Vaccination against Cervical Cancer, Genital Warts, and other HPV-Related Cancers and Diseases

Is there a vaccine to prevent HPV?

In 2006, the United States Food and Drug Administration (FDA) approved a vaccine that helps protect against diseases caused by 2 types of HPV (HPV 16 and 19) that cause 70% of all cervical cancers. The vaccine also helps to protect against 2 types of HPV (HPV 6 and 11) that cause 90% of genital warts. This quadrivalent vaccine that prevents cervical cancer, vulvar and vaginal cancers as well as genital warts is approved by the Philippine Bureau of Food and Drugs (BFAD) and is available in the Philippines. It is approved for use in children and adolescents (male and female) from 9 through 17 years old and women 18 to 45 years old.

Another vaccine that protects against HPV 16 and 18 that cause cervical cancer has been approved by the BFAD for use in the Philippines. This bivalent vaccine is approved for use in the Philippines for females from 10 years of age onwards.


How do the HPV vaccines provide protection against cervical cancer and other HPV-related diseases?

HPV vaccines are believed to stimulate the body’s immune system to produce neutralizing antibodies that help protect against HPV in the skin cells of the genital area.

HPV vaccines are not intended to treat already existing cervical cancer and other HPV caused diseases.


Who should get vaccinated with the HPV Vaccine?

For the quadrivalent vaccine:
• Girls and women ages 9 to 45 years
• Boys and male adolescent ages 9 to17 years
• Catch-up vaccination is recommended for females aged 13 to 26 years who have not been previously vaccinated.

For the bivalent vaccine:
• Girls and women ages 10 onwards

To be most effective, HPV vaccines should be given before a person has any type of sexual contact with another person.


Can women who are already sexually active or who have experienced HPV diseases still get vaccinated?

• Women who are already sexually active may still benefit from vaccination. That’s because even if a woman has been exposed to HPV, it's unlikely that she has been exposed to all virus types covered by an HPV vaccine. So the vaccine could still help protect against HPV types the woman hasn't been exposed to.

How are the HPV vaccines administered?

• The Quadrivalent HPV vaccine administration schedule involves three doses administered intramuscularly within 6 months
(day 1, month 2, and month 6).

• The Bivalent HPV vaccine administration involves three doses administered intramuscularly within 6 months
(day 1, month 1, and month 6)


Why is Vaccination at a Young Age Recommended?

• HPV vaccination is most effective when given during childhood or adolescence, i.e. before sexual debut, when HPV infection risk is nil or at its lowest.

• Vaccination at a young age is also ideal because this is when the immune system is at its strongest and, therefore, will mount a robust response to the vaccine.


Is vaccination with the HPV vaccines safe?

Appropriateness of HPV vaccination for each patient should always be determined by a doctor. Vaccinations should be upon doctor's prescription.

HPV vaccines are contraindicated to those who are hypersensitive to the active substances or to any of the excipients of the vaccine.

Always tell the doctor if the person getting vaccinated has any severe allergies.

Pregnant women should not get the vaccine.

Particular Safety Data for Each Vaccine:

For the Quadrivalent Vaccine:

Individuals exhibiting hypersensitivity to the active substances or to any of the excipients of the vaccine should not get the vaccine.
Individuals who develop symptoms indicative of hypersensitivity after receiving a dose of the vaccine should not receive further doses of the vaccine.

Women who are breastfeeding may get the vaccine.

Common adverse events include: pyrexia, pain in extremity, and erythema, pain, swelling and pruritus at the injection site

For the Bivalent Vaccine:

The effect on breastfed infants of the administration of the bivalent vaccine to their mothers has not been evaluated in clinical studies. The bivalent vaccine should only be used during breastfeeding when possible advantages outweigh the possible risks.

Common adverse events include: headache, GI including nausea, vomiting, diarrhea and abdominal pain, itching, pruritus, rash, urticaria, myalgia and arthral gia, pain redness and swelling at the injection site, fatigue and fever (=38°C).

For more information, please refer to the American Cancer Society (ACS) Frequently Asked Questions (FAQs).

HPV Vaccine may be effective in women 24 to 45 years old: according to study

June 16, 2009 — The quadrivalent human papillomavirus (HPV) vaccine may be effective in women aged 24 to 45 years who are not infected with the relevant HPV types at enrollment, according to the results of an ongoing multicenter, parallel, randomized, placebo-controlled, double-blind trial reported in the June 2 Online First issue of The Lancet.

"Although the peak incidence of...HPV infection occurs in most populations within 5-10 years of first sexual experience, all women remain at risk for acquisition of HPV infections," write Nubia Muñoz, MD, from the National Institute of Cancer in Bogotá, Colombia, and colleagues. "We tested the safety, immunogenicity, and efficacy of the quadrivalent HPV (types 6, 11, 16, 18) L1 virus-like-particle vaccine in women aged 24-45 years."

Clinical Context

The prevention of HPV infection and related disease has undergone a major change in the last several years with the introduction of the quadrivalent HPV vaccine. This vaccine is currently indicated for girls and women between the ages of 9 and 26 years, which makes sense as a preventive strategy because most women in the United States acquire HPV infection between the ages of 15 and 25 years. The vaccine has been demonstrated to reduce the risks for HPV infection and cervical dysplasia among younger women.

There is evidence that the risk of acquiring HPV in the third or fourth decade of life is increasing, although there are limited data regarding the use of the HPV quadrivalent vaccine in this population. The current study addresses this issue.

Clinical Implications

• Currently, the quadrivalent HPV vaccine is indicated for girls and women between the ages of 9 and 26 years.
• The quadrivalent HPV vaccine was effective in the current study in the prevention of HPV infection and genital/cervical disease among women between the ages of 24 and 45 years, particularly among women not infected with the relevant HPV types at the time of treatment.

HPV Vaccine for men & boys

Yes, clinical trials of Gardasil on males concluded in November 2008 and found the vaccine to be about 90% effective in preventing genital lesions/warts in men. It may also prove to reduce the incidences of HPV-related cancers in men. For more information, please see published reports online.

So, how soon will we see Merck begin to market a male HPV vaccine? And, how the public will respond -- will parents of boys rush to get their sons protected? Will sexually-active young men see this as important preventive healthcare? I would still like to see a major health education campaign about HPV so that all of us know what this virus is, how it spreads, how to get tested, what treatments are available, and the full list of health ramifications -- not only for women but also for men.