What You Need to Know About the HPV Vaccine

July 1, 2013
Taken from the July/August 2013 issue of the Women's Health Activist Newsletter.

But, the virus usually clears on its own, without causing any damage  — often without showing any symptoms. The HPV vaccine can prevent infection, but it’s not for everyone. We’ll tell you what you need to know about the virus and the vaccine.

What are the risks from HPV?

In both men and women, HPV infection can lead to warts or cancer in the person’s genitals, mouth, or throat. There are more than 150 types of HPV, but two (types 16 and 18) are thought to cause almost two-thirds of all cervical cancer cases, and close to half of all vaginal, vulvar, and penile cancers.

What are the current recommendations for cervical cancer screening?

The U.S. Preventive Services Task Force (USPSTF) recommends that women who have a cervix have a Pap test (which looks for pre-cancerous cells to screen for cervical cancer) every 3 years from ages 21 - 65.  Every 5 years from age 30-65, women are advised to get a Pap test plus HPV DNA testing to screen cells for certain high-risk types of HPV. The USPSTF does not recommend cervical cancer screening for women under 21 (i.e., neither Pap nor HPV DNA tests) because the tests are unlikely to find any problems.  Similarly, the USPSTF does not recommend HPV DNA tests for women under 30, because almost everyone will test positive for the virus at least once.  Even though the virus almost always goes away on its own, a positive HPV test increases people’s health care costs and anxieties.ii Some clinicians may order an HPV test as follow-up to an abnormal Pap test, but HPV DNA test is not meant for general screening or simply to determine HPV status.

Can HPV be prevented?

There are two vaccines — Cervarix and Gardasil — that prevent infection with the most common types of HPV, thereby reducing the risk of cervical and other cancers that are associated with high-risk strains of HPV. Cervarix protects against HPV types 16 and 18, the highest-risk strains of HPV, and is approved for girls ages 9 - 26. Gardasil protects against HPV types 16 and 18, as well as types 6 and 11, which provides additional protection against genital warts and anal cancer; it is approved for both girls and boys ages 9 - 26. While studies have shown vaccine efficacy over 5-6 years, longer-term data are not yet available to determine exactly how long the vaccines work to protect people.

How safe are the vaccines? What side effects can they cause?

The CDC notes that the country “currently has the safest, most effective vaccine supply in history. Years of testing are required by law before a vaccine can be licensed. Once in use, vaccines are continually monitored for safety and efficacy.”iii  The HPV vaccines are considered to be very safe, although reactions like dizziness, fainting, and soreness around the injection may occur. More information is available about Gardasil than Cervarix because it was approved first, but on-going safety studies are being done on both vaccines. As with any vaccine, patients should carefully review whether they have allergies to any of the ingredients before getting the vaccine.

When should vaccines occur?

The CDC recommends that, for greatest protection, vaccination should occur around age 11-12, so it has time to become effective well before sexual activity begins.iv (There is no evidence that having the HPV vaccine encourages a person to become sexually active.) For people under age 26 who are already sexually active, getting the HPV vaccine won’t affect any existing HPV infections, but it may prevent infection from a different HPV type if it’s also covered by that vaccine. Likewise, the vaccine doesn’t impact the need for cervical cancer screening; if you have a cervix, you should still follow the USPSTF’s screening recommendations.

Can pregnant women get vaccinated?

There have not yet been adequate studies to establish the vaccine’s safety for use by pregnant women and neither vaccine is recommended for use by pregnant women. Women who got the vaccine and then find out they were pregnant at the time of vaccination should call the manufacturer’s “HPV in pregnancy registry” to contribute to efforts to learn more about pregnant women’s response to the vaccine (800-986-8999 for Gardasil, 888-452-9622 for Cervarix).

Where can I get the vaccine and how much does it cost?

The vaccine is available from pediatricians, family doctors, ob/gyns, public health clinics, and family planning clinics. It is given in a three-dose series that may cost more than $500 in total. Insurance may cover the vaccine’s cost, however, and uninsured children may be eligible to get it at low cost from public health departments and clinics.

Do I need my parents’ permission to get vaccinated?

The rules vary from state to state. In many states, however, teens are explicitly allowed to get reproductive health care (like family planning and STI treatment and prevention services) without a parent’s or guardian’s knowledge or consent. These laws are in place to reduce barriers to young people getting sensitive health care services. If you get the vaccine from your provider using your parent’s insurance, keep in mind that they will get an “Explanation of Benefits” form that describes the services received. Scarleteen has an excellent HPV Vaccine FAQ with advice about parents who are concerned about this vaccine: http://www.scarleteen.com/article/infection/the_hpv_vaccine_faq.

What does the NWHN think about the vaccines?

The NWHN supports cervical cancer screening to identify pre-cancerous conditions and timely access to treatment and care, which will prevent cancer from developing. We believe the vaccines are an important option for filling the gap where regular access to health care — including Pap tests and follow-up ­— is not viable. This is particularly the case where women face barriers to health care due to poverty, ethnicity, language, and/or other factors. Nonetheless, more research is needed on the vaccines’ safety, long-term effects, and use in subgroups like older women.

For more information visit these websites:

The continued availability of external resources is outside of the NWHN’s control. If the link you are looking for is broken, contact us at nwhn@nwhn.org to request more current citation information.

References

i. Centers for Disease Control and Prevention (CDC), Genital HPV Infection - Fact Sheet. CDC: Atlanta, 2013. Available online at: http://www.cdc.gov/std/HPV/STDFact-HPV.htm
ii. U.S. Preventive Services Task Force (USPSTF), Recommendations: Screening for Cervical Cancer Screening for Cervical Cancer Topic Page. Rockville: USPSTF, April 2012. Available online at:http://www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm.
iii. Centers for Disease Control and Prevention (CDC), Vaccine Safety Information for Parents, CDC: Atlanta, 2011. Available online at:
http://www.cdc.gov/vaccinesafety/populations/parents.html. See also CDC, Frequently Asked Questions about HPV Vaccine Safety, CDC: Atlanta, 2013. Available online at:http://www.cdc.gov/vaccinesafety/Vaccines/HPV/hpv_faqs.html and CDC, Human Papillomavirus (HPV) Vaccine, CDC: Atlanta, 2013. Available online at:http://www.cdc.gov/vaccinesafety/Vaccines/HPV/index.html.
iv. CDC, 2013 Recommended Immunizations for Children from 7 Through 18 Years Old, CDC: Atlanta, 2013. Available online at:  http://www.cdc.gov/vaccines/who/teens/downloads/parent-version-schedule-....