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 is the funded HPV vaccine on the National Immunisation Schedule (see below). This topic 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 HPV vaccine?

The HPV immunisation progamme was introduced to New Zealand in 2008, and the funded vaccine is Gardasil.

Girls in school year 8 (age 12 years)
From 2011 onwards, the Gardasil vaccine is offered to girls in school year 8 (age 12 years), as part of the National Immunisation Schedule. If a school is not participating in the programme, the vaccine can also be obtained through GPs and health centres. Gardasil is given as a course of three injections, over a six-month period.

Females aged 12-20 - start before 20th birthday
The funded vaccine is also available for females from age 12 to 20 years, but they must have begun the course before their 20th birthday. (Contact your GP or health centre.)

Females born in 1990 or 1991: 31 Dec 2011 deadline
When the programme was introduced in September 2008, it was originally offered to young women born in 1990 or 1991. To be eligible for the funded vaccination programme, young women who were born in 1990 or 1991 have until 31 December 2011 to start the course.

Males 9-15, and females over 20 years [not funded]
Gardasil is approved for use in New Zealand for females aged 9-45 years and males aged 9-15 years. Males, and females over 20 years, can pay to have the vaccine (discuss this option with your doctor). A second vaccine, Cervarix, is also approved for use in New Zealand (but is not funded for any age groups).

Is the HPV vaccine really important?

Yes. The funded HPV vaccine (Gardasil) is 95% to 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 Gardasil vaccine offers a high level of protection against infection with four different HPV types (6, 11, 16 and 18) and helps protect against pre-cancers, cancers and genital warts caused by these HPV types.

Does the vaccine protect against all HPV types?

No. There are more than 100 types of HPV, and the vaccine Gardasil will not protect against all types of HPV. Gardasil has been developed to protect against the four most common types of HPV (6, 11, 16 and 18). Gardasil may also provide some protection against HPV types 31, 33, 52, 56, 58, and 59; these types cause approximately 12% of cervical cancers.

Is the vaccine useful for everyone?

To be most effective, the vaccine should be given before any sexual activity commences, which is why it is being offered to girls at a young age, through the HPV immunisation programme. 

However, even if you have become sexually active and have already been infected with one HPV type that is in the vaccine, the vaccine will still offer a high level of protection against being infected with the other types contained in the vaccine.

The vaccine Gardasil can be used in girls and women aged 9-45 years, and in males aged 9-15 years.

The vaccine is not recommended for some people (see 'Who should not be vaccinated' further below).

What does it not protect against?

The vaccine 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. The vaccine will not protect against diseases that are not caused by HPV.

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 offer a high level of protection against being infected with the other types contained in the vaccine.

Will sexually active females benefit?

Yes. Sexually active females can also benefit from the vaccine. They may not receive full protection if they are currently infected with one of the vaccine HPV types, but the vaccine will still offer a high level of protection against the other types it covers.

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. It does not work as a treatment for cervical smear abnormalities. The vaccine may provide some protection against progression of HPV infection to CIN 1 (the first pre-cancerous stage) though this is still being studied. 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 Gardasil vaccine 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 Gardasil 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 has been studied in clinical trials of over 20,000 women in many countries, before being approved for use in New Zealand.  

The most common side effects are local reactions at the injection site (eg, pain, redness, swelling), and headache and fever, which are mainly mild and usually disappear in a few days. Fainting after the injection can also occur in some people, and is thought to be due to anxiety. Very rarely, severe allergic reactions have been reported.

Is it safe in pregnancy?

The HPV vaccine is not licensed for use in pregnant women.

Who should not be vaccinated?

Some people are not recommended to have the HPV vaccine. These include:

• people who have a severe allergic reaction (anaphylaxis) to any part of the vaccine, including yeast
• pregnant women
• people who have a bleeding disorder or immune condition should seek medical advice before taking the vaccine.

Is regular cervical screening still required?

Yes, regular cervical screening is still required, 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.

More information

More information on the vaccine is available from the Immunisation Advisory Centre (see details under Further Information and Support below), and from the Ministry of Health website www.cervicalcancervaccine.govt.nz/. You can also talk to your doctor or practice nurse.

Related topics

Also see: Childhood immunisation and Cervical cancer causes and prevention

Original material provided by everybody, based on an article originally published in New Zealand Doctor by Dr Min Karen Lo, a sexual health physician in private practice in Auckland, 2006. Last updated by everybody, July 2011.