HPV Vaccine: What You Need to Know
Genital human papillomavirus (HPV) is the most common sexually transmitted virus in the United States. There are 40 types of HPV and over 20 million Americans are infected. Most infections don't cause any symptoms and go away on their own; however, the most effective way to prevent the spread of HPV is through vaccination.
Dr. Kristen Simpkins, pediatrician at Community Physician Network, answered some of the most common questions about the vaccine and why it's important to receive.
Who should get the HPV vaccine?
I recommend the quadrivalent HPV vaccine, Gardasil, for female and males starting at age 11. It’s called quadrivalent because it covers four different types of HPV: 6, 11, 16, and 18. Types 6 and 11 cause genital warts, and types 16 and 18 cause cervical, vaginal/vulvar, penile, anal and oropharyngeal cancers.
I also recommend it for males in addition to females, because it helps prevents HPV-related disease in males (genital warts, anal and penile cancer) AND decreases the transmission of HPV infection (including oral cancer) to female sex partners.
HPV infection is common in males and is readily transmitted, influencing disease infection rates in both males and females.
When should they get it?
The vaccine works best if given between the ages of nine and 13. It is typically administered in three doses: at time zero and then at two and six-month follow up appointments. Clinical data shows that the vaccine is most effective in those who have not been infected with HPV. Therefore, it is best to get the Gardasil vaccine prior to becoming sexually active.
While vaccination can start at age nine, I feel most parents decline the vaccine at that age because it is too early for them to start thinking about their child having sex.
At age 11, when most children are in junior high, I’ve found that parents are more willing to accept the fact that their children may soon start becoming sexually active.
Catch-up vaccination is recommended for females ages 13 to 26 years and males ages 13 to 21, who have not been previously vaccinated or who have not completed their vaccine series.
Are there individuals who should not get vaccinated?
Women should not receive the HPV vaccine while pregnant.
What are the major benefits to the vaccine?
Quadrivalent HPV vaccine has been shown to help prevent cervical, vaginal/vulvar, anal and penile cancers and genital warts. Persistent viral infection with carcinogenic HPV types causes virtually all cancer of the cervix and most cases of anal cancer.
The carcinogenic types, HPV 16 and HPV 18, cause approximately 70 percent of all cervical cancers worldwide and 72 percent of anal cancers.
HPV types 31, 33, 45, 52, and 58 are estimated to cause an additional 19 percent of invasive cervical cancers.
HPV 6 and HPV 11 cause approximately 90 percent of genital warts. Genital warts have a high rate of treatment failure, so their prevention is crucial.
The benefits of the vaccine far outweigh any side effects it may cause. The Gardasil vaccine is safe and well tolerated, apart from mild injection site reactions that can include pain, redness and swelling.
What if a patient doesn’t complete the series?
The Advisory Committee on Immunization Practices (ACIP) recommends that if the vaccination series is interrupted for any length of time, it can be resumed without restarting the series.
So, if your child has not followed the typical Gardasil vaccination schedule at zero, two and six months, when they come in for their subsequent Gardasil vaccines they do not need to start the series over. It is important though that they complete the series by age 13. That will offer them the best protection against HPV.
What about the new Gardasil 9 vaccine coming soon?
The quadrivalent vaccine (Gardasil) currently on the market covers HPV types 6, 11, 16, and 18. The 9-valent vaccine (Gardasil 9) includes HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58.
Once it is available, I will recommend the 9-valent vaccine for both my female and male patients given its greater coverage.
While it is not clear that greater HPV-type coverage will substantially improve male cancer prevention, it will likely further reduce the risk of cervical cancer in women indirectly through herd immunity.