There has been strong interest in the development of two human papillomavirus (HPV) vaccines, one of which (Gardasil) has been available in New Zealand for several years. Gardasil has also been confirmed for funding on the National Immunisation Schedule (see below). A lot of information is available, and this article is to help you answer some of the frequently asked questions (FAQs).

Also see our main topic on Cervical cancer - causes and prevention

FAQs

Who is eligible for the funded vaccine?

The HPV vaccine (Gardasil) is being funded by the New Zealand Government for certain age groups. It involves a course of three injections, given over a six-month period. Those eligible for funded vaccination:

From 1 September 2008
Girls aged 17 and 18 years (born in 1990 and 1991) are able to receive HPV vaccine from primary care or health clinics.

From 2009
-HPV vaccine will be part of the National Immunisation Schedule for 12-year-old girls (in primary care and health clinics) and girls in school Year 8. 
-HPV vaccine will be offered to girls aged 13 to 18 years. This will be phased in over 2009 and 2010.

Other people will usually have to pay to receive the vaccination.

Is the new vaccine really important?

Yes. The available HPV vaccine is 100% effective against disease caused by HPV types 6, 11, 16 and 18.

Why are these HPV types important?

HPV types 16 and 18 cause around 70% of high-grade pre-cancerous changes and cervical cancers as well as vaginal and vulval cancers. HPV types 6 and 11 cause an estimated 90% of genital warts. The currently available vaccine prevents you being infected with four different HPV types (6, 11, 16 and 18) and protects against pre-cancers, cancers and genital warts caused by these HPV types.

Does the vaccine protect against all HPV types?

No. The vaccine has been developed to protect against the four most common types of HPV.Therefore, it will not prevent infection with other less common types.

Is the vaccine useful for everyone?

The vaccine does not work for a particular HPV type in the vaccine if you are already infected with that HPV type - it prevents HPV infection through sexual activity. That is why the target is a young age group (females 9-26 years; males 9-15 years). However, if you have been infected with one HPV type that is in the vaccine, the vaccine will still prevent you being infected with the other types contained in the vaccine.

What does it not protect against?

It will not protect against 30% of cancers and 10% of genital warts, which are caused by other less common types of HPV not in the vaccine.

Why is the vaccine recommended for such young girls?

HPV is sexually transmitted. The vaccine is best given when you do not have an HPV infection from an HPV type in the vaccine. Therefore, people who receive the vaccine before sexual activity begins will receive the maximum benefit and protection against the HPV types in the vaccine. However, if you have been infected with one HPV type that is in the vaccine, the vaccine will still prevent you being infected with the other types contained in the vaccine.

Why is it only recommended for girls/women aged nine to 26?

The safety and efficacy data from studies are well established for this age group. Further research is awaited on women older than 26.

Will sexually active females benefit?

Yes. Sexually active females will also receive protection. They may not receive full protection if they are currently infected with one of the vaccine HPV types, but they will be protected against the other types covered in the vaccine.

What if I already have genital warts?

The vaccine only works to prevent acquisition of HPV virus. It does not work as a treatment for genital warts. However, the vaccine can still be given to protect against the other HPV types covered in the vaccine.

What if I already have had an abnormal smear?

The vaccine only works to prevent infection with HPV virus. It does not work as a treatment for cervical smear abnormalities. The vaccine provides some (about 25%) protection against progression of HPV infection to CIN 1 (the first pre-cancerous stage) and worse. However, the vaccine can still be given to protect against the other HPV types covered in the vaccine.

Is there a test to see which HPV types I may have, or a screening test before having the vaccine?

An HPV DNA test is not routinely available in general practice. It is not necessary to know whether someone already has HPV before giving them the vaccine. Those who have already acquired one HPV type that is in the vaccine will still benefit from the vaccine by protecting themselves from the other types.

What about vaccinating boys and men?

The available HPV vaccine (Gardasil) is currently indicated for boys aged 9-15 years. This may change to include older males as research is completed. It makes sense to vaccinate males as this will protect them from genital warts and will have indirect benefits for partners.

How is the vaccine given?

It is a three-dose schedule given over six months - you receive the first dose, the second is given two months later and the third is given six months after the first one (0, 2 and 6 months).

How long does it work for? Is a booster needed?

The vaccine gives protection for at least five years. Follow-up trial data will likely show the duration of protection is even longer. It is not yet known if a booster is required, but current data show the vaccine produces a high immune response and is unlikely to need a booster.

Is it possible to get infected by the vaccine?

No. The vaccine is not a live vaccine. It does not contain the complete HPV virus and cannot cause HPV infection.

What if I do not finish the three doses?

It is not known yet what level of protection is provided by only one or two doses.

Are there any adverse effects?

The HPV vaccine is safe and has been studied in over 20,000 women. The most common side effects are local reactions at the injection site and fever, which are mainly mild and usually disappear in a few days.

Is it safe in pregnancy?

There is no evidence to suggest adverse outcomes in pregnancy. However, the vaccine is not licensed for use in pregnant women. If a woman becomes pregnant after starting the vaccination schedule, she should give birth before receiving the next dose. The vaccine is safe for breastfeeding mothers.

Who should not be vaccinated?

People with allergy to yeast or components of the vaccine should not be vaccinated.

Is regular cervical screening still required?

Yes, because the vaccine does not protect against all types of HPV that might cause cervical cancer. Also, some women may not complete the full schedule or may have previously acquired one of the vaccine HPV types.

As cervical cancer is the second most common cause of cancer death in women on a worldwide basis, this vaccine represents a significant advance in preventive health.
If you would like to find out more about HPV vaccination talk to your doctor or practice nurse.

Original material provided by everybody, and is based on an article originally published in New Zealand Doctor by Dr Min Karen Lo, a sexual health physician in private practice in Auckland. Last updated December 2008.