HPV Vaccine

Human Papilloma Virus (HPV) is an extremely common virus that can cause cancers of the mouth, throat, anus and genitals, as well as genital warts.  HPV affect both males and females, most often in the late teenage years and the early 20s.  In fact, it is the most common sexually transmitted infection.  It is estimated that there are over 150 types of HPV, and about 40 that are known to cause genital infections.  Annually in the United States, about 26,000 men and women are diagnosed with cancers caused by HPV and 4000 women die from cervical cancer.  Most of these cancers can be prevented by the HPV vaccine.

Most forms of HPV are not serious and people will not know that they are infected with the virus.  The body can actually clear the virus on its own.  HPV is spread through direct intimate skin to skin contact, and most people will contract the virus with 2 or 3 years of sexual activity.  People who have only one lifetime sexual partner can also contract HPV.

The HPV vaccine has been shown to be effective in preventing cervical cancer, head, neck and anal cancers as well as genital warts caused by those strains of HPV contained in the vaccine.  There are three HPV vaccines: Cervarix, Gardasil and Gardasil-9.  Cervarix immunizes against HPV 16 and 18, Gardasil  against HPV 6, 11, 16, 18, and Gardasil-9 against HPV 6, 11, 13, 16, 18, 31, 33, 45, 52, and 58.  All three vaccines are administered in a 3 dose series starting at the age of 11.  The upper age recommendation at this time is 26 years old.   In the last week, the Advisory Committee on Immunization Practices (ACIP) has recommended that children under age 15 years receive 2 doses of the HPV vaccine administered 6 to 12 months after the first dose.  For those who are older than 15, they should continue to receive 3 doses.   If a patient has started the series with Gardasil, they may complete the series with Gardasil-9.   In addition, if there is a delay or break in the recommended schedule, the ACIP does state that the series can be continued rather than restarted.

Although families may be hesitant about giving the vaccine at this age, it is important to know that the vaccine is more effective when given at a younger age when compared to older teenagers.  Younger people will have a stronger immune response to the vaccine.  This fact contributes to the new recommendation regarding 2 rather than 3 doses.  The Center for Disease Control (CDC)has stated that younger patients “produced an immune response similar or higher than the response in young adults (aged 16 to 26 years) who received three doses.”  The HPV vaccine is most effective when given to people have no exposure or infection with HPV, but it will provide some protection to those who have already had contact with HPV .   In addition, the vaccine was tested in over 30,000 people for 7 years before it was licensed.  It was then studied in post-license trials in over 1 million individuals.  At this time, over 170 million doses have been given and its safety is monitored in over 80 countries.    The vaccine does not contain thimerosal. Proven immunization reactions do include a mild injection site reaction as well as fainting episodes.  In order to combat the fainting, the ACIP recommends that a patient be observed for 15 minutes after administration of the vaccine.  Many studies have disproven concerns that HPV vaccine will lead to multiple sclerosis and other neurological vaccines.

Others who do not question the safety of the vaccine may raise concerns about the association between the vaccine and encouraging sexual activity.  Studies have not shown an increased incidence of “risky sexual behavior” after receiving HPV vaccine.  In fact, offering the vaccine in the preteen years can provide an opportunity for families to begin their conversations regarding safe sex and sexual health.  It is important to stress to patients that the HPV vaccine is only one way to prevent HPV.  While patients should be reminded to always use condoms, they should also be reminded that condoms cannot fully prevent HPV as they do not cover all areas that may transmit the infection.  Abstinence is in fact the only way to prevent HPV as well as other sexually transmitted infections.   In addition, girls should routinely follow with a gynecologist and have regular Pap smears to detect HPV.

Statistics show that in the United States, HPV vaccine could prevent about 29,000 cases of cancer in boys and girls and about 4800 deaths.  The CDC reports that currently only about 42% of teen girls and 28% of teen boys receive all three doses.  “It is so important to stress that the HPV vaccine is effective and safe and will provide long lasting immunity against HPV and its associated infections and cancers."