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Immunizations - Human Papillomavirus (HPV)

Description

An in-depth report on the purpose of immunizations and recommended schedules.

Alternative Names

Measles; Rubella; Tetanus; Vaccinations; Whooping cough

Human Papillomavirus (HPV):

In 2006, the U.S. Advisory Committee on Immunization Practices (ACIP) voted to recommend the use of the first vaccine (Gardasil) to protect against 4 types of the human papillomavirus (HPV). This group of 100 viruses, about 40 of which are sexually transmitted. Some HPV viruses can significantly increase the risks of cervical cancer, as well as cancers of the vulva, vagina, anus, and penis.

HPV is a very common virus; an estimated 20 million people in the U.S. have it. At least half of all sexually active men and women will eventually develop the virus.

The Gardasil vaccine is 100% effective against cervical, vaginal, and vulvar diseases caused by 4 types of HPV (6, 11, 16, and 18). Of note, Gardasil prevents cervical cancer caused by HPV strains 16 and 18, which account for 70% of cervical cancer cases in the United States. It is less effective in women who were exposed to the virus before they were vaccinated. The vaccine has been shown to be effective for 5 years after women receive the initial dose. In September 2008, the FDA also approved Gardasil for the prevention of vaginal and valvular cancers caused by HPV 16 and 18.

Who Should be Vaccinated for HPV?

Girls ages 11 - 12 should get the vaccine, but they can get it as early as age 9. Adolescents and women ages 13 - 26 also should get the vaccine if they haven't already received it. Young women should ideally get the vaccine before they are sexually active, but it is still effective in sexually active women who haven't yet been infected with HPV. Currently there is no research to confirm the vaccine's effectiveness in women over 26, so there is no recommendation yet for this age group. Gardasil is not recommended for pregnant women.

Young women should get 3 doses of the vaccine. They should get the second dose 2 months after the first dose, and the third dose 6 months after the first dose.

Side Effects

Studies have shown no significant side effects from the HPV vaccine. The most common side effect was soreness at the injection site.

Resources

www.immunize.org -- Immunization Action Coalition
www.cdc.gov/vaccines/ -- The National Immunization Program
www.fda.gov/cber/vaers/vaers.htm -- Vaccine Adverse Event Reporting System
www.hrsa.gov/vaccinecompensation/ -- National Vaccine Injury Compensation Program
www.immunizationinfo.org -- The National Network for Immunization Information
www.vaccine.chop.edu -- Vaccine Education Center, Children's Hospital of Philadelphia
www.vaccinesafety.edu -- Institute for Vaccine Safety, Johns Hopkins School of Public Health
www.whathealth.com -- National Partnership for Immunization
www.immunofacts.com -- Information on vaccinations
www.vaccines.org -- The Vaccine Page

References

American Academy of Pediatrics Committee on Infectious Diseases. Prevention and control of meningococcal disease: recommendations for use of meningococcal vaccines in pediatric patients. Pediatrics. 2005 Aug;116(2):496-505.

Centers for Disease Control and Prevention. Recommended Immunization Schedule for Ages 0 - 6 Years, United States, 2009.

Centers for Disease Control and Prevention. Recommended Immunization Schedule for Ages 7 - 18 Years, United States, 2009.

Centers for Disease Control and Prevention. Recommended Immunization Schedule for Adults, United States, 2009. Available online.

Centers for Disease Control and Prevention. Revised Recommendations of the Advisory Committee on Immunization Practices to Vaccinate All Persons Aged 11 - 18 Years with Meningococcal Conjugate Vaccine. Morbidity and Mortality Weekly Report. 2007:56(31);794-795.

Centers for Disease Control and Prevention. Notice to Readers: Recommendation from the Advisory Committee on Immunization Practices (ACIP) for Use of Quadrivalent Meningococcal Conjugate Vaccine (MCV4) in Children Aged 2 - 10 Years at Increased Risk for Invasive Meningococcal Disease. Morbidity and Mortality Weekly Report. 2007;56(48);1265-1266.

Centers for Disease Control and Prevention. Prevention of influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008. Morbidity and Mortality Weekly Report. 2008:57(No. RR-7).

Centers for Disease Control and Prevention. Update on Hib Vaccine Shortage. October 22, 2008. Available online.

Chaves SS, Gargiullo P, Zhang JX, Civen R, Guris D, Mascola L. Loss of vaccine-induced immunity to varicella over time. NEJM. March 15, 2007;356:1121-1129.

Garland SM, Hernandez-Avila M, Wheeler CM, Perez G, Harper DM, Leodolter S, et al. Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. NEJM. May 10, 2007;356:1928-1943.

GlaxoSmithKline. Boostrix Prescribing Information. December, 2008.

Grijalva CG, Nuorti JP, Arbogast PG, Martin SW, Edwards KM, Griffin MR. Decline in pneumonia admissions after routine childhood immunisation with pneumococcal conjugate vaccine in the USA: a time-series analysis. Lancet. April 7, 2007;369:1179-1186.

Poehling KA, Szilagyi PG, Crijalva CG, Martin SW, LaFleur B, Mitchel E, et al. Reduction of frequent otitis media and pressure-equalizing tube insertions in children after introduction of pneumococcal conjugate vaccine. Pediatrics. April 4, 2007;119:707-715.

US Food and Drug Administration. FDA Approves Expanded Uses for Gardasil to Include Preventing Certain Vulvar and Vaginal Cancers. September 12, 2008.

US Food and Drug Administration. FDA Approves New Vaccine to Prevent Gastroenteritis Caused by Rotavirus. April 3, 2008.

US Food and Drug Administration. Zostavax Questions and Answers. Available online. Last Accessed 3/12/2009.

World Health Organization. Immunization surveillance, assessment and monitoring -- United States of America (the) reported cases. Last Updated: December 18, 2008. Available online.

Zuckerman JN. Protective efficacy, immunotherapeutic potential, and safety of hepatitis B vaccines. J Med Virol. 2006 Feb;78(2):169-77.

Reviewed last on: 3/23/2009
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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