1. The HPV Vaccine: Protecting Girls from Cervical Cancer
It’s a team effort.
As educators and support staff, parents trust your advice
It is important that you have the facts about the HPV vaccine to help us inform parents to help protect BC girls from cervical cancer

2. The Facts
Cervical cancer kills 400 women each year in Canada
Cervical cancer affects young women
Almost 100% of all cervical cancer cases are caused by the Human Papillomavirus (HPV)
Cervical cancer is a devastating disease
Deaths are often among women who have not had children yet, or who have young families
Almost all cervical cancer cases are caused by HPV and we have a vaccine against it!
This vaccine is an amazing breakthrough in protecting BC girls and women from cancer
PROTECT BC girls against cervical cancer: Support immunization against HPV

3. Help PROTECT BC GIRLS against these outcomes
HPV Immunization in BC
Each year in BC HPV immunization could PREVENT:
150 women from developing cervical cancer
40 women from dying from cervical cancer
5,000 women from developing precancerous cells
10,000 women from requiring invasive procedures to treat abnormal cells
20,000 women from requiring additional follow up and evaluation due to abnormal pap tests
HPV infection accounts for almost 100% of cervical cancer cases in Canada
While pap tests may detect abnormal cell growth before it is cancerous, the additional follow-up and methods of invasive evaluation of abnormal cells can be painful and emotionally stressful
Help PROTECT BC GIRLS against these outcomes

4. HPV infection CAUSES cervical cancer
What is HPV?
The Human Papillomavirus
HPV is one of the most common sexually transmitted infections (STIs) in BC
Most infections clear on their own, but 10% will not go away and cells infected with the virus can become cancerous over time.
HPV is a virus, and stands for The Human Papilloma virus
The majority of HPV infections are temporary and cause no symptoms or problems and last for approximately 8 months.
90% of new HPV infections clear within 2 years.
Because the infection is so common, this remaining 10% still represents a large number of women
In BC alone, of the over 500,000 women who receive annual Pap testing, 30,000 have abnormal Pap smears.
Some infections can cause abnormal cell growth that may later be cleared by the body
Sometimes, however, HPV infection can persist for many years and cause pre-cancerous cell growth which can progress into cervical cancer over many years
This infection must persist for years to permit progression to cancer.
HPV infection CAUSES cervical cancer

5. Who Can Get HPV?
ANYONE who has been sexually intimate with another person
Common infection:
70% of all women will be infected at some point in their lives
HPV infection is highest among adolescents and young adults (23% vs. 4% among older adults)
HPV is transmitted through intimate skin-to-skin contact, typically through sexual interactions although sexual intercourse is not necessary for transmission
HPV is a very common infection
Adolescents and young adults are at a higher risk of infection due to physiological reasons
The lining of the reproductive tract in teenaged girls is still developing which makes it easier for them to get infected with HPV
HPV infection incidence is highest among adolescents and young adults
There are lower rates in adults because they have likely cleared the infection by this point, and they are less likely to get re-infected as a result of acquired immunity and less likely to become infected due to lifestyle choices and physiology
Three out of four sexually active women will get HPV at some point in their lives.
Infected with HPV

6. The Society of Obstetricians and Gynecologists of Canada
The HPV Vaccine
Protects against 70% of all cervical cancers and 90% of all genital warts
All women should continue to have regular cervical cancer screenings (pap tests)
The vaccine protects against 4 types of HPV
2 of which cause 70% of all cervical cancers HPV 16 and 18
2 of which cause 90% of all genital warts (these can also lead to complications requiring invasive procedures and treatments) HPV 6 and 11
The vaccine does not protect against all types of cervical cancer, and for this reason, it is important for even vaccinated girls to receive regular cervical cancer screenings (pap tests)
“The approval of [HPV] vaccine is a great medical milestone in the fight against cancer.”
- Dr. Barry Rosen,
The Society of Obstetricians and Gynecologists of Canada

7. HPV Vaccine Effectiveness
~100% protection when given before HPV exposure!
Evidence that protection will last for at least 15 years, and will probably last for life
Need for a booster is being closely monitored
Younger girls build better protection
Protection is against the two types of cancer causing HPV in the vaccine
There were similar questions about protection duration with other vaccines when they were introduced and this process is not unusual.
Many successful vaccination programs have been introduced without knowing how long the vaccine protection will last.(e.g. hepatitis B vaccine program in grade 6).
Women are most at risk for HPV infection as adolescents and young adults, so it is important to vaccinate them now.
Even if a booster becomes necessary in the future, it is still better to vaccinate now and get a booster later
Not vaccinating at all leaves girls unnecessarily at risk for cervical cancer.
SUPPORT HPV Immunization.

8. HPV Vaccine Safety The HPV Vaccine is SAFE.
Vaccines are only licensed in Canada if they meet very strict standards and are safe
Some girls may have minor side effects
The HPV vaccine has been studied for over 10 years
A clinical study on the HPV vaccine was done in over 20,000 women for over 5 years in several countries
Over 44 million doses have been distributed worldwide
Canada has some of the strictest standards for vaccine licensing in the world.
There are only minor side-effects associated with the HPV Vaccine: swelling, itching, pain at injection site, feeling faint. (similar to other vaccines).
Reported serious side-effects during the studies were NO DIFFERENT B/W the groups that received the vaccine and those who did not.
During the course of the studies involving 21, 464 participants, ten subjects in the vaccine group and seven in the group that did not receive the vaccine died:
None of these deaths were considered to be vaccine related
Deaths were due to trauma, suicide, pulmonary embolus, cancer, complication of cesarean section and arrhythmia
There were 13 reports of GBS which is a nervous system problem, but these rates are below the expected rate that occurs naturally in the population
Clinical study was conducted in North America, Europe, Latin America, and the Asia Pacific Region
This group is still being followed to assess duration of protection
BC Public Health Nurses support this program because it has been proven to be safe
There has been a lot of scientific research on this product
This vaccine is being administered in Canada because it is safe
The HPV Vaccine is SAFE.

9. The vaccine PREVENTS HPV.
Why Immunize Now?
Immunization is about PREVENTION
Vaccine must be given BEFORE EXPOSURE for best results
Studies have shown that the vaccine is BUILDS BETTER PROTECTION if given to younger girls
Studies have shown that the vaccine results in highest immune response when given to girls under the age of 13.
Therefore, vaccinating now will provide women with the strongest protection possible
Vaccination is only effective if it is administered before an exposure.
If someone is already infected with HPV, the vaccine does not get rid of that infection.
By vaccinating girls at this age, we are making sure that they are well protected before she could be exposed to HPV.
The vaccine PREVENTS HPV.
It does not treat HPV.

10. PROTECT BC Girls from cervical cancer.
HPV Vaccine and Girls
Immunization DOES NOT promote earlier sexual activity
Immunization should occur BEFORE sexual activity to be most effective
Studies have demonstrated that vaccinating against a sexually transmitted disease does not lead to increased or earlier onset of sexual activity Ex. McCreary Report
Similar concerns surrounded the HepB vaccine when it was introduced, and there has not been an increase in sexual activity associated with that vaccine
This vaccine is about protecting girls from cervical cancer
For maximum efficacy, vaccine should be administered before sexual debut
HPV infection can occur during first sexual encounter, so it is important that girls are protected before this occurs
PROTECT BC Girls from cervical cancer.

11. School-based HPV Immunization
Grade 6 girls
Grade 9 girls for two more years
3 doses
1st dose nd dose rd dose
6 months total
2 months
4 months
The school based grade 9 program is only funded for 2 more years. Grade 6 girls will not be offered the HPV vaccine in school when they are in grade 9.
The HPV Immunization program is a Grade 6 program. Temporary grade 9 program is simply for catch-up of older girls.
If parents decide to not get their daughter immunized in grade 6, they will have to go to a public health unit to have their daughter immunized (still free)
Best/most convenient option is to have their daughter immunized in the school based program
As stated before, girls will have the best immune response if immunized in Grade 6, so the best time to vaccinate is now
We Need Your Help!

12. How Can You Help?
The success of this program depends on the commitment and support of educators and school staff. Our goal is to protect as many girls as possible from cervical cancer, but we need your help to achieve this goal!
Health messages reinforced by educators and school staff increase consent returns and vaccine uptake.
Ways in which you can help us are:

13. WORKING TOGETHER to PROTECT BC girls and women from Cervical Cancer
Summary
The vaccine protects against 70% OF ALL CERVICAL CANCER types
The HPV vaccine is SAFE
Girls are best protected when they get the HPV vaccine before they become sexually intimate
The HPV vaccine builds better protection in young girls
WORKING TOGETHER to PROTECT BC girls and women from Cervical Cancer

14. Questions?
For more info visit:
immunizebc.ca

15. Optional Additional Information

16. HPV and Cervical Cancer
0-1 years years years
Continuing Infection
Pre-Cancerous Cell Growth
Invasive Cervical Cancer
Initial HPV Infection
Abnormal Cell Growth
The majority of HPV infections are temporary and cause no symptoms or problems and last for approximately 8 months.
90% of new HPV infections clear within 2 years.
Some infections can cause abnormal cell growth that may later be cleared by the body
Sometimes, however, HPV infection can persist for many years and cause pre-cancerous cell growth which can progress into cervical cancer over many years
This infection must persist for years to permit progression to cancer.
HPV Infection Cleared

17. The Cervix
The cervix is the narrow area located above the vagina and below the uterus
Cervix means neck in Latin, and is sometimes referred to as the “neck of the uterus”
The cervix is also sometimes called the “birth canal” since it expands during childbirth to all the baby to move from the uterus to the vagina for birth

18. Virus Penetrates Cervix
HPV infects only certain types of cells in the cervix
There is a region in the cervix called the “transformation zone” where most of these cells are located
In younger women who are post-pubertal, this zone is larger than older women, which means that they have more cells that are vulnerable to HPV infection
In addition, in younger women, these vulnerable cells are present throughout the cervix on the outside layer, which makes it easier for young women to become infected with HPV
The amount of these cells present on the outside layer of the cervix decreases naturally as women age, making them less at risk for HPV infection

19. HPV Vaccine Bridging Study
HPV Vaccine is Safe for girls 9-15 years old
What is a bridging study?
A bridging study is a study that is done to see if a vaccine or drug will have the same effect on a new group of people as it did on a group that has already been studied.
In this case, the first group studied for the HPV vaccine was women aged years
These studies involved blood tests and pelvic exams (pap tests)
The blood tests tested for the women’s immune response (protection from) the HPV Vaccine
Pelvic exams tested for pre-cancer changes in the cervix to see if the vaccine was preventing these from forming
These studies showed that the HPV vaccine was ~100% effective at protecting these women from developing cervical cancer
Then, studies were done on younger women to determine if the vaccine would provide this same protection for girls aged 9-15 years:
These studies involved only blood tests, since it is not ethical to do pelvic exams (pap tests) on girls this young
Study showed that younger girls had high protection from HPV after immunization
These girls had higher protection from HPV after immunization than older girls
So…..
The Bridge
Since studies showed that in the older group of women the immune response to (protection from) the HPV Vaccine prevented ~100% of all pre-cancer cell growth in the cervix, researchers could conclude that the vaccine would have the same effect in younger women as well since they also showed strong immune responses to (protection from) the HPV vaccine.
Through this technique researchers were able to avoid the need to conduct pelvic exams on young girls, while still determining that the vaccine will protect these girls from developing cervical cancer
This “Bridging Study” method is an acceptable and reliable method for determining vaccine efficacy and safety.

20. The HPV Vaccine and Boys
Not currently licensed for use on boys in Canada
Clinical trials are currently underway to determine vaccine safety and efficacy in boys
Results look promising
Protecting boys and girls would be ideal
Ideally, both girls and boys would be vaccinated, since they pass the virus to each other
HPV is also associated with other, more rare cancers, like penile and anal cancers
HPV also causes genital and anal warts in boys (as it does in girls)