Update on HPV Vaccine Recommendations

By: Lynn Simpson, MD • Posted on January 19, 2017

Human Papillomaviruses (HPV) Vaccination

There has been a lot in the news lately about vaccinations. Rest assured, vaccinations are one of the biggest public health advances. Many vaccines reduce cancer risk, including the HPV vaccines. There is not a day in my practice of OB-GYN and Women’s Health that I do not encounter women with HPV related disease.

I frequently see young women with HPV related diseases who had the opportunity to be vaccinated, but did not receive it because of fears they or their mothers had because of things they heard or read. Your doctor will welcome the opportunity to answer any questions you have about the benefits of HPV vaccination. Disease prevention is the goal of all vaccination.

The New HPV Vaccination Recommendations

Currently, vaccination rates for HPV are unacceptably low. Following the vaccination recommendations recently updated by the CDC is an opportunity to both help young people now and in future generations avoid or limit HPV related diseases. New recommendations have reduced from 3 to 2 vaccines for some groups.

Human papillomaviruses (HPV) are some of the most common types of viruses that infect skin tissues. There are more than 120 HPV types with most of them infecting cutaneous skin cells. These types lead to the common warts that can be seen on hands and feet. There are at least 40 types of HPV that infect mucosal skin cells like those of the genitals, anus, mouth and throat. Most of these infections have no symptoms and will resolve on their own.

HPV Infections Can Lead to Cancer If Not Vaccinated

Some HPV infections will persist and some will lead to cancer. Vaccinations are important for both females and males.

Cancer causing strains, primarily types 16 and 18

Persistent infections with cancer causing strains (primarily types 16 and 18) can cause the following types of cancer:

• Cervical cancer in women
• Vulvar cancer in women
• Vaginal cancers in women
• Penile cancer in men
• Oropharyngeal and anal cancer in both women and men

Non-cancer viruses, types 6 and 11

Low-risk, non-cancer viruses (types 6 and 11) can cause the following:

• Genital warts
• Laryngeal warts

90 Million People Are Infected With HPV

Approximately, 90 million people are infected with HPV. Every year, an additional 14 million people will be newly infected, mostly teens and young adults.

Every year on average, 38,000 cancers are diagnosed in areas that HPV infects, with 23,000 females and almost 16,000 males being affected. Of these cancers, 30,000 are attributable to HPV, most commonly types 16 and 18. Although there is the Pap screening test for cervical cancer, there is no screening test for penile, anal or oropharyngeal cancers, making prevention of these cancers the goal.

HPV vaccines have been licensed by the Food and Drug Administration since 2006:

1. 2 valent
2. 4 valent
3. The most recent 9 valent vaccines

9-Valent Vaccine Only Option in U.S.

At the beginning of 2017, only the 9-valent vaccine will be available in the United States.

• The 9-valent vaccine protects against types 6 and 11, which causes 90% of genital warts. It also protects against types 16 and 18, which cause 66% of cervical cancers as well as the majority of HPV related cancers in the United States.
• The 9-valent vaccine protects against five other cancers and pre-cancer causing types. The protection from the additional five types will benefit women more than men, as they are associated mainly with pre-cancer and cancer of the cervix.

If you or your child was vaccinated with one of the earlier vaccines, there is no recommendation to re-vaccinate with the 9-valent vaccine.

CDC HPV Recommendations for Children

Centers for Disease Control and Prevention (CDC) recommends the following age groups get the HPV vaccine:

• Children ages 11–12 and can be started as young as 9.
• Girls and boys ages 13-26 who were not vaccinated when they were younger.

In October 2016, the CDC (Centers for Disease Control) changed its dosing recommendations for HPV vaccine.

1. For children who start the vaccine before their 15th birthday, the new recommendation is for 2 doses with the second dose being administered 6 – 12 months after the first.
2. The CDC continues to recommend a 3-dose schedule for children starting the series between the ages of 15- 26 years of age.
3. The second dose is administered 1 – 2 months after the first dose.
4. The third dose is administered 6 months after the first dose.
5. In children with immune compromising conditions such as HIV, cancer or autoimmune diseases, the CDC continues to recommend the 3 dose series ages 9 – 26 to make sure they get the most benefit.

These are the minimum dosing intervals. There are no maximum intervals so there is no reason to restart the series if more time has elapsed between doses.

Why the new HPV recommendations?

These new recommendations are based on studies which demonstrated that children ages 9–14 had an antibody response to the 2-dose injection as good or better than the 3 dose series. This age group has a better antibody response than older children, which is another reason to vaccinate at these ages.

Further studies on older age groups are in progress. Ideally, adolescents should be vaccinated before HPV exposure, but they may still obtain protection from other virus types covered by the vaccine after this has occurred.

HPV vaccines are very effective. Since vaccine introduction in the United States in 2006, HPV infections in adolescent girls decreased by 56%. Cervical cancer screening is still recommended for women beginning at age 21 through age 65 for both vaccinated and unvaccinated women.

HPV Vaccines Have Proven Safe

HPV vaccines have a proven safety record with the benefits of vaccination far outweighing the risks. The most common side effects are:

• Pain
• Swelling
• Redness at the vaccination site

These are common side effects after administration of any vaccine and they should disappear in a day or two. The vaccine should not be administered to people allergic to this vaccine or a hypersensitivity to yeast. The HPV vaccine conveys long lasting protection. Current studies in progress show no decrease in immunity up to 10 years after vaccination and at this time no booster vaccinations are recommended.

Be Strong. Be Healthy. Be in Charge!

-Lynn Simpson, MD

References

• ACOG Committee Opinion. Human Papillomavirus Vaccination. Number 641, September 2015
• CDC media release. CDC Recommends only two HPV Shots for Adolescents. October 19. 2016
• CDC Office of the Director. Supplemental Information and guidance for vaccination providers regarding use of 9-valent HPV
• CDC. Human Papillomavirus-Associated Cancers – United States, 2008-2012. Weekly/July 8 , 2016/65(26)

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