hvp

This Q&A on the HPV vaccine is lengthy but necessary. 

The questions are bolded to make searching more accessible, and you may be able to explore the questions and answers on your computer by using the “find” feature (control+F). You will find all of the resources used underneath each answer. 

This first one isn’t exactly a question but a great point brought up by one of my readers. She stressed the importance of understanding the disease the vaccine is protecting against before you decide whether to vaccinate. It’s essential to understand all of these vaccine-preventable diseases so you can make an educated decision when vaccinating your children. 

In this quick overview of human papillomavirus (HPV), I’ve hi-lighted the answers to a few questions that were asked before I get to the in-depth questions. 

As far as HPV goes, you probably have heard of it, but you may not know a whole lot about it. HPV stands for human papillomavirus—a widespread virus among both men and women. Almost all of us have had one type of HPV in our lifetime and may not have even known it. 

There are over 150 known strains of the virus. Around 60 HPV types cause warts on areas like the hands and feet. The rest enter the body via sexual contact. Most of the time, people don’t know they have HPV and pass it on to a partner. That includes the strains that are linked to a higher likelihood of cancer. It’s also possible to be infected with more than one strain of HPV. 

As I’ve stated, most of the HPV infections clear up on their own, but there are several high-risk strains. HPV strains 16 and 18 are responsible for about 70% of cervical cancer cases. Strains 31, 33, 45, 52, 58, are among a few other are high-risk strains that can cause cancers of the cervix, vagina, vulva, penis, anus, back of throat, base of tongue, and tonsils. According to the Centers for Disease Control and Prevention (CDC) HPV causes 33,700 cases of cancer in men and women a year. According to the FDA, 12,000 women are diagnosed with HPV-associated cervical cancer per year, and around 4,000 women die from it. 

Lower-risk strains such as HPV 6 and 11 cause about 90% of genital warts. These warts don’t often develop into cancer, but they sure are nasty. Warts usually show up weeks to months after a sexual encounter with an infected partner. They look like bumps and sometimes shaped like cauliflower. 

Although uncommon, pregnant women can pass HPV to her baby at delivery. A baby with HPV inside the throat can cause a condition called recurrent respiratory papillomatosis (RRP). This disease causes noncancerous tumors to grow in the respiratory tract, the larynx (most common), and the air passages such as the nose, mouth, and lungs. The tumors can be removed, but they often grow back. 

According to the CDC, 80 million Americans are infected with at least one strain of HPV right NOW, and around 14 million people in the US will become newly infected every year. Approximately 50% of these cases are among 15-24-year-olds. 

Unfortunately, only about half of adolescents in the US are up-to-date on the HPV vaccine. That leaves the majority of adult men and women at risk for HPV infection that could lead to cancer.

Resources: 

• Centers for Disease Control (CDC)
• American Cancer Society
• US Food and Drug Administration (FDA)
• National Institutes of Health (NIH)
• Michelle Pugle. Adults 27 to 45 Can Now Get HPV Vaccination. Will Infection Rate Drop? Healthline. October 15, 2018

What’s the vaccine for HPV?

The vaccine currently used to protect against HPV is called Gardasil 9. Two others, Gardasil (both made by Merck) and Cervarix (GlaxoSmithKline Biologicals) have mostly been phased out. 

Gardasil (approved in 2006) and Cervarix protect against HPV strains 16 and 18, but likely does not offer coverage for males. Should a male have had Cervarix, they need to be re-vaccinated. Gardasil also protects against two more strains responsible for genital warts. Both have been faded out. 

GARDASIL 9 became available in February of 2015. This 9-valent, recombinant vaccine protects against the nine most high-risk strains of HPV: 6, 11, 16, 18, 31, 33, 45, 52, and 18. The vaccine protects against genital warts and 90% of cervical cancers.

The vaccine is given in either two or three doses (more on schedule next). 

Resources: 

• Merck Vaccines
• American Cancer Society
• US Food and Drug Administration
• Healthline
• Immunize.org

What’s the age and schedule for Gardasil 9?

It’s crucial to be vaccinated before infection occurs to prevent cancers from the 9 high-risk strains. That’s why these injections are given at a young age before the child is engaging in sexual activity. 

The vaccine has been approved for children as early as age nine.

The vaccine will is given on a two or three-dose schedule. For the two-dose schedule, the vaccine is given before the child’s 15th birthday, and the second dose is given no earlier than six months after the first dose. If it is given before the six months then the child must follow the three-dose schedule. 

Schedule: 

Age 9-14 years, two-dose regimen: at first dose, then second at 6-12 months after first 

Age 9-14 years, three-dose regimen: first dose, and then at 2 and 6 months after 

Age 15-45 years, three-dose regimen: first dose, and then at 2 and 6 months after

Resources:  

• Merck vaccines: https://www.merckvaccines.com/Products/Gardasil9/dosing-administration

Can you get the HPV vaccine as an older adult? 

You can. In October 2018, the FDA approved Gardasil 9 for men and women age 27-45.

A study followed 3,200 women dosed with the HPV vaccine for 3.5 years that aged 27-45 years old. The vaccine was found to be 88% effective in the prevention of persistent infection, genital warts, vulvar and vaginal precancerous lesions, cervical precancerous lesions, and cervical cancer related to Gardasil 9 protected HPV types. 

The safety of Gardasil 9 in adults was tracked through 13,000 men and women with the most common adverse reactions being pain at injection site pain, swelling, redness, and headaches. 

The vaccine is safe and effective for adult men and women from 27-45 years. 

Resources: 

• Megan McSeveney. FDA News Release, Oct. 5, 2018: FDA approves expanded use of Gardasil 9 to include individuals 27 through 45 years old.
• Food and Drug Administration (FDA)

But, SHOULD you get the HPV vaccine as an older adult?

Adults are still at risk for HPV due to the lag in vaccine rates adolescents and other adults. When the younger population has been vaccinated, the incidence of these cancers will start to decrease as they become adults. That will keep the rate of HPV-related cancers down in adults, eventually. 

One of the problems we encounter with adults is that they are unaware they still need some vaccines (link to adult vaccines). Another? A lot of adults have already been exposed to HPV strains. However, experts suggest that getting the vaccine may still offer coverage from cancer-causing HPV strains should the individual not already have them. Even still, if you already have/had HPV related cancer, you still can benefit from the vaccine. 

There are so many strains of the virus that chances are you’ll still get some coverage from the vaccine. Anything to keep the possibility of cancer lower is worth it. 

Experts are mostly in agreement that adults should get the vaccine. 

Resources: 

• Michelle Pugle. Adults 27 to 45 Can Now Get HPV Vaccination. Will Infection Rate Drop? Healthline. October 15, 2018
• FDA

What about co-use with other vaccines?

Adolescents at the age where they’re getting the HPV vaccine most likely won’t be getting other vaccines at the same visit, so this shouldn’t be a problem. However, research shows that inactivated (killed) and attenuated (live) vaccines are acceptable to be administered at the same time as the HPV vaccine. The HPV vaccine is an inactivated vaccine. 

Resource: 

• immunize.org

What are the side effects of the vaccine?

All vaccines may have mild side effects such as pain, redness, or swelling at the injection site. This vaccine may cause a fever, headache, tiredness, nausea, or muscle and joint pain. 

Of the cases reported with side effects, only 3% were severe. However, researchers are not able to identify if the vaccine was the cause of the severe reactions in these patients. None of the cases were directly tied to the vaccine. 

The serious and sometimes long-term side effects may be blood clots, seizures, Guillain-Barre syndrome (immune system attacks nerves), chronic inflammatory demyelinating polyneuropathy (weakness and impaired sensory function in arms and legs), myalgic encephalomyelitis/chronic fatigue syndrome (overwhelming, disabling fatigue not improved by rest), and in some very rare cases, death. All of these side effects are extremely rare. 

According to an extensive study by Ozawa, K. et al., the vaccine may be related to chronic regional pain syndrome (damage to central nervous system causing chronic pain to arms, legs, hands, or feet) and autonomic (part of the nervous system that controls breathing, blood pressure, digestion, and temperature regulation) and cognitive (brain function) dysfunctions. 

Resources: 

• CDC
• WebMD
• Mayo Clinic
• NIH
• Clevelandclinic.org
• Ozawa, K., Hineno, A., Kinoshita, T., Ishihara, S., & Ikeda, S. I. (2017). Suspected Adverse Effects After Human Papillomavirus Vaccination: A Temporal Relationship Between Vaccine Administration and the Appearance of Symptoms in Japan. Drug safety, 40(12), 1219–1229. doi:10.1007/s40264-017-0574-6

Where is the vaccine administered?

The vaccine is given in the deltoid or the upper area of the thigh. 

Is the HPV vaccine painful?

Most claim the vaccine is no more painful than any other shot. Some argue that it’s the most painful of the childhood vaccines. The manufacturer of Gardasil 9 acknowledges the sting, and studies show more pain with the HPV vaccine than with the placebo. The pain may be due to the more viscous nature of the suspension injected 

There are also higher reports of fainting with the shots in girls. It’s not clear whether the sting from the shot is related to the fainting or if it’s due to the nervousness factor. Teens seem to be more prone to fainting from vaccines than children. 

Some who get the vaccine report pain the day after the injection, which appears to be more common. 

According to Dr. Andy Andrews, a pediatrician in Atlanta, the pain of the shot hasn’t kept teens from coming back, even by themselves, for the booster doses.

Resources

• Associated Press. Cervical Cancer Vaccine Called Most Painful Shot. Fox News. Jan 13, 2015.

Can a child with a yeast allergy get the HPV vaccine? 

The HPV vaccine is made using baker’s yeast, and there may be some tiny amounts of yeast in the vaccine. However, the HPV vaccine contains less than 0.007mg of yeast proteins compared to other vaccines that may have up to but no more than 5mg of yeast. 

One out of every 600,000 with allergies to the hepatitis B vaccine have yeast-related reactions to the vaccine and the HepB vaccine contains 5mg/ml yeast—a much, much higher (but still very low) amount of yeast than the HPV vaccine does (0.007mg/ml).

The vaccine could cause a reaction in people with severe yeast allergies, but this would be very rare. 

According to experts, children should get the vaccine unless otherwise told by the pediatrician to not do so. If you think your child has an allergy to any of the vaccine ingredients, it’s important to wait at the doctor’s office for an hour or two post-vaccination to make sure there are no immediate threats to your child’s health. 

Resources: 

• Children’s Hospital of Philadelphia 

How effective and safe is the HPV vaccine? What are the benefits vs. risks of getting the vaccine? 

According to the CDC and FDA, the HPV vaccine has an excellent safety record. More than 80 million doses of the vaccine have been administered since 2006 when the vaccine was first introduced. 

The most common side effects (risks) are pain and swelling at the injection site and possible fainting during injection most likely due to nervousness. (See also side effects above.)

This vaccine works exceptionally well in preventing cervical cancer and other associated cancers, which is a huge benefit to getting the vaccine. 

The HPV vaccine provides nearly 100% protection against the 9 HPV strains that are more likely to cause cancer and genital warts. Research shows that the vaccine induces long-lasting protection as the original vaccine, given in 2003 still offers nearly 100% protection in patients over ten years later. 

Resources: 

• CDC

HPVvaccine.org

Can an immune-suppressed child get the HPV vaccine? 

This is always a question for your doctor. (Disclaimer: I’m not your child’s doctor.)

Immunocompromised children are at a higher risk for developing HPV-related cancers than otherwise healthy children because their immune systems aren’t working at the highest capacity. 

Research shows that HPV vaccines are safe and should be given to children with immune suppression to keep them protected from these higher rates of cancer. 

Many immune-suppressed children aren’t advised to get live attenuated vaccines such as MMR, rotavirus, chickenpox (varicella), and sometimes polio and the flu vaccine. They are advised to get the inactivated killed vaccines such as HepA, Hib, HepB, HPV, pertussis, pneumococcal, meningococcal, and shingles.  

Of course, with these children yearly screening for cancer is extremely important. 

Resources:

• vaccines.gov
• Garland, S. M., Brotherton, J., Moscicki, A. B., Kaufmann, A. M., Stanley, M., Bhatla, N., … IPVS (2017). HPV vaccination of immunocompromised hosts. Papillomavirus research (Amsterdam, Netherlands), 4, 35–38. doi:10.1016/j.pvr.2017.06.002
  

Will future versions of the HPV vaccine have fewer side effects?

The vaccine we have has an excellent safety reputation. The vaccine has been given a bad reputation with articles circulating online, as have many vaccines. 

It’s hard to predict what the future holds. However, researchers are always working to improve vaccine safety and efficacy.

Resources: 

The Vaccine Mom 

Does the HPV vaccine cause infertility?

According to the CDC, there is no current evidence that the HPV vaccine causes infertility.

When a woman has HPV-related cancer, this may keep a woman from getting pregnant. Removal of the cervix/radiation/chemotherapy all may prevent a woman from being able to get pregnant. By getting the vaccine, chances are less likely of developing one of these cancers. 

Another concern of women is “premature menopause,” a condition at which the woman’s ovaries stop working before the age of 40. There are many causes premature menopause so it’s difficult to determine why this happens to particular women. The  CDC and FDA have not linked the HPV vaccination so far with any of these reported cases. 

Resources: 

• CDC

Can you get the HPV vaccine while pregnant?

Hpv vaccines are not approved or recommended for pregnant women. Should a woman get a dose of Gardasil 9 before she knows she’s pregnant, she should be fine. However, the doctor should report it to the Vaccine Adverse Event Reporting System (VAERS) for ongoing monitoring.

The next dose of the vaccine should not be given, and the injections need to be started again after the woman has given birth. 

Resources: 

• CDC
• AAP

There’s often a stigma associated with HPV. How do we overcome this? 

Since HPV is sexually-transmitted, there are a lot of stigmas, shame, and anxiety about getting the vaccine. However, by getting your child vaccinated, you are protecting him or her from potentially debilitating and fatal cancers. No one but the doctor has to know your child has been vaccinated. Trust me, your child’s doctor will be proud that your child is protecting not only himself/herself but other adolescents in the community from cancer-causing HPV infection. 

Public awareness is a great way to lessen stigma as is learning what HPV can do to the body. Knowing the disease will help you to want to prevent it. Look for stories about people living with HPV cancer very soon on The Vaccine Mom (right here)!

Always make sure you are using reputable sources with researching. The CDC, AAP, WHO, NIH, and of course, The Vaccine mom are excellent sources of information. 

Resources: 

• Waller J, Marlow LAV, Wardle JThe association between knowledge of HPV and feelings of stigma, shame and anxietySexually Transmitted Infections 2007;83:155-159.

Does insurance cover the vaccine? 

Right now, several states in the US have insurance companies covering the vaccine costs. Others may have insurance reimbursement for the cost of the vaccine, but sometimes this reimbursement takes a while to get. The problem is, you are going to have to ask for this information. 

Anyone over the age of 25 might have to pay for the vaccine for the time being. This is keeping the vaccine rates much lower than we’d like to see. 

The vaccine costs around $300, and if you have to pay for it, know that it’s an excellent health investment.

Resources: 

• Michelle Pugle. Adults 27 to 45 Can Now Get HPV Vaccination. Will Infection Rate Drop? Healthline. October 15, 2018

Have there been phase four studies done on the HPV vaccine? What’s the data? (heavy read)

Phase IV clinical trials involve people. 

A study conducted by GlaxoSmithKline, examined the ability of the HPV vaccine to prevent infection with cervical cancer-causing HPV strains 16 and 18 in 18,000 women aged 15/25 years (at the start of the study). They also evaluated the vaccine safety over 48 months. These women received the HPV vaccine Cervarix or Havrix, or a control vaccine (HepA) administered intramuscularly at a 0-1-6 month schedule. Only 36 out of 18,000 people in the study were found to have contracted HPV strains 16 or 18 associated lesions at 34.9 months post-dose three. That puts the vaccine at 95% effective according to this study. 

A randomized phase four treatment trial preformed by Fred Hutch of the University of Washington Cancer Consortium, administered the HPV vaccine (or placebo vaccine) to people with vulvar or anal lesions. They found that the HPV vaccine peptides (antigens) helped induce the immune response to kill tumor cells by 50% and lessen the chance s that these cancers progressed or came back compared to the placebo vaccine. They followed this cohort at 7, 12, 18, 24, 36, and 42 months. In the study, they used both female and males aged 27-69 years who had already developed anal or vulvar lesions. 

A study lead by Jessica P. Hwang found Gardasil 9 prevented HPV infections in patients with cancers in the blood-forming tissue of cells of the immune system. This shows that vaccines such as Gardasil 9 may help the body build an effective immune response to kill cancer cells. They used patients 18+ years, both male and female, that already had these cancers. 

Resources: 

• GlaxoSmithKline. Human Papilloma Virus (HPV) Vaccine Efficacy Trial Against Cervical Pre-cancer in Young Adults With GlaxoSmithKline (GSK) Biologicals HPV-16/18. Last edit: August 20, 2018. Clinical trial: NCT00122681
• Fred Hutch. HPV Vaccine Therapy in Interrupting Progression in Patients With High-Grade Vulvar or Anal Lesions. University of Washington Cancer Consortium. Seattle, Washington. clinicaltrials.gov. NIH. Last edited: July 2019. Clinical trial: NCT03051516
• Jessica P. Hwang. Gardasil 9 Vaccine in Preventing HPV Infection in Patients with Hematologic Malignancies Undergoing Donor Stem Cell Transplant. MD Anderson center. Huston, Texas. clinicaltrials.gov. NCI. Last edited: June 5, 2019. Clinical trial: NCT0302363

If most HPV infections clear up on their own, then why is it so important to get the vaccine? 

According to the CDC, around 80 million Americans have HPV infections right now. That’s one in four people in the US. There are over 150 different strains of the virus. Unless they get the vaccine, a lot of sexually active people are very susceptible to HPV. 

HPV can stay in the body for years and can be passed because most people don’t even know they have it. Many times there are no symptoms. The virus often clears within one to two years. Screening for women is available but not for men. 

There is no cure for HPV infection. However, it can be treated. 

Although many strains of HPV that clear up on their own, there’s the chance that you may contract common strains that may cause potentially deadly cancers. If you can protect yourself and your children from these strains you most definitely should. The HPV vaccine is crucial to get. 

Resources: 

• Healthline
• CDC

I hope this helps you decide to vaccinate your child with the HPV vaccine. It’s incredibly effective at limiting cancer risk and is essential to keep from spreading particularly debilitating and deadly strains from circulating. Protect your teen and consequently help protect other adolescents from HPV. These nasty strains of HPV could become as rare as many other vaccine-preventable diseases here in the United States. So do your part. Protect yourself and your children and don’t spread disease.