HPV Vaccine

Human Papillomavirus (HPV)

Human Papillomavirus What is human papillomavirus (HPV)? HPV is the most common sexually transmitted infection. There are more than 40 types of HPV that can infect both men and women. Disease infects the genital area, mouth and throat. The different types of HPV cause different symptoms/conditions. Some types can cause cancer, some can cause genital warts. References: http://www.cdc.gov/std/hpv/default.htm; http://www.cancer.org/cancer/cancercauses/othercarcinogens/infectiousagents/hpv/what-women-should-know-about-cervix-cancer-and-hpv

HPV continued… How is it transmitted? Genital contact, oral sex and genital-to-genital contact. Condoms do not completely protect against the transmission of HPV. Can be passed between both straight and same-sex partners even when the infected person has no signs or symptoms. A person can have HPV even if it has been years since they had contact with an infected person. Most people infected with HPV are unaware that they have contracted the disease or that they are passing it on to other partners. In very rare instances, a pregnant woman with genital HPV can pass the infection to her baby during delivery, which can result in the baby developing Recurrent Respiratory Papillomatosis (RRP).

HPV continued… About 20 million Americans (approximately 15% of the population) are currently infected with HPV and about 6 million more are affected each year. It is estimated that a new case of HPV is contracted every minute. There is currently no known cure for the virus once contracted, although certain symptoms can be managed. Genital warts caused by HPV can be treated with medication. Future outbreaks of genital warts can be prevented using medication. Warts in the throat from RRP can be treated with medication and surgery, usually multiple surgeries over a period of a few years. It is important to remember that prevention is key when it comes to HPV – because there is no cure, preventing people from contracting the most dangerous types of HPV is the key. Reference: http://www.cdc.gov/std/HPV/STDFact-HPV-vaccine-hcp.htm

HPV and Cancer How does HPV cause cancer? HPV is spread through sexual contact and infects areas of the genital region, like the cervix in women. Because the virus does not have a known cure, it stays in the body and causes its normal cells to change becoming pre-cancerous and in some cases cancerous. Every day in the United States 30 women are diagnosed with cervical cancer (about 11,000 each year) and 11 women die from it. Both males and females can develop HPV-related cancers. Although cervical cancer is most often recognized as being caused by HPV, there are other types of cancer caused by HPV. Reference: http://www.cancer.org/cancer/cancercauses/othercarcinogens/infectiousagents/hpv/what-women-should-know-about-cervix-cancer-and-hpv

HPV and Cancer continued… Cervical Cancer – this is the most common HPV-associated cancer and almost all cervical cancers (over 99%) are caused by HPV. Second leading cause of cancer deaths of women in the world. In the U.S., over 12,000 women get cervical cancer every year and over 4,000 will die from it. Vulvar Cancer – about 50 percent of this type of cancer is related to HPV infection. Vaginal Cancer – about 65 percent of this type of cancer is related to HPV infection. Penile Cancer – about 35 percent of this type of cancer is related to HPV infection. Anal Cancer – about 95 percent of this type of cancer is related to HPV infection. Oropharyngeal Cancer – about 60 percent of this type of cancer is related to HPV infection. Reference: http://www.cdc.gov/std/hpv/default.htm

HPV Vaccine

HPV Vaccine In June 2006, the Food and Drug Administration (FDA) licensed the HPV4 Gardasil vaccine for use in females ages 9 through 26 years for prevention of four types of HPV and their related outcomes. In October 2009, the FDA licensed Gardasil for use in males ages 9 through 26 years. Also in October 2009, the HPV2 vaccine, Cervarix, which contains two types of HPV, was licensed by the FDA for use only in females ages 10 through 26 years. Reference: http://www.cdc.gov/hpv/vaccine.html

HPV Vaccine and Cancer Prevention HPV types 16 and 18 (found in both Gardasil and Cervarix) cause: Approximately 75 percent of cervical cancer, 70 percent of vaginal cancer, and up to 50 percent of vulvar cancer in women. Almost all anal cancer in both men and women. 40 percent of penile cancers in men. 25 – 35 percent of all oropharyngeal cancers in men and women. In North Dakota, men are more likely to contract this type of cancer than women. References: CDC, 2010; Walhart, T. Parents, adolescents, children and the human papillomavirus vaccine: a review, International Nursing Reivew 59, 305-311.

Vaccine continued… In 2011, cancer was the leading cause of death of North Dakota residents with approximately 3,400 residents newly diagnosed with cancer and 1,400 cancer-related deaths each year. Cervical cancer had the third highest percent of late-stage cancer diagnoses in the state. Cancer survival rates are higher when diagnosed early; late- stage diagnosis can lead to an increased chance of mortality. References: North Dakota Division of Vital Records, 2011; ND Cancer Registry, 2010

Vaccine continued… After Gardasil was licensed in 2006, the Advisory Committee on Immunization Practices (ACIP) recommended routine vaccination of females at age 11 to 12 years and catch-up vaccination for females aged 13 to 26 years. It is important for male and female adolescents to get vaccinated before the onset of sexual activity to ensure protection before the possibility of disease exposure. In October 2011, the ACIP recommended routine vaccination of males ages 11 to 12 years with three doses of Gardasil vaccine to prevent HPV infection and HPV- related disease. Many people believe that the only reason to vaccinate males is to protect their future partners from contracting HPV, but other reasons include preventing cancer and genital warts. Reference: http://www.cdc.gov/hpv/vaccine.html

HPV Vaccination Schedule Recommended for? Recommended Age Ages Licensed Dose 1 to Dose 2 Dose 2 to Dose 3 female and male adolescents 11 to 12 years 9 to 26 years* administer 2nd dose 1 to 2 months after first dose administer 3rd dose 12 weeks after second dose and 6 months (24 weeks) after first dose * Vaccine series must be started and should be completed before the age of 26. However, if the series was started before turning 26 but was not completed, the final dose(s) can still be administered after the 26th birthday. Since the HPV vaccine is a 3-dose series, many times adolescents do not complete the series because they must return to their healthcare provider for the 2nd and 3rd doses. It is important to know that the vaccine is not effective if the adolescent doesn’t receive all of the doses.

Vaccine continued.. The ACIP recommended age for HPV vaccination coincides with the recommended age for other adolescent vaccines Tdap (tetanus, diphtheria and acellular pertussis) and MCV4 (meningococcal conjugate vaccine), although the rate of vaccination for HPV is much lower than both Tdap and MCV4. Tdap and MCV4 are also requirements for North Dakota school entry and attendance.

Vaccine continued… North Dakota participates in the Vaccines For Children (VFC) program, which provides free vaccine for children who are 18 years of age and younger and who are uninsured, underinsured, have Medicaid and/or are American Indian. Ask your primary care provider or contact your local public health department to find out if they participate in the VFC program and can provide you with free vaccine. The North Dakota Immunization Program has an adult VFC program for HPV vaccine. Adults ages 18 to 26 who would normally no longer be able to receive VFC vaccine can qualify under this program if they are uninsured or underinsured. Parental/guardian consent is required when vaccinating children younger than18. However, kids 14 and older can receive Hepatitis B and HPV vaccine without parental consent. The North Dakota Department of Health’s Family Planning Program can provide vaccine on a sliding fee scale. Visit their website at: www.nd.gov/familyplanning.

Myths and Misconceptions Myth 1: Getting my kids vaccinated against HPV will encourage sexual activity. A recent study was conducted looking for any correlation between HPV vaccination and sexual activity-related outcomes (i.e., pregnancy, sexually transmitted infection testing or diagnosis and contraceptive counseling) over a three-year period of time. After comparing outcomes in vaccinated vs. unvaccinated 11 to 12-year-old females, it was found that HPV vaccination during the ACIP recommended ages was not associated with an earlier onset of sexual activity or an increase in sexual activity-related outcome rates (less than .01% difference between the two groups). When adolescents get the HPV vaccine, it provides parents with an opportunity to discuss sexuality with their kids. Of course this can be an uncomfortable discussion for both parties, but a very necessary one. Studies have shown that parents who have discussions with their kids about the importance of waiting to begin sexual activity until an older age actually have a large impact on their kids’ decision to wait to become sexually active. References: http://www.cdc.gov/hpv/vaccine.html; Walhart, T. Parents, adolescents, children and the human papillomavirus vaccine: a review, International Nursing Review 59, 305-311.; Bednarczyk, Robert A, et al. Sexual Activity-Related Outcomes After Human Papillomavirus Vaccination of 11 to 12 Year-Olds, Pediatrics, October 2012, 2012.

Myths continued… Myth 2: Vaccines often cause the very disease they are trying to protect against. You cannot get HPV from the HPV vaccine because it does not contain a live virus. The vaccine actually works using a protein that helps the body’s immune system produce antibodies against the disease – without actually causing the disease itself.

Myths continued… Myth 3: The vaccine is not safe. Prior to the FDA licensing the vaccines, nearly 60,000 men and women participated in a study that ensured the vaccine’s safety, and both the FDA and CDC monitor vaccine safety continually after licensure. Fainting and redness and swelling at the injection site are the two most common side effects of this vaccine. Having the patient sit or lie down for 15 minutes after getting the shot can help decrease the incidence of fainting. Mild fever is also a fairly common side effect but is not a cause for concern. Recently published research looked at ER visits and hospitalizations for 60 days following vaccination. More than 200 categories of illness were reviewed and in almost all cases, the condition existed prior to the patient receiving the vaccine and getting HPV vaccine did not increase the likelihood of developing lupus, rheumatoid arthritis, multiple sclerosis or Type 1 diabetes. Of the 14 deaths that were recorded among girls and women in the study the causes (including car accidents, congenital heart problems, suicide, lupus and pneumonia) were not linked to the vaccine. References: http://www.cdc.gov/hpv/vaccine.html; http://online.wsj.com/article/SB10000872396390444138104578030722032422706.html?mod=googlenews_wsj

Myths continued… Myth 4: The vaccine doesn’t really work. Studies of HPV4 conducted using both males and females ages 16 to 26, showed nearly 100 percent vaccine efficacy in preventing cervical, vulvar and vaginal pre-cancers and genital warts caused by the types of HPV in the vaccines in women; 90 percent efficacy in preventing genital warts; and 75 percent efficacy in preventing anal pre-cancers in men.

Myths continued… Myth 5: My son doesn’t need to be vaccinated against HPV because he can’t get cervical cancer. Although male cancers related to HPV infection are less common than female cancers, the strains of HPV the vaccine protects against can still help in the prevention of penile (400 male HPV-related cases annually), anal (1,500 male HPV-related cases annually) and oropharyngeal (5,600 male HPV-related cases annually). Males can contract HPV the same way females can contract it and can pass the disease on to future sexual partners with no knowledge of having the disease. Vaccinating males helps increase the protection of others against associated cancers. References: http://www.cdc.gov/hpv/vaccine.html; Walhart, T. Parents, adolescents, children and the human papillomavirus vaccine: a review, International Nursing Review 59, 305-311.

Myths continued… Myth 6: I am already sexually active so there is no benefit for me with this vaccine. Because HPV vaccine protects against more than one type of HPV, individuals who may have been exposed to any strain of HPV through sexual activity can still benefit from the vaccine’s protection against other strains of the disease. Efficacy studies have shown that in females already infected with HPV, over 99 percent still developed antibodies.

Next Steps The following are things that you, as a parent/guardian, can do next: Talk to your kids. Keep an open line of communication between you and your kids about sexual activity, sexually transmitted infections and things that can be done to protect them, like getting vaccinated against HPV. Call your primary health-care provider or local public health unit if you have more questions/concerns about the vaccine and/or to make an appointment for vaccination. Do further research. Information about HPV disease and vaccination, as well as vaccine information statements, can be found on the CDC website at: http://www.cdc.gov/hpv/vaccine.html http://www.cdc.gov/std/hpv/default.htm http://www.cdc.gov/vaccines/pubs/vis/default.htm Print materials for patients (adults and teens) can be found at: http://www.cdc.gov/vaccines/vpd-vac/hpv/default.htm#patient Print materials include one page fact sheets with great information for patients.