Many young women and parents probably have questions about the HPV vaccine; you may have heard about it through a primary care doctor or pediatrician, or from a gynecologist at your daughter’s first appointment.
Receiving this vaccination only has been an option for about a decade, but it’s been hailed as a huge difference-maker in women’s health (and public health in general) and so has rather quickly been added to regular vaccine recommendations all around the world.
HPV (Human Papillomavirus) is a virus passed during sexual contact with infected partners. Some kinds of HPV cause genital warts, and others can lead to more serious health problems including cancer of the cervix and several other tissues. There are more than 40 types of genital HPV, but only about one quarter of them cause the majority of cancers and genital warts. HPV can be contracted through any type of genital touching, not just through sexual intercourse.
HPV vaccines have been commercially available since 2006, and are sold under brand names including Gardasil and Cervarix. They are very safe, and the World Health Organization now recommends them as part of routine childhood vaccinations, a recommendation now followed in nearly 60 countries. One of the newest vaccines available, Gardasil 9 protects against the nine most pathogenic strains of the virus, which cause 85 to 90 percent of all HPV-related cancers and/or genital warts, and is FDA-approved for use in females aged 9 to 26 and males aged 9 to 15.
The Centers for Disease Control and Prevention (CDC) in Atlanta recommends that all girls and boys who are 11 or 12 years old get the recommended series of HPV vaccine, though it can be started at as early as 9. The CDC also recommends that older teens of both sexes who did not receive the vaccine when they were younger get it now. Vaccination at 11 or 12 years of age (roughly corresponding to the onset of puberty) is recommended because the vaccine is most effective when given prior to any exposure to HPV virus, which in most cases only occurs through post-pubescent sexual activity.
In young adults, the CDC recommends HPV vaccination for women up to age 26, and for men up to age 21, though men who identify as gay or bisexual or who intend to have sex with men should get the vaccine through age 26, as should transgender individuals.
Young adults who have conditions that compromise their immune systems (including HIV) should also receive HPV vaccine through age 26. There is some new evidence that it can be effective in preventing cervical cancer in women up to age 45. The vaccines have not been sufficiently tested during pregnancy and should not be used by pregnant women.
Since 2006, HPV vaccines have been recommended in a three-dose series given over six months. However, in 2016, the CDC changed the recommendation to two doses for persons starting the series before their 15th birthday, recommending that the second dose be given 6 to 12 months after the first. Adolescents who receive their two doses less than five months apart will require a third dose of HPV vaccine.
According to the CDC there has been no evidence to suggest that HPV vaccine loses any ability to provide protection over time, though since it’s only been commercially available since 2006, data are only available for about 10 years of follow-up after vaccination.
Reported side effects from HPV vaccines have been minimal and almost entirely limited to non-serious issues such as headache, nausea, muscle or joint pain and local reddening/swelling at the site of injection. In 2015, the European Medicines Agency’s Pharmacovigilance Risk Assessment Committee concluded that there is no evidence to support assertions that HPV vaccination causes more serious conditions.
HPV vaccines not only have helped prevent millions of individuals from becoming infected and potentially developing cancer, they als have greatly reduced the chances of anyone — vaccinated or unvaccinated — of contracting the virus (a population-level effect known as “herd immunity”). In Australia, the incidence of genital warts went down during the first four years of the vaccination program among young males who were not being vaccinated at the time, simply because a high percentage of the nation’s girls had been vaccinated.
Since the first HPV vaccine was recommended in 2006, there has been a 64 percent reduction in vaccine-type HPV infections among teenage girls in the United States.
“Widespread vaccination has the potential to reduce cervical cancer deaths around the world by as much as two-thirds if all women were to take the vaccine and if protection turns out to be long-term,” according to the National Cancer Institute. “In addition, the vaccines can reduce the need for medical care, biopsies and invasive procedures associated with the follow-up from abnormal Pap tests, thus helping to reduce health care costs and anxieties related to abnormal Pap tests and follow-up procedures,” the institute says.
Most private insurance plans cover HPV vaccination. The federal Affordable Care Act (ACA) requires all new private insurance plans to cover recommended preventive services, including HPV vaccination, with no copay or deductible. If you would like to get your child vaccinated against HPV but do not have health insurance, the Vaccines for Children (VFC) program provides vaccines at no cost to children ages 18 years and younger who are uninsured, Medicaid-eligible, or American Indian/Alaska Native.
Dr. Jennifer Schott is a pediatrician at Cooley Dickinson Medical Group’s Sugarloaf Pediatrics, in South Deerfield.
Women’s Health is written by health care professionals affiliated with Cooley Dickinson Hospital in Northampton. It appears here monthly.