Two vaccines are available to prevent the human papillomavirus (HPV) types that cause most cervical cancers. These vaccines are Cervarix (GlaxoSmithKline) and Gardasil (Merck). One of the HPV vaccines, Gardasil, also prevents genital warts as well as anal, vulvar and vaginal cancers. Both vaccines are given in 3 shots over 6 months.
Why the HPV vaccine is important
Genital HPV is a common virus that is passed from one person to another through direct skin-to-skin contact during sexual activity. Most sexually active people will get HPV at some time in their lives, though most will never even know it. HPV infection is most common in people in their late teens and early 20s. There are about 40 types of HPV that can infect the genital areas of men and women. Most HPV types cause no symptoms and go away on their own. But some types can cause cervical cancer in women and other less common cancers— like cancers of the anus, penis, vagina, and vulva (area around the opening of the vagina) and oropharynx (back of throat including base of tongue and tonsils). Other types of HPV can cause warts in the genital areas of men and women, called genital warts. Genital warts are not a life-threatening disease. But they can cause emotional stress and their treatment can be very uncomfortable. Every year, about 12,000 women are diagnosed with cervical cancer and 4,000 women die from this disease in the U.S. About 1% of sexually active adults in the U.S. have visible genital warts at any point in time.
Which girls/women should receive HPV vaccination?
HPV vaccination is recommended with either vaccine for 11 and 12 year-old girls. It is also recommended for girls and women age 13 through 26 years of age who have not yet been vaccinated or completed the vaccine series; HPV vaccine can also be given to girls beginning at age 9 years.
Will sexually active females benefit from the vaccine?
Ideally females should get the vaccine before they become sexually active and exposed to HPV. Females who are sexually active may also benefit from the vaccine, but they may get less benefit from it. This is because they may have already gotten one or more of HPV types targeted by the vaccines. However, few sexually active young women are infected with all HPV types prevented by the vaccines, so most young women could still get protection by getting vaccinated.
Can pregnant women get the vaccine?
The vaccines are not recommended for administration to pregnant women. Although studies show that HPV vaccines do not cause problems for babies born to women who received HPV vaccination when pregnant, more research is still needed. A pregnant woman should not get any doses of either HPV vaccine until her pregnancy is completed.
Getting the HPV vaccine when pregnant is not a reason to consider ending a pregnancy. If a woman realizes that she got one or more shots of an HPV vaccine while pregnant, she should do two things:
- Wait until after her pregnancy to finish the remaining HPV vaccine doses.
- Call the pregnancy registry [800-986-8999 for Gardasil or 888-452-9622 for Cervarix]. These pregnancy registries help us learn more about how pregnant women respond to each of the vaccines.
Should girls and women be screened for cervical cancer before getting vaccinated?
Girls and women do not need to get an HPV test or Pap test to find out if they should get the vaccine. However it is important that women continue to be screened for cervical cancer, even after getting all 3 shots of either HPV vaccine.
Effectiveness of the HPV Vaccines
The vaccines target the HPV types that most commonly cause cervical cancer. One of the vaccines also protects against the HPV types that cause most genital warts. Both vaccines are highly effective in preventing specific HPV types and the most common health problems from HPV.
The vaccines are less effective in preventing HPV-related disease in young women who have already been exposed to one or more HPV types. That is because the vaccines can only prevent HPV before a person it is exposed to it. HPV vaccines do not treat existing HPV infections or HPV-associated diseases.
How long does vaccine protection last?
Research suggests that vaccine protection is long-lasting. Current studies (with up to about six years of follow-up data) indicate that the vaccines are effective, with no evidence of decreasing immunity.
What does the vaccine not protect against?
The vaccines do not protect against all HPV types— so they will not prevent all cases of cervical cancer. About 30% of cervical cancers will not be prevented by the vaccines, so it will be important for women to continue getting screened for cervical cancer (regular Pap tests). Also, the vaccines do not prevent other sexually transmitted infections (STIs). So it will still be important for sexually active persons to lower their risk for other STIs.
Will girls and women be protected against HPV and related diseases, even if they don’t get all 3 doses?
It is not yet known how much protection girls and women get from receiving only one or two doses of an HPV vaccine. So it is very important that girls and women get all 3 doses.
Safety of the HPV vaccine
Both vaccines have been licensed by the Food and Drug Administration (FDA) for females aged 9 through 26 years and approved by CDC as safe and effective. Both vaccines were studied in thousands of people around the world and vaccine safety continues to be monitored by CDC and the FDA. These studies showed no serious safety concerns. Common, mild adverse events reported during these studies include pain where the shot was given, fever, dizziness, and nausea.
Fainting can occur after any medical procedure, including vaccination. Recent data suggest that fainting after any vaccination is more common in adolescents. Falls and injuries can occur after fainting. Adolescents and adults should be seated or lying down during vaccination. Sitting or lying down for about 15 minutes after a vaccination can help prevent fainting and injuries.
More than 35 million doses of HPV vaccine have been distributed in the United States as of June, 2011. Almost all doses distributed have been Gardasil.
Why is HPV vaccination only recommended for women through age 26?
HPV vaccines are licensed and recommended for females through age 26 years. Vaccination would have the greatest benefit when administered to girls. As in trials in younger women, a clinical trial of quadrivalent vaccine in women >26 years found the vaccine to be safe. This study also showed that the vaccine was effective in women without evidence of existing or past infection with HPV vaccine types. However, the study demonstrated no protection against disease in the overall study population. Neither vaccine is licensed in the United States for use in women over the age of 26 years. Although women over age 26 years are not recommended to receive HPV vaccination, they should have cervical cancer screening as currently recommended.
What about vaccinating boys and men?
The quadrivalent vaccine is also safe and effective for males ages 9 through 26 years. It is licensed by the FDA for prevention of anal cancer and genital warts. Since October 2009, the CDC’s Advisory Committee on Immunization Practice’s guidance has been that the 3-dose series of quadrivalent HPV vaccine may be given to males aged 9 through 26 years to reduce their likelihood of acquiring genital warts. The vaccine is not routinely recommended for administration to males.
Cost and Paying for the HPV vaccine
As of July 18, 2011, the retail price of the vaccine is about $130 per dose ($390 for full series).
Is HPV vaccine covered by insurance plans?
Most health insurance plans cover the cost of vaccines, but you may want to check with your insurance provider before going to the doctor. If you don't have insurance, or if it does not cover vaccines, the Vaccines for Children (VFC) program may be able to help.
How can I get help paying for HPV vaccine?
The Vaccines for Children (VFC) program helps families of eligible children who might not otherwise have access to vaccines. The program provides vaccines at no cost to doctors who serve eligible children. Children younger than 19 years of age are eligible for VFC vaccines if they are Medicaid-eligible, American Indian, or Alaska Native or have no health insurance. "Underinsured" children who have health insurance that does not cover vaccination can receive VFC vaccines through Federally Qualified Health Centers or Rural Health Centers. Parents of uninsured or underinsured children who receive vaccines at no cost through the VFC Program should check with their healthcare providers about possible administration fees that might apply. These fees help providers cover the costs that result from important services like storing the vaccines and paying staff members to give vaccines to patients. However, VFC vaccines cannot be denied to an eligible child if a family can’t afford the fee.
What vaccinated girls/women need to know: will girls/women who have been vaccinated still need cervical cancer screening?
Yes, vaccinated women will still need regular cervical cancer screening (Pap tests) because the vaccines protect against most but not all HPV types that cause cervical cancer. Also, women who got the vaccine after becoming sexually active may not get the full benefit of the vaccine if they had already acquired HPV.
Other ways to prevent Cervical Cancer
Regular cervical cancer screening and follow-up can prevent most cases of cervical cancer. The Pap test can detect cell changes in the cervix before they turn into cancer. Pap tests can also detect most, but not all, cervical cancers at an early, treatable stage. Most women diagnosed with cervical cancer in the U.S. have either never had a Pap test, or have not had a Pap test in the last 5 years. There are HPV tests that can tell if a woman has HPV on her cervix, but the HPV tests on the market should only be used to help screen women at certain ages and to help health care providers assess women with certain Pap test findings for cervical cancer. These tests can be used with the Pap test to help your doctor determine next steps in cervical cancer screening.
Are there other ways to prevent HPV?
For those who are sexually active, condoms may lower the chances of getting HPV, if used with every sex act, from start to finish. Condoms may also lower the risk of developing HPV-related diseases (genital warts and cervical cancer). But HPV can infect areas that are not covered by a condom—so condoms may not fully protect against HPV.
People can also lower their chances of getting HPV by being in a faithful relationship with one partner; limiting their number of sex partners; and choosing a partner who has had no or few prior sex partners. But even people with only one lifetime sex partner can get HPV. And it may not be possible to determine if a partner who has been sexually active in the past is currently infected. That's why the only sure way to prevent HPV is to avoid all sexual activity.