Human Papillomavirus
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papillomavirus

Human papillomavirus (HPV) is the most common reproductive system infection in the United States. There are more than 100 HPV types. Most types affect the skin, causing common warts. Some high-risk types of HPV are oncogenic (cancer-causing) and cause cervical cancer and other anogenital cancers. Cervical cancer does not develop in all women who are infected with high-risk types of HPV, but all women with cervical cancer have been infected with high-risk types of HPV. HPV is also associated with cancer of the vulva, vagina, penis, anus, and some head and neck cancers. Most people infected with HPV have no symptoms and the infection does not develop into cancer.

The human papillomavirus is spread person-to-person primarily through direct sexual contact. It also can be transmitted to infants during childbirth. HPV is a public health concern because scientists believe that most sexually active people will contract HPV before 50 years of age. Sexually active people can reduce their chances of HPV infection by properly and consistently using condoms or by being in a monogamous relationship with a non-infected partner.

It is important that women get routine Pap smears for cervical cancer screening. Routine screening can identify cancer early, when it is still curable. Because about 30% of cervical cancers are not prevented by HPV vaccine, sexually active women who have received HPV vaccine still need routine Pap smears.

About the Vaccine

There are two human papillomavirus (HPV) vaccines. Gardasil® contains the four types of HPV (6, 11, 16, and 18) that cause most cervical cancer and genital warts. Cervarix® contains the two types of HPV (16 and 18) that cause most cervical cancer. Upon completing the vaccine series, almost all recipients who have not been previously infected with HPV develop protective immunity to these HPV types. At this time only Gardasil® is approved for use in males.

HPV Vaccine Licensed for Use in the U.S

Product: Gardasil® (Human Papillomavirus Quadrivalent (Types 6, 11, 16, 18) Vaccine, Recombinant)
Manufacturer: Merck & Co
Year licensed: 2006
Product Insert

Product: Cervarix® (Human Papillomavirus Bivalent (Types 16 and 18) Vaccine, Recombinant)
Manufacturer: GlaxoSmithKline
Year licensed: 2009
Product Insert

Indications Contraindications and precautions
  • Gardasil is licensed for use among males and females 9 through 26 years of age.
  • Cervarix is licensed for use among females 10 through 25 years of age.
  • Routine HPV vaccination of females and males is recommended at 11 to 12 years of age, before most become sexually active.
  • Catch-up HPV vaccination is recommended for females who did not receive the vaccine at 11 to 12 years of age.
  • Catch-up HPV vaccination is recommended for males 13 through 21 years of age who have not been vaccinated or who have not completed the 3-dose series.
  • Males 22 through 26 years of age may be vaccinated, especially if immunocompromised or if male sexual partners.
  • People who have had a severe allergic reaction to yeast, any other component of HPV vaccine, or to a previous dose of HPV vaccine should not get the vaccine.
  • Females who are pregnant should not receive the vaccine.see footnotes below
  • People who are moderately or severely ill should wait until recovery before receiving any vaccine. Minor illnesses, such as a cold, are not a contraindication.
  • Males may not receive Cervarix.
Precautions:
  • People who have an impaired immune system (decreased ability to fight infection) can safely receive HPV vaccine; however, they may not develop adequate protection against the virus.

Footnote 1: During pregnancy, HPV appears to be safe for both the mother and the fetus, but it is still being studied. If a woman is found to be pregnant after a dose of HPV vaccine, the remainder of HPV vaccine doses should be delayed until after the pregnancy. Receiving HPV vaccine when pregnant is NOT a reason to consider terminating the pregnancy. Any woman who learns that she was pregnant after receiving Cervarix can call 888-452-9622 (for Cervarix). The pregnancy registry for Gardasil has closed. Information from these registries will help scientists learn how pregnant women respond to HPV vaccine.

Footnote 2: Females who are breastfeeding may safely receive HPV vaccine.

Vaccine Dose/Route Recommended Schedule Re-vaccination (booster)
Gardasil® Dose: 0.5 mL
Route: Intramuscular injection in people who have hemophilia, thrombocytopenia, or are on anticoagulation therapy.
Contains an aluminum component to enhance effectiveness, which is irritating to subcutaneous (fatty) tissue; avoid SQ injection.
0, 2, 6 months None
Cervarix® Dose: 0.5 mL
Route: Intramuscular injection in people who have hemophilia, thrombocytopenia, or are on anticoagulation therapy.
Contains an aluminum component to enhance effectiveness, which is irritating to subcutaneous (fatty) tissue; avoid SQ injection.
0, 1, 6 months None
HPV Side Effects
  • Swelling, pain, or redness at the injection site in up to 80% of recipients
  • Mild fever in about 25% of recipients
  • Itching at the injection site or moderate fever in less than 5% of recipients
  • Syncope has been reported among adolescents. Recipients should always be seated during administration and monitored for 15 to 20 minutes after vaccination.
  • Systemic symptoms of nausea, dizziness, myalgia, and malaise occur with equal frequency among both vaccine recipients and placebo recipients.
  • Severe allergic reaction (very rare)       
Product Name Supplied Storage and Handling
Gardasil®
Merck & Co.
0.5 mL single-dose vials (1 or 10 per package) and 0.5 mL single-dose prefilled syringes (6 per package) Store refrigerated between 2° to 8°C (35° to 46°F). Do not freeze. Discard if vaccine has been frozen.

Gardasil® is a sterile white, cloudy suspension. It contains inactive purified virus particles for HPV types 6, 11, 16, and 18. Shake vial/syringe well before administering. Thorough agitation is needed to maintain suspension of the vaccine.
Cervarix®
GlaxoSmithKline
0.5 mL single dose vials (1 or 10 per package) and 0.5 mL single dose prefilled syringes (1 or 5 per package) Store refrigerated between 2° to 8°C (35° to 46°F). Do not freeze. Discard if vaccine has been frozen.

Cervarix® is a sterile white, cloudy suspension. It contains inactive purified virus particles for HPV types 16 and 18. Shake vial/syringe well before administering. Thorough agitation is needed to maintain suspension of the vaccine.     
Quadrivalent Human Papillomavirus Vaccine Initiation, Coverage, and Compliance Among U.S. Active Component Service Women, 2006-2011 -  Consistent with ACIP recommendations, the DoD has made the HPV4 vaccine available to all eligible service members aged 17–26 years. Despite vaccine availability, utilization of the HPV4 vaccine by active component U.S. service women has been reported to be low.
AAP recommends immunization against human papillomavirus (HPV) for all 11- through 12-year-old children as part of the adolescent immunization program.
Learn about HPV and the HPV Vaccine; an interactive webcast, presented by Jay Montgomery, MD, of the VHC - Portsmouth.
COGARD PDF 06 Sep 12
HUMAN PAPILLOMAVIRUS (HPV) VACCINE FOR MALES
ALCOAST PDF 28 Mar 07
GARDASIL - HUMAN PAPILLOMAVIRUS (HPV) VACCINE
02 Jan 14

Sample Q&A: The Vaccine

Can I still receive HPV vaccine if I am already sexually active?
Yes you can still receive HPV vaccine. However, sexually active females may get less protection and benefit from the HPV vaccine because they may have already been exposed to the HPV virus.

The vaccine is currently approved for females aged 9-26 years old. For individual questions about the HPV vaccine you may contact a MILVAX-VHCN healthcare provider or send us an email message using our Ask VHC secure messaging system.
Package Insert - Vaccine
Package Insert - Vaccine
Cervarix 19 Oct 09
Bivalent Human Papillomavirus (Types 16 and 18) Recombinant Vaccine
Gardasil 09 Jun 06
Quadrivalent Human Papillomavirus (Types 6, 11, 16, 18) Recombinant Vaccine
Centers for Disease Control and Prevention
MMQC-13-2183 20 Dec 13
GARDASIL {Human Papillomavirus Quadrivalent (Types 6,11,16, and 18) Vaccine, Recombinant} / Merck
This 30-second animated video about HPV-related cancers has a positive reminder that with vaccination you can close the door to HPV cancer.
Vaccine Information Statement (Interim)
Vaccine Information Statement (Interim)
Author(s): Slade BA, Leidel L, Vellozzi C, Woo EJ, Hua W, Sutherland A, Izurieta HS, Ball R, Miller N, Braun MM, Markowitz LE, Iskander J
Publication: JAMA, Vol 302, No. 7
Subject: Vaccine-Safety
Disease: 
Human Papillomavirus