British Columbia Specific Information
Human Papillomavirus is one of the most common sexually transmitted infections . HPV can cause genital warts and cancers of the anus, cervix, mouth and throat, penis, vagina, and vulva. The HPV vaccines protect against infection from certain types of HPV, however, they do not get rid of the infection once it has occurred.
Health Canada has approved 2 HPV vaccines:
- Cervarix®
- Gardasil®9
To determine if you are eligible to receive the free vaccine, see HealthLinkBC File #101b Human Papillomavirus Vaccines, visit ImmunizeBC HPV , or speak with a public health nurse at your local public health unit. Those not eligible for the free HPV vaccine can purchase it at most pharmacies and travel clinics and at some sexual health clinics.
To learn more about HPV infection, see HealthLinkBC File #101a Human Papillomavirus Infection and Genital Warts. For more information on STIs, sexual health information, where to get tested and other sexual health services in your area, visit SmartSexResource.
When Should You Be Vaccinated
The vaccines are given 2 or 3 times over a 6- to 12-month period. The timing of doses is important to make sure the vaccines are as effective as possible. If all doses of the vaccine are not given, or they are not given at the right time, you may not get the full benefit of the vaccine.
The vaccines are most effective if theyre given before a person becomes sexually active because their risk of infection will be lower. The vaccines are also more effective in young teens when the immune system is most responsive to the vaccine.
Should Hpv Vaccines Be Given To People Who Are Already Infected With Hpv Or Have Cervical Cell Changes
ACIP recommends that people who have an HPV infection and/or an abnormal Pap test result that may indicate an HPV infection should still receive the HPV vaccine if they are in the appropriate age group because the vaccine may protect them against high-risk HPV types that they have not yet acquired. However, these people should be told that the vaccination will not cure them of current HPV infections or treat the abnormal results of their Pap test .
Although HPV vaccines have been found to be safe when given to people who are already infected with HPV, the vaccines provide maximum benefit if a person receives them before he or she is sexually active .
It is likely that someone previously infected with HPV will still get some residual benefit from vaccination, even if he or she has already been infected with one or more of the HPV types included in the vaccines.
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Fact : The Hpv Vaccine Can Protect Not Harm Fertility
There are no data to suggest that getting the HPV vaccine will affect your chances of having children later on . In fact, the HPV vaccine can help protect women from future fertility problems linked to cervical cancer and pre-cancer. The HPV vaccine is a safe way to help protect health and the ability to have healthy babies.
Efficacy And Effectiveness Of The Human Papillomavirus Vaccine
The impact of HPV vaccination in real-world settings has become obvious, particularly among women who get vaccinated before HPV exposure in countries with high vaccine uptake. Maximal reductions of approximately 90% for HPV 6/11/16/18 infections, approximately 90% for genital warts, approximately 45% for low-grade cytological cervical abnormalities, and approximately 85% for high-grade histologically proven cervical abnormalities have been reported. The estimated vaccine effectiveness with one dose or more of the HPV vaccine was 8396.1% .
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The Health Risks Of Hpv
HPV causes almost all cervical cancers but is also linked to cancer of the throat, oral cavity, penis, anus, vagina or vulva. More research is needed to define the extent of these linkages.
Anogenital warts, although rarely associated with cancer, are still a significant burden for those affected often leading to physical, emotional and social problems. They can be effectively treated by applying prescribed medication either in a doctor’s office or by you at home. Other medical treatments include cryotherapy , an electric current, or a laser or surgical removal of the warts but these methods do not always eliminate HPV infection. Even with treatment, warts can recur.
HPV does not appear to affect a woman’s ability to become pregnant. Although considered rare, the baby may be at risk of getting an HPV infection in the throat. A C-section delivery is not routinely recommended, unless there is a significant obstruction or other risks.
Fact : The Hpv Vaccine Lasts A Long Time
When your child gets the HPV vaccine they will make proteins called antibodies that fight the virus. Antibodies give strong and long-lasting protection. Current research shows that theres no sign the vaccine protection lessens with time. Research will continue to look at how long protection against HPV lasts, and if booster shots will be needed.
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Who Should Get Hpv Vaccine
HPV vaccination is recommended at ages 1112 years. HPV vaccines can be given starting at age 9 years. All preteens need HPV vaccination, so they are protected from HPV infections that can cause cancer later in life.
- Teens and young adults through age 26 years who didnt start or finish the HPV vaccine series also need HPV vaccination.
CDC recommends that 11- to 12-year-olds receive two doses of HPV vaccine 6 to 12 months apart.
- The first dose is routinely recommended at ages 1112 years old. The vaccination can be started at age 9 years.
- Only two doses are needed if the first dose was given before 15th birthday.
Teens and young adults who start the series later, at ages 15 through 26 years, need three doses of HPV vaccine.
- Children aged 9 through 14 years who have received two doses of HPV vaccine less than 5 months apart will need a third dose.
- Three doses are also recommended for people aged 9 through 26 years who have weakened immune systems.
Vaccination is not recommended for everyone older than age 26 years.
- Some adults age 27 through 45 years who are not already vaccinated may decide to get HPV vaccine after speaking with their doctor about their risk for new HPV infections and the possible benefits of vaccination for them.
- HPV vaccination in this age range provides less benefit, because more people in this age range have already been exposed to HPV.
How Cdc Monitors Vaccine Safety
CDC and FDA monitor the safety of vaccines after they are approved or authorized. If a problem is found with a vaccine, CDC and FDA will inform health officials, health care providers, and the public.
CDC uses 3 systems to monitor vaccine safety:
- The Vaccine Adverse Event Reporting System : an early warning system, co-managed by CDC and FDA, to monitor for potential vaccine safety problems. Anyone can report possible vaccine side effects to VAERS.
- The Vaccine Safety Datalink : a collaboration between CDC and 9 health care organizations that conducts vaccine safety monitoring and research.
- The Clinical Immunization Safety Assessment Project: a partnership between CDC and several medical research centers that provides expert consultation and conducts clinical research on vaccine-associated health risks.
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What Is In The Vaccine
The HPV vaccine used in the New Zealand Immunisation Programme from 2017 is Gardasil® 9. The vaccine contains HPV virus-like particles of HPV types 6, 11, 16, 18, 31, 33, 45, 52 and 58. These particles are proteins from the outer shell of the virus. The VLPs do not contain DNA fragments in a form that could allow them to infect cells or reproduce. The particles mimic the HPV virus so that the immune system makes antibodies against it. These recombinant types of vaccine have been used around the world for over 20 years.
Each 0.5ml dose of the vaccine also contains a small amount of aluminium, which stimulates the immune response. Aluminium has been safely and effectively used in vaccines for more than 70 years. The vaccine also contains tiny amounts of sodium chloride , L-histidine , Polysorbate 80, sodium borate and sterile water.
The vaccine does not contain preservatives, antibiotics or any human or animal materials.
The Medsafe website has further information about Gardasil 9:
Who Is Eligible And How Many Doses Are Needed
In the UK the HPV vaccine has been routinely offered to girls aged 12-13 years since 2008. The vaccine will also be offered to boys aged 12-13 from September 2019. This means that all boys and girls in school year 8 will be offered the first and second doses of the vaccine in school. See this video from the NHS about the year 8 HPV vaccine.
Any girls or boys who have missed the vaccine in school are still eligible to receive it for free through their GP until their 25th birthday. Those who are over 15 years old when they receive the first dose of the vaccine will need three doses instead of the usual two doses if they are under 15. All doses are covered by the NHS for boys and girls who are in the eligible cohorts:
- Girls who started year 8 in 2008 or later, up to their 25th birthday
- Boys who started year 8 in 2019 or later, up to their 25th birthday
Since April 2018 the HPV vaccine has also been offered to all men who have sex with men that are aged 45 or younger. This follows a successful pilot programme that has run since 2016. The vaccine will be offered at routine check-ups at sexual health clinics and HIV clinics. See the Public Health England news item.
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Where Can I Find These Vaccines
HPV vaccine may be available at doctor offices, community health clinics, school-based health centers, and health departments.
If your doctor does not stock HPV vaccine, ask for a referral.
You can also contact your state health department to learn more about where to get HPV vaccine in your community.
Sensitivity And Scenario Analyses
In further sensitivity analyses, the impact of vaccine efficacy, duration of protection, and vaccine price were analyzed . shows that including the benefits of cross-protection against HPV31, -33 and -45 resulted in a further improvement of the cost-effectiveness of the vaccination, the ICER now remaining below 30000/QALY even for women of 25 years of age. Lowering of the vaccines efficacy to 83.1% for all age groups resulted in a slight increase of the ICERs .
Impact of vaccine price on the estimated ICER for different age groups. Open dots, 125/dose closed dots, 105/dose open triangle, 85/dose closed triangle, 65/dose and open square, 45/dose.
When the duration of protection was reduced to 20 years, the ICER increased to values above 20000/QALY for all age groups but remained below 50000/QALY for women up to the age of 25 . Inclusion of a booster vaccination, 20 years after the original vaccination, resulted in slightly more favorable ICERs, but the values remained above 20000/QALY for all age groups.
illustrates that the ICERs are highly sensitive to the vaccine price. For example, when the vaccine price was reduced to 65/dose, the ICER was highly cost-effective for all women < 25 years of age. ICERs remained below 20000/QALY for women < 30 years when the vaccine price was 45/dose.
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Alternative Schedules Of The Hpv Vaccine
Clinical studies evaluating reduced dose schedules and the intervals between doses for both vaccines have demonstrated non-inferior antibody responses in girls younger than 15 years of age who received two doses, given 6 months apart, when compared with women who received the standard three doses of vaccine and had evidence of efficacy in clinical trials. These findings have led to the recommendations and approval of two-dose schedules in 9- to 14-year-old girls . Immunogenicity data for a single vaccine dose are limited. Although lower than the levels induced by two- and three-dose schedules, a single dose of HPV vaccine induced detectable HPV 16 and HPV 18 antibody levels higher than natural infection levels and remained 100% seropositive for 7 years .
National Advisory Committee On Immunization Recommendations
In February 2007, based on sound scientific consideration, the National Advisory Committee on Immunization issued recommendations for the use of Gardasil® for females ages nine to 26. In January 2012, NACI issued an update on human papillomavirus vaccines, which included recommendations in light of the expanded use of Gardasil® for males ages nine to 26 and females ages 27 to 45, as well as the approval of Cervarix® for females. In 2015, NACI issued updated recommendations on the HPV immunization schedule, including recommendations for either a 2- or 3- dose schedule in healthy, immunocompetent, non-HIV infected individuals 9-14 years of age, based on new evidence about the efficacy of HPV vaccines in this population. In 2016, NACI issued recommendations on the new vaccine, Gardasil®9, authorized for use in Canada. In 2017, NACI provided evidence-based recommendations on a 2-dose schedule for the most recently approved HPV vaccine, and summarized evidence and resulting recommendations on HPV immunization in immunocompromised populations.
Currently, all HPV vaccines are recommended by NACI for:
- girls and women 9 to less than 27 years of age, including those who have had previous Pap test abnormalities, cervical cancer or genital warts, and may be administered to women 27 years of age and older at ongoing risk of exposure to HPV
HPV vaccination prior to onset of sexual activity and exposure to HPV is recommended to maximize the benefit of the vaccine.
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Sensitivity And Scenario Analysis
Because there is uncertainty about the vaccines efficacy and the duration of protection, and because the vaccine price may vary, we performed several sensitivity and scenario analyses to evaluate the robustness of our results.
First, assumptions regarding the vaccine efficacy were evaluated in 2 different subanalyses: Vaccine efficacy was decreased to 83.1% for all age groups, as indicated above , and cross-protection against other HPV types was included . Cross-protection against nonvaccine HPV types was included as reported for the bivalent vaccine .
Next, the impact of waning immunity on the ICER was analyzed. As vaccine efficacy has only been proven for 9/7.3 years after vaccination, in this scenario the duration of protection was reduced from lifelong to 20 years . Such medium-term protection can be motivated, since after 9/7.3 years antibody titers remained high and no clinically relevant reduction in protection has been reported . Furthermore, the impact of an additional 1-dose booster, 20 years after the initial vaccination scheme, was analyzed, assuming the booster to provide lifelong protection thereafter.
Fact : The Vaccine Is Safe
The HPV vaccine has been used since 2006. The vaccine went through extensive safety testing before becoming available. More than 270 million doses of the HPV vaccine have been given worldwide, including 120 million doses in the US. Scientists and health organizations around the world closely monitor HPV vaccine safety.
In the US, vaccine safety is watched by several national systems that work together to make sure that any harmful effects of vaccines can be found early. More than 100 studies in millions of people worldwide have all shown that the HPV vaccine is safe.
Like any vaccination, there may be common mild side effects from the HPV vaccine that go away quickly like headache or fever. There can be pain, redness, and/or swelling where the shot was given. A small number of people may have a more serious side effect that could occur with any vaccine, such as an allergic reaction or fainting when the vaccine is given. Anyone who has a severe allergy to yeast or any other ingredient in the vaccine should not receive the HPV vaccine.
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Uk Study Finds Hpv Vaccine Reduced Cervical Cancer Rates By 87%
When children are inoculated between 12 and 13 years old, the vaccine is most effective
Daily Correspondent
Human papillomavirus is a sexually transmitted infection that can cause cervical, penile, and oropharyngeal cancer later in life. HPV is common around the globe, and most people are infected with HPV at some point in their lives after becoming sexually active, reports Yasemin Saplakoglu for Live Science. It is estimated that 570,000 women and 60,000 men worldwide get HPV-related cancer each year. The majority of cervical cancer cases are caused by HPV, and more than 100 countries offer HPV vaccinations to young girls as a preventative measure against the infection.
A new study found that an National Health Service vaccination program started in the United Kingdom to prevent cervical cancer has reduced cases by 87 percent in women who received an HPV vaccine between the ages of 12 and 13, Live Science reports. The study published this month in The Lancet is the first direct, worldwide evidence of vaccination for two types of HPV preventing cervical cancer, per the Guardian.
Cervical cancer rates in women inoculated between 12 and 13, who are now in their twenties, were 87 percent lower than in those who are unvaccinated, the Guardian reports. Cases of cervical cancer for women in their twenties, which are already rare in this age group, dropped from 50 cases per year to only five cases.
Hpv Vaccination Is Preventing Cancer
HPV infections and cervical precancers have dropped since 2006, when HPV vaccines were first used in the United States.
- Among teen girls, infections with HPV types that cause most HPV cancers and genital warts have dropped 88 percent.
- Among young adult women, infections with HPV types that cause most HPV cancers and genital warts have dropped 81 percent.
- Among vaccinated women, the percentage of cervical precancers caused by the HPV types most often linked to cervical cancer has dropped by 40 percent.
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