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.
Immunogenicity Efficacy And Effectiveness
Immunogenicity
HPV vaccine is highly immunogenic. More than 99% of vaccine recipients develop an antibody response to vaccine HPV types after completing a 3-dose series. In immunocompetent, non-HIV infected individuals 9 to 14 years of age, a 2-dose schedule of HPV2, HPV4, or HPV9 vaccine is as equally immunogenic as a 3 dose series in individuals 15 to 24 years of age. The immune correlates of protection against HPV infection are unknown.
Efficacy and effectiveness
In Canada, immunization against HPV types 16 and 18 contained in HPV2, HPV4 and HPV9 vaccine can prevent approximately 70% of anogenital cancers and 60% of high-risk precancerous cervical lesions. Immunization against HPV types 31, 33, 45, 52, and 58 contained in HPV9 vaccine could further prevent up to 14% of anogenital cancers and 30% of high-risk precancerous cervical lesions. Immunization with either HPV4 or HPV9 vaccine can prevent approximately 90% of genital warts.
HPV vaccine has no proven therapeutic effect on existing HPV infection. Prior infection with one or more vaccine HPV types does not diminish vaccine efficacy against other vaccine HPV types. The duration of protection following HPV vaccination is not known. Clinical trial subjects have been followed for approximately 10 years for HPV2 and HPV4 vaccines with no evidence of waning protection.
The Future Of The Hpv Vaccine
Vaccination against the human papillomavirus is an exciting advancement in the war against cancer. This achievement deserves great respect, but it should be approached with thoughtful acknowledgment of the many questions still unanswered . One of the larger unknowns is the length of time that the HPV vaccine provides protection against the target subtypes. It may or may not be necessary to administer booster doses of the vaccine throughout a woman’s lifetime. The regional and global impact of the vaccine has yet to be determined. The true efficacy of the vaccine is going to be limited by barriers such as cost, access and complianceâthe same factors that have impeded the success of cervical cancer screening. Other challenges that remain include determining the utility of the vaccine in immunocompromised patients and its efficacy in men or in women over the age of 26.
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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.
Do I Need To Go To Cervical Screening If Ive Had My Hpv Vaccination
Yes, you should still consider going to cervical screening if youve had the HPV vaccine. The HPV vaccine doesnt protect against all types of HPV. And cervical screening is another effective way to reduce the risk of developing cervical cancer.
Cervical screening is for people without symptoms and helps to spot early cell changes caused by HPV. This means any abnormal cells can be removed before they have a chance to become cancer.
But dont wait for your next screening appointment if youve noticed anything thats unusual for you or wont go away. If somethings not normal for you speak to your doctor.
Cervical screening is for women aged between 25 and 64, and anyone else within this age range who has a cervix. This can include transgender men and people who are non-binary.
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Are Hpv Vaccines Safe
All of the HPV vaccines were tested in thousands of people around the world before they were approved. And they continue to be constantly monitored for safety. So far, all studies show no deaths have been linked to any HPV vaccine. Common, mild side effects include headache, fever, nausea, and dizziness. Sometimes pain and redness can happen where the shot was given.
As with any medication or injection, people may have an allergic reaction afterwards. Anyone who has a severe allergy to any ingredient in the HPV vaccine should not get the vaccine, including a severe allergy to yeast. Some people may faint after getting any vaccine, including HPV vaccines. Fainting after getting a shot is more common in teens than in young children or adults. To keep people from getting hurt from fainting, a 15-minute waiting period for people of all ages is recommended after any vaccination.
Safety And Side Effects
Between 2009 and 2018 more than 10 million doses of HPV vaccine were given in the UK, which means over 80% of women aged 15-24 have received the vaccination. There have been no examples of the vaccine causing serious side effects during this period. The side effects associated with the vaccine are listed below:
Very common :
- Pain, swelling and redness at the injection site
- Headache
Common :
- Bruising or itching at the injection site
- Raised temperature
Rare :
- Hives
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Monitoring Safety Of Hpv Vaccines
The Yellow Card Scheme allows doctors, other healthcare professionals and members of the public to report suspected side effects from any medicine taken, including vaccines.
It’s run by the Medicines and Healthcare products Regulatory Agency .
The scheme regularly reviews the reports and, if there’s a potential problem, will carry out an investigation and take appropriate action if necessary.
There’s also a legal requirement for pharmaceutical companies to report serious and suspected adverse events to the MHRA.
Vaccines For Adolescents: A New Generation Of Vaccines
Adolescents, like adults, were recommended to get tetanus boosters every 10 years most requiring their first booster dose around age 11. Other than this, however, most adolescents did not require additional vaccines unless they missed one in childhood. By 2005, vaccines specifically recommended for adolescents were only recommended for sub-groups based on where they lived or medical conditions that they had. However, a new group of vaccines became available in the latter part of the decade.
- New vaccines: Tdap, 2005, meningococcal conjugate , HPV , meningococcal serogroup B vaccine
- Additional recommendations for existing vaccines: HPV , intranasal influenza vaccine
- New versions of existing vaccines: HPV
- Discontinuation of vaccine: intranasal influenza vaccine
2000
Pneumococcus
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The American Cancer Societys Recommendations For Hpv Vaccine Use
- Girls and boys should get 2 doses of the HPV vaccine between the ages of 9 to 12.
- Teens and young adults age 13 through 26 who have not been vaccinated, or who havent gotten all their doses, should get the vaccine as soon as possible. Vaccination of young adults will not prevent as many cancers as vaccination of children and teens.
- The ACS does not recommend HPV vaccination for persons older than age 26 years.
The COVID-19 pandemic has resulted in health care check-ups and annual physicals being put on hold, including visits for routine vaccinations. Learn important information that can help you plan a safe return to well-child visits in Getting Essential Childhood and Adolescent Vaccines During the COVID-19 Pandemic.
Summary Of Key Points
- In 2007, Australia became the first country to roll out a national HPV vaccination program.
- In 2013, boys were included in the program, too.
- 200 million doses have been distributed to date, in 130 countries.
- The current vaccines protect against about 70 per cent of cervical cancers, 90 per cent of genital warts, 70 per cent of vaginal cancer cases and up to 50 per cent of vulva cancer cases.
- In the first four to five years after the program started, HPV infections of the types that are included in the vaccine decreased by 77 per cent in 1824-year-olds.
- Precancerous abnormalities decreased by 34 per cent in in 20-24-year-olds.
- The next-generation vaccine prevents persistent infection and precancerous lesions associated with nine different HPV types. Seven of these types cause cancer and are together found in around 90 per cent of cervical cancers worldwide.
- It will further improve protection and lower rates of HPV-related cancers, especially cervical cancer.
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Annual Updates To The Immunization Schedule 1995 To 2010
As more vaccines became available, an annual update to the schedule was important because of changes that providers needed to know, such as detailed information about who should receive each vaccine, age of receipt, number of doses, time between doses, or use of combination vaccines. New vaccines were also added.
Important changes to the schedule between 1995 and 2010 included:
- New vaccines: Varicella , rotavirus hepatitis A pneumococcal vaccine
- Additional recommendations for existing vaccines: influenza hepatitis A
- New versions of existing vaccines: acellular pertussis vaccine intranasal influenza
- Discontinuation of vaccine: Oral polio vaccine
2000 | Recommended Vaccines
* Given in combination as DTaP** Given in combination as MMR
The Safety Record Of The Hpv Vaccine
The HPV vaccine has been used worldwide for many years in countries such as Australia, Canada, the UK, the US and most of western Europe.
More than 100 million people have been vaccinated worldwide.
A number of authorities around the world, including the Centers for Disease Control and Prevention in the US, the World Health Organization and the EMA, have monitored the use of the HPV vaccine very closely for many years.
They use lots of different kinds of safety data and continue to say the HPV vaccine is very safe.
As with all medicine and vaccines, there are some mild side effects associated with the HPV vaccination.
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Vaccine Efficacy In Women Aged > 26 Years
The first RCTs in women older than 25 or 26 years also enrolled participants from multiple countries . The Gardasil trial, FUTURE III, included 3800 women and the Cervarix trial, VIVIANE, included about 5700 women . The trial designs were similar with women enrolled without regard to HPV infection status or number of lifetime partners, and the primary end points were vaccine type 6-month persistent infection or vaccine typeâattributable CIN1+ . For the primary end points, efficacy in the PP/ATP populations was statistically significant and similar in the Gardasil and Cervarix trials, 88.7% and 90.5%, respectively. For vaccine-type CIN2+, the point estimates of efficacy were high, but not statistically significant owing to small numbers. In the ITT population, Gardasil efficacy was 47.2% against a combined end point of persistent infections, extragenital lesions, and/or CIN1+âattributable to HPV type 6, 11, 16, or 18. For Cervarix, efficacy was 86.5% for a combined end point of persistent infection and/or CIN1+âattributable to HPV-16 or HPV-18.
Contraindication For The Hpv Vaccine
Regarding HPV vaccine administration, reports have shown that it is usually safe, and adverse effects are usually rare the benefits of the vaccine being well beyond the risks of the adverse effects. Thus, many studies regarding the vaccine shot and the appearance of the disease, made the use of the vaccine against HPV controversial . There is a high risk of vaccine refusal when the HPV vaccine is associated with an autoimmune disease because the vaccine is usually recommended for young men and women, in whom the incidence for such an autoimmune disease is high.
There was a report that suggested that there is a possible role of a genetic predisposition to vaccine-induced autoimmune disease . This is a possible and accepted risk compared to the benefit that this vaccine offers against different cancers.
These types of problems can make the parents decline the recommendation for vaccination against HPV for their children, which can lead to the spread of the disease in both men and women.
Regarding the MSM population, one of the most important benefits of the vaccine is the decrease in anal cancer cases. The effectiveness of vaccination has proven to have a good cost-efficiency result. The fact that this vaccine in men can be efficient against other types of cancer, such as oral or penile cancer, make it even more attractive, even though its contribution to this type of cancer is lower than for anal cancer and genital warts.
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Hpv Vaccine Licensure And Policy
Since the first HPV vaccine was licensed in 2006, there have been changes in regulatory indications and vaccination policy . Cervarix and Gardasil were first licensed by the US FDA and many other regulatory authorities for girls and women from age 9 or 10 through age 25 or 26 years. Because the initial efficacy trials were conducted only in women, it was not until 2009, after data were available in men, that Gardasil was licensed for boys and men in the United States. When trials were completed in persons older than 26 years, some authorities outside the United States extended the licensed age indications through age â¥45 years. The FDA did not approve any HPV vaccine for use above age 26 years until 2018, when the Gardasil 9 manufacturer submitted a supplemental application to extend the age through 45 years .
The changes in HPV vaccination recommendations of the Centers for Disease Control and Preventionâs Advisory Committee on Immunization Practices and WHO are shown in . In the United States, routine vaccination has been recommended since 2006 for girls at age 11 or 12 years vaccination can be started at age 9 years. Vaccination is also recommended through age 26 years for girls and women not vaccinated previously .
Recommendations for Human Papillomavirus Vaccination From the Advisory Committee on Immunization Practices and the World Health Organization
| Yeara . |
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Having The Hpv Vaccine
The vaccine is given in your arm and you need 2 doses to be fully protected.
The first injection is given in year 8 and the second one is usually 6 to 12 months later. You will be informedwhen you are due the second dose.
To give you the best protection, the vaccine should be given before you become sexually active. If you are sexually active you should still have the vaccine.
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How Does The Hpv Vaccine Work
The HPV vaccine tricks the body into thinking it has been exposed to the real HPV virus. This triggers the bodys immune system to produce antibodies against HPV. This is how our body usually fights against and clears infections.
And our immune system has a memory. This means the body will recognise HPV and have antibodies ready if it is exposed to the real virus in future, making HPV much easier to fight off.
The NHS have more information on how vaccines work.
HPV can cause changes to the DNA in our cells that make them more likely to turn cancerous. By protecting against HPV infection, we can help prevent these cell changes and reduce the risk of cancer linked to HPV.
Vaccine Efficacy In Young Adult Women
The first phase III efficacy trials were large, multisite, international RCTs including thousands of young women . The trials for Gardasil and Cervarix were designed and conducted by the respective manufacturers, with women receiving 3 doses via intramuscular injection over a course of 6 months and then followed over approximately 4 years . In addition, a trial of Cervarix, the Costa Rica Vaccine Trial, was undertaken by the US National Cancer Institute in cooperation with the Costa Rican government . Clinical end points were based on histologic determination of CIN/adenocarcinoma in situ and type-specific HPV DNA detection. After licensure of Cervarix and Gardasil by the US Food and Drug Administration and the European Medicine Agency, efficacy trials were also conducted in some other countries, as required by local regulatory authorities .
Women in the efficacy trials were enrolled without regard to HPV infection status. The primary efficacy analyses included women who were negative for cervicovaginal HPV DNA and serum antibody throughout the period of vaccination and received 3 doses: the per-protocol or according-to-protocol cohorts. Analyses including all randomized women who received â¥1 vaccine dose, the total vaccinated or intention-to-treat cohorts, were also conducted. Results in the PP/ATP analyses reflect the anticipated efficacy in adolescent girls, vaccinated before onset of sexual activity.
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