Which Girls/women Should Receive Hpv Vaccination
HPV vaccination is recommended for 11 and 12 year-old girls. It is also recommended for girls and women age 13 through 26 years of age who have not yet been vaccinated or completed the vaccine series HPV vaccine can also be given to girls beginning at age 9 years. CDC recommends 11 to 12 year olds get two doses of HPV vaccine to protect against cancers caused by HPV. For more information on the recommendations, please see:
Nhanes Data Suggest Yes But Researchers Urge Caution
byKristin Jenkins, Contributing Writer, MedPage Today January 2, 2020
A single-dose vaccination regimen for human papillomavirus had similar efficacy against HPV infection compared with the recommended two- or three-dose series, although researchers caution that more research is needed.
Analysis of 2009-2016 data from 1,620 women in the National Health and Nutritional Examination Survey showed infection with strains covered by the quadrivalent vaccine in 2.4% of those who received one dose of the vaccine compared with 5.1% in those given two doses and 3.1% who received three doses.
Among unvaccinated women, prevalence of infection with HPV type 6, 11, 16, or 18 was 12.5%, reported Kalyani Sonawane, PhD, of the University of Texas Health Science Center at Houston, and colleagues in JAMA Network Open.
“Our study suggests that US women who received 1 dose of the HPV vaccine may have gained similar protection against vaccine-type infections compared with those who received additional doses,” the study authors wrote. “These findings support previous observational studies and post hoc analyses of vaccine trials that demonstrated comparable effectiveness of one dose to two or three doses.”
“If ongoing trials confirm sufficient efficacy and sustained duration of protection from a single-dose regimen, vaccine initiation will become a more achievable metric of population coverage,” they wrote.
Disclosures
Primary Source
JAMA Network Open
Cervical Cancer Screening In Women Who Have Received Hpv Vaccine
While HPV vaccines have been shown to be highly effective against cancer precursors caused by HPV type 16 and HPV type 18, these two HPV types are responsible for approximately 70% of cervical cancer. Those vaccinated will still be susceptible to infection from other high-risk HPV genotypes and women who were sexually active prior to receiving HPV vaccine may already have been infected with HPV type 16 or HPV type 18. All women should continue to take part in the currently recommended cervical cancer screening programs. As more females receive the vaccine, it may be possible to modify screening programs in either type or frequency of screening, or both. This area requires continued research and surveillance before guidelines are changed.
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How Long Does It Take To Work
Typically, your body starts building up an immunity about 2 weeks after you get a vaccine. Therefore, Gardasil 9 will start working in your body within a couple weeks of getting the vaccine. In clinical studies, people who received Gardasil 9 had evidence of immune system cells that fight HPV by 1 month after their last dose.
Its important to complete the vaccine series of two to three doses. Although the vaccine starts to build immunity in your body after one dose, the second doses build up your immunity even more. Youll be the most protected by getting the two-dose or three-dose series thats recommended by your doctor or pharmacist.
Dosage For Preventing Cervical Vulvar Vaginal And Anal Cancer Caused By Hpv
Gardasil 9 is recommended to prevent certain cancers caused by HPV such as cervical, vulvar, vaginal, and anal cancers. The recommended dosage for adults ages 18 to 45 years old is a 0.5-mL injection into the muscle, usually in your upper arm.
Its recommended that you receive three doses of Gardasil 9. After you receive one dose, you get a second dose 2 months later and a final dose 6 months after the first dose.
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How Can I Protect Myself From Hpv
The most important way to protect against HPV infection is by getting the HPV vaccine.
For people who have sex, condoms offer some protection against HPV. Condoms can’t completely prevent infections because hard-to-see warts can be outside the area covered by a condom, and the virus can infect people even when a partner doesn’t have warts. Also, condoms can break.
The only way to be completely sure about preventing HPV infections and other STDs is not to have sex . Spermicidal foams, creams, and jellies aren’t proven to protect against HPV or genital warts.
If you have questions about the vaccine or are worried about STDs, talk to your doctor.
Are There Hpv Vaccine Side Effects
Research shows that the vaccine is safe. The most common side effect is temporary pain and redness where you get the shot.
One of the reasons the HPV vaccine is controversial is because it prevents a sexually transmitted infection, which leads some people to believe its inappropriate for children. But, the thing is, the vaccine works best if you get it long before you have sex. So its a good idea to get it when youre young so you wont have to worry about getting certain kinds of cancer later in life.
Studies show that the HPV vaccine doesnt lead to people having more sex or sex at a younger age. So giving kids the HPV vaccine doesnt encourage them to have sex. All it does is help protect them from genital warts and cancer in adulthood.
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How Is The Hpv Vaccine Given
The human papillomavirus vaccine is given as an injection into the upper arm: 2 doses are needed, with at least 6 months between them.
The 1st dose of the HPV vaccine is offered to girls and boys aged 12 and 13 years in Year 8 of school.
People who have the 1st dose of the HPV vaccine at 15 years of age or above will need to have 3 doses of the vaccine.
Girls and boys who became eligible for the HPV vaccine in Year 8, but missed having their doses at school, can get the vaccine up until their 25th birthday.
Talk to your school nurse, school immunisation team or GP surgery about getting vaccinated if you missed out and want to have it.
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.
Immunocompromised persons
Refer to Immunization of Immunocompromised Persons in Part 3 for additional information about vaccination of people who are immunocompromised.
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Why Is The Hpv Vaccine Important
Genital HPV is a common virus that is passed from one person to another through direct skin-to-skin contact during sexual activity. Most sexually active people will get HPV at some time in their lives, though most will never even know it. HPV infection is most common in people in their late teens and early 20s. There are about 40 types of HPV that can infect the genital areas of men and women. Most HPV types cause no symptoms and go away on their own. But some types can cause cervical cancer in women and other less common cancers like cancers of the anus, penis, vagina, and vulva and oropharynx. Other types of HPV can cause warts in the genital areas of men and women, called genital warts. Genital warts are not life-threatening. But they can cause emotional stress and their treatment can be very uncomfortable. Every year, about 12,000 women are diagnosed with cervical cancer and 4,000 women die from this disease in the U.S. About 1% of sexually active adults in the U.S. have visible genital warts at any point in time.
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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Gardasil 9 And Breastfeeding
Not enough studies have been done to determine if Gardasil 9 is safe to receive while breastfeeding. Its not known if Gardasil 9 can pass into breast milk. There is no animal data to determine if Gardasil 9 can pass into breast milk or harm a breastfeeding child.
If you are breastfeeding, talk to your doctor or pharmacist about the best time to get your Gardasil 9 vaccine.
Here are answers to some frequently asked questions about Gardasil 9.
Human Papillomavirus Vaccine: Canadian Immunization Guide
For health professionals
Last complete chapter revision: May 2017
New recommendation: HPV9 vaccine may be administered to immunocompetent males and females 9 to 14 years of age according to a 2-dose or 3-dose immunization schedule. The second dose of HPV9 vaccine in a 2-dose schedule should not be administered earlier than 24 weeks following the first dose. Immunocompromised individuals should continue to receive a 3-dose immunization schedule, as previously recommended.
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Gardasil 9 For Preventing Cervical Vulvar Vaginal And Anal Cancer Caused By Hpv
Gardasil 9 is FDA-approved to prevent several types of cancers that can be caused by the human papillomavirus . HPV is spread by vaginal, anal, or oral sex with someone whos infected with the virus. Even if a person doesnt show any symptoms, they may still be infected with HPV. According to the , HPV is the most common sexually transmitted infection.
There are more than 100 types of HPV that can cause problems such as genital warts or cancer. Gardasil 9 protects against nine types. The vaccine contains proteins from each of these nine types of HPV.
The types of HPV that cause cancer are different from the types of HPV that cause genital warts. Gardasil 9 protects against HPV-related anal cancer in men and women. It also protects against the following types of HPV-related cancer in women:
- cervical cancer
- vulvar cancer
- vaginal cancer
These cancers can be caused by HPV type 16, 18, 31, 33, 45, 52, and 58. After getting the vaccine, youd be protected from all of these types.
Effectiveness
Gardasil 9 has been found to be effective in preventing abnormal changes or cancer in the cervix, vulva, vagina, or anus. For information on how the drug performed in clinical studies, see Gardasil 9s prescribing information.
The recommends vaccinating children ages 9 through 12 years against HPV.
Other Ways To Prevent Hpv
Overall, the best way to prevent HPV is by getting vaccinated. Other ways you can prevent getting the virus include the following:
- Use condoms or other barrier methods during sex. Condoms, dental dams, and other types of barrier protection can lower your risk of contracting or transmitting HPV.
- For women: Get routine screenings for cervical cancer. Doctors can find abnormal cell changes in women ages 21 to 65 with regular cervical cancer screenings done through Pap tests.
- Maintain a healthy diet.
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Data Sources And Linkage
In Australia, from 1991 to 30 November 2017, the National Cervical Screening Program recommended two-yearly cervical cytology screening using Papanicolaou tests for sexually active women aged 18 to 69. Cervical screening registries from all eight jurisdictions in Australia supported the Program and each systematically recorded cervical screening results, including histopathology inclusive of cancer, for participants. Women could âopt offâ a registry but opt off rates were low . Quality of cytology was high, with close quality and safety monitoring of the program down to the individual laboratory level through the registries . Participation in screening was high, with 73·5% of women aged 20â24 having at least one screen in the period 2010â2014 .
Data from 1 January 2000â31 December 2014 from all eight registries was provided to the Data Linkage Unit, Australian Institute of Health and Welfare , for linkage to data from the same time period obtained from the Australian Cancer Database , National Death Index and National HPV Vaccination Program Register . The NHVPR recorded individual HPV vaccination doses given in Australia. Quadrivalent vaccine was given in three doses from 2007 to 2017. Between 2007 and 2009, all females 12â26 years were offered vaccination with high coverage , and thereafter girls were vaccinated at age 12â13 years in school and boys from 2013.
Protecting Against Hpv Through Immunization
Health Canada has authorized three vaccines to prevent infections from the most common types of HPV: Gardasil®, Gardasil®9 and Cervarix® . All three vaccines are safe and very effective in preventing HPV infection and changes in the cells of the cervix related to these types of HPV.
Studies have found HPV vaccines to be safe. Other than a brief soreness at the injection site, participants reported few side effects. The vaccines cannot cause disease because they contain no live biologicals or DNA and are thus not infectious. Also, the vaccines do not contain any preservative or antibiotics, including thimerosal or mercury. It is important to note that Cervarix® contains a special new adjuvant/additive which studies have also shown to be safe.
If you are infected with one type of HPV you can still benefit from the HPV vaccine. It can protect you against other strains of the virus. Unfortunately, even if you are vaccinated, you are still at risk for some types of HPV not covered by the vaccine. It is important that women who receive the vaccine still have regular Pap tests and practice safer sex.
None of the HPV vaccines have an impact on an existing infection or any consequences of infection that you may already have. Talk to your doctor for more information.
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Before Taking This Medicine
To make sure Gardasil 9 vaccine is safe for you, tell your doctor if you have ever had:
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an allergy to yeast, polysorbate 80, or to other vaccines
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a weak immune system or
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treatment with cancer medicine, steroids, or other drugs that can weaken your immune system.
Tell your doctor if you are pregnant or plan to become pregnant. If you get pregnant before you receive all needed doses of this vaccine, you may need to wait until after your baby is born to finish the series of shots.
If you are pregnant, your name may be listed on a pregnancy registry to track the effects of human papillomavirus vaccine on the baby.
It may not be safe to breastfeed while using human papillomavirus vaccine. Ask your doctor about any risk.
Gardasil 9 vaccine will not protect against sexually transmitted diseases such as chlamydia, gonorrhea, herpes, HIV, syphilis, and trichomoniasis.
Alternatives To Gardasil 9
Gardasil 9 is currently the only vaccine approved in the United States to protect against certain diseases caused by human papillomavirus .
In the past, another vaccine called Cervarix was used to prevent two types of HPV . There was also an older version of Gardasil that protected against four types of HPV. Both of these vaccines have been discontinued and are unavailable in the United States. This is because Gardasil 9 is very effective, protects against the largest number of types of HPV, and can protect both men and women from HPV-related diseases.
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Strengths Limitations And Future Studies
Although Dr. Markowitz called the results of the two new studies very encouraging, she noted some limitations, including that relatively few women in the Costa Rica Trial received one or two vaccine doses, and they were not randomly assigned to the specific dosing schedule. She noted that some other, shorter-term studies have suggested that one dose of the HPV 16/18 vaccine will work as well as two or three doses.
None of the published studies to date have randomly assigned women to receive a single vaccine dose. It is possible that women in the Costa Rica Trial who received a single dose were different in some way, Dr. Markowitz said. However, she continued, the trial investigators have done extensive analyses to look at how comparable the single-dose women were to the women who received three doses.
Indeed, Dr. Kreimer said, we launched the ESCUDDO study to directly evaluate the question of single-dose protection of HPV vaccines in a new randomized clinical trial.
The ESCUDDO study enrolled more than 20,000 adolescent girls, randomly assigned to receive one or two doses of Cervarix or Gardasil 9, which protects against nine HPV types. More than 4,000 young adult women were also enrolled to document HPV rates in the population at the start of the study.
Together, the new findings of long-lasting protection give us a first glimpse of hope that these vaccines will last as long as we need them to, Dr. Kreimer explained.