.
The vaccine was found to be 88 percent effective in preventing infection, genital warts, precancerous lesions, and cervical cancer related to the HPV strains covered by the vaccine. Long-term follow-up study data also contributed to overall findings.
Its just amazing how much potential cancer there would have been that weve prevented, Dr. Ruff marvels. Thats pretty impressive data.
Since the virus is sexually transmitted, most adults encounter at least one HPV strain at some point in their lives. If youve already been exposed to a particular strain of HPV, the vaccine wont work against that one, but it will protect you against strains youve not yet encountered.
I think its a worthwhile vaccine, she says, noting the impressive data and little to no side effects.
The Above Policy Is Based On The Following References:
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What Does Gardasil Cost
Under the Affordable Care Act , the Gardasil 9 vaccine should be provided without cost for everyone in the recommended age groups by all covered private insurance plans and the insurance obtained through the health exchanges as of 2017. Changes to or repeal of the Affordable Care Act could result in changes to the vaccine benefit offered by insurance companies.
The vast majority of health insurance providers cover Gardasil 9, but that varies from company to company. Merck, the manufacturer of the vaccine, recommends contacting your insurer to ask whether it is covered, what restrictions there might be, how much you will have to pay, whether there are deductibles that apply, and if there is an annual coverage maximum that will apply.
Gardasil is covered under the VCF program, a federal program available to children through age 18 who are uninsured, Medicaid-eligible, American Indian, Alaska Native, or underinsured. This makes the vaccine free to eligible children. Those over age 18 may be covered by Medicaid, varying by state. In states where the Children’s Health Insurance Program is separate from Medicaid, the vaccine is covered. You may need to go to a public health clinic to get the vaccine if your healthcare provider is not enrolled as a VFC provider.
Merck has a patient assistance program and offers the vaccine at no cost for adults of ages 19 to 26 who do not have health insurance and cannot afford to pay for the vaccine.
What Else Do You Need To Make Your Decision
Check the facts
- That’s not right. The HPV vaccines protect against the most common types of HPV that cause problems.
- That’s right. The HPV vaccines protect against the most common types of HPV that cause problems.
- It may help to go back and read “Get the Facts.” The HPV vaccines protect against the most common types of HPV that cause problems.
- That’s right. The best time to get the vaccine is before you become sexually active. But it can prevent infection with HPV if you are already sexually active and don’t have HPV.
- That’s not right. The vaccine can prevent infection with HPV if you are already sexually active and don’t have HPV.
- It may help to go back and read “Get the Facts.” The vaccine can prevent infection with HPV if you are already sexually active and don’t have HPV.
- That’s right. The HPV vaccine is a series of 3 shots. For it to work best, you need to get all the shots.
- Sorry, that’s not right. The HPV vaccine is a series of 3 shots. For it to work best, you need to get all the shots.
- It may help to go back and read “Get the Facts.” The HPV vaccine is a series of 3 shots. For it to work best, you need to get all the shots.
1. How sure do you feel right now about your decision?
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Msm Hepatitis B Vaccination Status
Clinics or clinicians should take the opportunity to check patients hepatitis B virus vaccination status. Hepatitis B vaccination uptake amongst MSM attending specialist sexual health services is below national targets, both for first dose uptake and for completion of 3 doses of vaccine. Recording of both HBV immunity and hepatitis B vaccine delivery by clinician coding is also suboptimal. The UKs risk-based vaccination policy for hepatitis B includes MSM and maintaining high vaccine coverage in MSM is important to avoid outbreaks of HBV infection.
Further information is available in the Green Book Hepatitis B Chapter 18and in the British Association for Sexual Health and HIV s National Guidelines for the Management for Viral Hepatitides 2017 interim update.
Administering The Hpv Vaccine At The Same Time As Other Vaccines
Gardasil and Gardasil 9 are inactivated vaccines and will not be affected by, nor interfere with other inactivated or live vaccines given at the same time, or at any interval from each other.
If more than 1 vaccine is given at the same time, the vaccines should be given at separate sites, preferably in a different limb. If given in the same limb, they should be given at least 2.5cm apart. The site at which each vaccine was given should be noted in the individuals records.
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Does Insurance Cover The Vaccine
The HPV vaccine is fully covered by most insurance plans. For more information, check out UHS Charges and Insurance page.
If youre uninsured or underinsured, check if you qualify for a free vaccine with the Merck Vaccine Assistance Program. Austins Big Shots immunization program also offers vaccines to uninsured and underinsured adults.
What Are The Side Effects Of Vaccines
Most side effects from vaccines are minor, if they occur at all. Ask your doctor or pharmacist about the reactions that could occur. They may include:
- Redness, mild swelling, or soreness where the shot was given.
- A slight fever.
- Drowsiness, crankiness, and poor appetite.
- A mild rash 7 to 14 days after chickenpox or measles-mumps-rubella shots.
- Temporary joint pain after a measles-mumps-rubella shot.
Serious reactions, such as trouble breathing or a high fever are rare. If you or your child has an unusual reaction, call your doctor.
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Vaccination Of Specific Populations
Pregnancy and breastfeeding
HPV vaccines are not recommended for use in pregnancy because data on HPV vaccination in pregnancy are limited. HPV vaccine, however, has not been causally associated with adverse outcomes of pregnancy or adverse events to the developing fetus. In the absence of data, it is recommended that initiation of the HPV vaccine series should be delayed until after completion of the pregnancy. If a woman is found to be pregnant after initiating the vaccination series, completion of the series should be delayed until after pregnancy. No intervention is required if vaccine has been administered during pregnancy.
Vaccine recipients and health care providers are encouraged to report any exposure to HPV4 or HPV9 vaccine during pregnancy to the vaccine manufacturer at 1-800-567-2594. Exposure to HPV2 vaccine during pregnancy should be reported to the vaccine manufacturer at 1-800-387-7374.
There are limited data on the effects on breastfed infants from HPV vaccination of their mothers however, there have been no reported adverse events thought to be vaccine-related. Therefore, HPV vaccine may be administered to breastfeeding women.
Refer to Immunization in Pregnancy and Breastfeeding in Part 3 for additional information about vaccination of women who are pregnant or breastfeeding.
Refer to Immunization of Immunocompromised Persons in Part 3 for additional information about vaccination of people who are immunocompromised.
Postural Orthostatic Tachycardia Syndrome
POTS is 4 times more common in females and has peak onset in adolescence. Given the number of girls vaccinated, a large number of diagnoses of POTS around the age HPV vaccine is given would be expected, regardless of any association with the vaccine.
In previous years, concerns regarding the safety of the HPV vaccine have been raised in the UK and other European countries, with some parents and pressure groups linking the vaccine to POTS. In June 2015, the JCVI carried out a routine review of HPV vaccine safety and concluded that it had no concerns about the safety of the HPV vaccine. The European Medicines Agency has also conducted an independent review and, in line with findings from the UKs MHRA, concluded that available evidence does not support that HPV vaccines cause complex regional pain syndrome or POTS.
HPV vaccine was temporarily suspended by the Japanese government in 2013 but as no causal link was found between the vaccine and the illnesses reported in Japan the suspension was lifted in 2020. No other health authorities have taken similar action, and the World Health Organization continues to endorse the HPV vaccine.
Various worldwide independent health bodies and authorities have also reviewed the safety of the HPV vaccine and all have concluded that the evidence does not support a link between HPV vaccine and the development of a range of chronic illnesses.
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Monitoring For Possible Side Effects
Like all vaccines, even old vaccines approved many years ago, the HPV vaccines are continuously monitored for side effects. The US Centers for Disease Control and Prevention and the US Food and Drug Administration review all serious side effects reported to the Vaccine Adverse Event Reporting System to watch for potential safety concerns that may need further study.
What Vaccines Are Recommended For Adults
The vaccines you need as an adult depend not only on your age, lifestyle, overall health, pregnancy status, and travel plans but also on who you are in close contact with and what vaccines you had as a child.
Talk to your doctor about which vaccines you need. Common adult vaccines include:
In some states, pharmacists can give some of these shots.
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What Are The Benefits Of The Hpv Vaccine
There are many types of HPV. Some types of the virus can cause genital warts. Other types can cause cervical or oral cancer and some uncommon cancers, such as vaginal and anal cancer. The HPV vaccine protects against the most common HPV types that can cause serious problems.footnote 3
The HPV vaccines were tested in thousands of people before being approved by the U.S. Food and Drug Administration , and there were no serious side effects. You can’t get HPV from the vaccine, and it doesn’t contain mercury.
Who Should Get Hpv Vaccination
The Centers for Disease Control and Preventions Advisory Committee on Immunization Practices develops recommendations regarding all vaccination in the United States, including HPV vaccination. The current ACIP recommendations for HPV vaccination are :
- Children and adults ages 9 through 26 years. HPV vaccination is routinely recommended at age 11 or 12 years vaccination can be started at age 9 years. HPV vaccination is recommended for all persons through age 26 years who were not adequately vaccinated earlier.
- Adults ages 27 through 45 years. Although the HPV vaccine is Food and Drug Administration approved to be given through age 45 years, HPV vaccination is not recommended for all adults ages 27 through 45 years. Instead, ACIP recommends that clinicians consider discussing with their patients in this age group who were not adequately vaccinated earlier whether HPV vaccination is right for them. HPV vaccination in this age range provides less benefit because more people have already been exposed to the virus.
- Persons who are pregnant. HPV vaccination should be delayed until after pregnancy, but pregnancy testing is not required before vaccination. There is no evidence that vaccination will affect a pregnancy or harm a fetus.
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