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HPV Vaccine

May 30, 2015

We now know that almost all cervical cancers and cervical dysplasias (precancerous changes of the cervix) are caused by the human papilloma virus (HPV).  Since the mid-1900’s, we have screened women with pap smears to look for these precancerous changes to prevent cervical cancer.  Pap smear screening was a resounding success and cervical cancer deaths decreased dramatically.  The downside was yearly testing for all women and that most women would have an abnormal pap test at some time in their lives and need biopsies and repeated evaluation--many of those to prevent cancer (yay!) but often for changes that would have resolved on their own with time (not so good).

In the past decade, pap smear co testing combined with HPV testing became available.  Now we could stop repeatedly testing women who are HPV negative and thus not at risk for cervical disease.  We could start focussing our testing, evaluation and treatment on women who were HPV positive, the women who were actually at risk for disease.  

But we were still chasing the horse after it had escaped from the barn.  Human papilloma virus is transmitted by skin to skin contact during sexual activity.  While condom use can decrease transmission, it does not totally prevent it.  And, of course, people who are trying to get pregnant will not be using condoms.

The bottom line was that something was needed to prevent acquisition of HPV in the first place.  In April of 2006, the HPV vaccine became available.  The vaccine is most effective if administered prior to the onset of sexual activity, although women who are already sexually active before being offered the vaccine do obtain protection also.  The vaccine is approved and covered by insurance for females aged 9-26 and males aged 9-15 in the US.  In New Zealand and Australia, where HPV vaccination of girls has been school based and free for almost a decade and HPV vaccination of boys included since 2013, the incidence of HPV and cervical cancer has decreased by about 75%.  This is an amazingly successful vaccination program.  In the US, where fewer than 50% of people eligible for the vaccine have received it, there is still a large decrease in the incidence of HPV and cervical cancer.  If we were to obtain higher vaccination rates, we would be even more successful.

The most recent HPV vaccine to be approved is Gardasil 9.  It was approved for use by the FDA on December 10, 2014.  Gardasil 9 protects against infection by HPV 6, 11, 16, 18, 31, 33, 45, 52 and 58.

Gardasil 9 is approved for use in females aged 9-26 and males aged 9-15.  Gardasil 9 protects against cancer and pre-cancerous changes caused by HPV in the cervix, vagina, vulva and anus.  While Gardasil 4 (protects against HPV 6, 11, 16 and 18) and Cervarix  (protects against HPV 16 and 18) are still available and approved for use the the FDA, the greatest protection against HPV infection and the cervical changes it causes will be achieved with Gardasil 9.  

The Gardasil vaccines also protect against transmission of HPV 6 and 11, the strains that cause genital warts.  While genital warts are not life-threatening, anybody who has had them knows that it is not fun to undergo treatment. These can be prevented by getting the vaccine before the onset of sexual activity.

Many people are worried about the side effects of getting the vaccine.  The biggest side effect is pain at the injection site.  Other minor side effects can be minor muscle aches, nausea, vomiting, dizziness or fainting directly after getting the vaccine.  These other side effects are very, very rare. Over 67 million doses of the vaccine were given between 2006 and 2014 (almost all of them Gardasil).  About 30,000 adverse events were reported.  That is about 4/10,000 or much, much less than one percent for all side effects.  “Serious adverse events” have only been reported in about 4/100,000 doses given.  The general incidence of stroke in young women is about 4/100,000.  The general incidence of Guillain Barre in young women is about 2/100,000.  So, getting the vaccine does not increase the baseline risk of serious neurologic events at all over the baseline.  Nine years of general vaccine use and 67 million doses should provide reassurance for anyone who is worried about getting the vaccine.

You can prevent cervical cancer!  If you are a young woman (or a young man), get vaccinated!  If you are the parent of a teen, get your child vaccinated!

As always, you should talk to your doctor about your specific health situation before getting any medical treatment.