The Vaccines
[/trx_title]There are currently two vaccines which protect against HPV infection. These are called Gardasil and Cervarix. Cervarix is only for women.
- Gardasil9 is designed to protect against nine different types of HPV.
- HPV types 12, 18, 31, 33, 45, 52 and 58 that cause cervical cancer
- HPV types 16, 18, 31, 33, 45, 52, 58 that cause vulvar and vaginal cancer
- HPV types 16, 18, 31, 33, 45, 52 and 58 that cause anal cancer
- HPV types 6 and 11 that cause genital warts
- HPV types 6, 11, 16, 18, 31, 33, 45, 52 and 58 that cause abnormal and precancerous anal lesions
- HPV types 6, 11, 16, 18, 31, 33, 45, 52 and 58 that cause abnormal and precancerous cervical, vaginal, and vulvar lesions
- Cervarix is designed to protect against HPV types 16 and 18. It also helps protect females between that ages of 10 and 25 against precancerous conditions and cancers of the cervix.
Both vaccines are licensed in Canada.
The HPV vaccine works best if given before a person comes into contact with HPV, as the virus is transmitted through skin to skin sexual contact below the waistline even without penetration with fingers, mouths or other body parts, also condoms do not fully protect people from giving/getting this virus because the condom only covers the length of the penis and there are still other parts below the waist that will have direct skin to skin contact. To be clear, a person comes into contact with this virus when using their mouth, hands, or fingers below the waistline of a partner. As previously mentioned, this also includes putting a penis or an object in a vagina or a butt, and rubbing against each other with skin to skin contact below the waistline even without any penetration.
In practical terms, the easiest and most effective way to reach everybody is for girls and boys to be vaccinated before they are sexually active. In Canada, the vaccination programs for HPV are implemented for girls and boys in schools between grades 5 and 8 depending on the province.
Vaccines are given by injection into the muscle, usually the upper arm. Two separate doses are needed. The second dose should be given anytime between six to 12 months after the first, but it can be given up to 24 months after.
There is some evidence that the HPV vaccines provide cross protection for other types of HPV which may mean that it has a higher protection level than first thought [1] [2] [3]. Research indicates that the HPV vaccine could prevent two thirds of cervical cancers in women aged below 30 by 2025 but only if uptake of the HPV vaccination is at 80% [4].
The Vaccination Program
[/trx_title]The Canadian national HPV immunization program was introduced into schools in 2007, 2008, 2009 and 2010 depending on the province. This program is offered to boys and girls (depending on the province and territory) and first vaccination occurs between grades 4 and 8 depending on location. (An Advisory Committee Statement (ACS) National Advisory Committee on Immunization (NACI)† Update on Human Papillomavirus (HPV) Vaccines)).
The vaccines are over 98% effective in preventing cervical abnormalities associated with HPV 16 and 18 in women who have all three doses and in those who have not yet been infected with HPV [1][2][3][4]. However, efficacy is decreased if the vaccinated woman has already contracted the virus. Recent research shows that antibody response to two doses in adolescent girls is as good as a three dose course in the age group.
More information on the HPV vaccination program:
https://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/12vol38/acs-dcc-1/index-eng.php
If you are not eligible for the free vaccine you can pay for it privately. Some local pharmacists also offer the vaccine. Talk to your healthcare provider about the HPV vaccine.
The HPV vaccination will help reduce the number of cases of HPV related cancers and the number of individuals who have to be treated for genital warts or HPV-related cancers. Whether girls/women have been vaccinated or not, the best protection against cervical cancer is to continue going for regular Pap tests and HPV tests for women over 30. The combination of HPV vaccination and cervical screening can help reduce cervical cancer incidence in Canada.
Human papillomavirus immunization programs by province/territory :
| Province/Territory | Routine Schedule for girls- 1,2 and 6 months (Year of implementation) | Routine Schedule for boys (Year of implementation) | Catch-up program for girls | Catch-up programs for boys | Other Information – Updated 2020 |
|---|---|---|---|---|---|
| British Columbia | Grade 6 (2008) | Grade 6 (2017) | – Females and males (born in 2006 or later) vaccination initiated before 19 and catch up to 26 (2020) | – Females and males (born in 2006 or later) vaccination initiated before 19 and catch up to 26 (2020) | High Risk Program: HIV+ (9-26). Transgender 9-26. (2020) |
| Alberta | -Grade 6 (2020) | -Grade 6(2020) | – Students eligible to receive vaccine in Grade 6 continue to be eligible to receive the vaccine up to and including 26 years of age; Males and females 17 years up to and including 26 years of age (2020) | -Students eligible to receive vaccine in Grade 6 continue to be eligible to receive the vaccine up to and including 26 years of age; Males and females 17 years up to and including 26 years of age (2020) | – High Risk Program: Hematopoletic Stem Cell Transplant recipient: Less inclusive as catch-up program; Organ transplant candidates and recipients: less inclusive as catch-up program (2020) |
| Saskatchewan | -Grade 6 (2008) | -Grade 6 (2017) | – Females born since 1996 (2020) – Females and males younger than 27 years old with specific medical conditions. Publicly funded immigrant and Refugee immunization | – Males born since 2006 Females and males younger than 27 years old with specific medical conditions. Publicly funded immigrant and Refugee immunization | High Risk Program: HIV+ males (9-17) (2020) |
| Manitoba | Grade 6 (2008) | Grade 6 (2016) | – Females born 1997or later (2020) can get up to 3 doses, if they missed the Grade 6 program. – Females born between 1986 and 2005 with an increased risk if HPV infection are eligible for the 3 doses, if they started the vaccine series before March 31, 2014. – Females who are immunocompromised or HIV-positive and born during or after 1997 are also eligible to receive 3 doses. | – Grades 8+9 (2016) – Males born 2002 or later (2020) | – High Risk Program: HIV + and immunocompromised Males 9-26 years of age Females 9 -45 yeas of age. Dx RRP (past or present); Men<18 incarcerated (past or present), Gay, bisexual male & Transgender 9-26; Sexual assault victims Males: 9-26/Females:9-45 Females 9-45 with new high-grade cervical histopathology (2020) |
| Ontario | Grade 7 (2007) | Grade 7 (2016) | – Until Grade 12 (2020) – Girls starting Grade 8 in the 2016-17 school year will be able to receive the vaccine. | – Until Grade 12 (2020) | High Risk Program: High Risk Males 9-26 -Those with multiple sex partners up to 26 (2020) |
| Quebec | Grade 4 (2008) | – Grade 4 (2016) – Also, men 26 years old and younger, who have sex with other men can get the HPV vaccine free of charge. (2016) | – Until age 18 | – Until age of 18 | High Risk Program: Immunocompromised men or women (9-26) (2020) |
| New Brunswick | Grade 7 (2008) | Grade 7 (2017) | — | — | |
| Nova Scotia | Grade 7 (2007) | Grade 7 (2015) | — | — | High Risk Program: HIV and MSM 9-45 (2020) |
| Prince Edward Island | Grade 6 (2007) | Grade 6 (2013) | – Individuals who missed the HPV immunization in Grade 6 since 2007 (2020) | – Individuals who missed the HPV immunization in Grade 6 since 2007 (2020) | High Risk Program: Adult males: 18-26 with following risk factors: – having unprotected sex with multiple partners (male and female) -history of genital warts – individuals who missed the HPV immunization in Grade 6 since 2012 Men who have sex with men (MSM) and for immunocompetent males and females who have HIV regardless of age. Adult females: 18-45 with the following risk factors – having unprotected sex with multiple partners (male and female) – history of genital warts – an abnormal PAP test (2020) |
| Newfoundland and Labrador | – Grade 6 (2007) | – Grade 6 (2017) | — | — | |
| Northwest Territories | – Grade 4, 5 or 6 *9-14 yrs: 2 doses *15 yrs +: 3 doses | — Grade 4, 5 or 6 | – Males and Females 9-26 (2020) | – Males and Females 9-26 (2020) | It is important to note that the GNWT’s Immunization schedule for HPV vaccine is very comprehensive. The Northwest Territories (NWT) Immunization schedule allows for health care professionals to offer the HPV vaccine in school at grade 4, 5 or 6 and again in grade 7 as a catch-up to ensure students have every opportunity to have access to the vaccine in school. The HPV vaccine is not limited to students in these age groups. For example; if a student moves to the NWT at a different grade, or a parent changes their mind and would like their child vaccinated, they are encouraged to book an appointment at a local public health unit or community health centre at to receive the vaccine |
| Yukon | – Grade 6 (2008-09) | Grade 6 (2017) | – Females age 15-18 | — | High Risk Program: Males and Females HIV+ (age 9-45) Males high risk (9-26); MSM; Street involved (2020) |
| Nunavut | – Grade 6 (2010) or more than 9 years old | -Grade 6 or more than 9 years old (2020) | — | — |
Advisory Committee Statement (ACS) and National Advisory Committee on Immunization (NACI). (2012). Update on Human Papillomavirus (HPV) Vaccines. Canada Communicable Disease Report. Vol. 38
Side Effects Caused by Vaccination
[/trx_title]Thousands of girls and women of different ages took part in the clinical trials for the HPV vaccines [1]. These trials found that the vaccine offers 98% protection against infection with the high-risk types of HPV in girls who haven’t previously been infected with the virus. Side effects from both vaccines are usually mild.
Side effects for the Gardasil HPV vaccine include [2]:
Very common side effects (side effects which may occur in more than one per 10 doses of vaccine) reported by girls who have received the vaccine are:
- Injection site problems such as redness, bruising, itching, swelling, pain or cellulitis
- Headaches
Common (side effects which may occur in less than one per 10 but more than one per 100 doses of vaccine):
- Fever
- Nausea (feeling sick)
- Painful arms, hands, legs or feet
Rare (side effects which may occur in less than one per 100 but more than one per 1,000 doses of vaccine):
- More than one in 10,000 people who have the Gardasil HPV vaccine experience:
- An itchy red rash (urticaria)
- Fewer than 1 in 10,000 people who have the Gardasil HPV vaccine experience:
- Restriction of the airways and difficult breathing (brochospasm)
For information on side effects for the HPV Vaccine, please see these websites:
References
The Vaccines.
- Wheeler C. et al., 2009. The Impact of Quadrivalent Human Papillomavirus (HPV; Types 6, 11, 16, and 18) L1 Virus-Like Particle Vaccine on Infection and Disease Due to Oncogenic Nonvaccine HPV Types in Sexually Active Women Aged 16-26 Years. J Infect Dis, 199(7), 936-44.
- Szarewski A. 2008. HPV vaccines: peering through the fog. Journal of Family planning and Reproductive Health Care 34(4), 207-209.
- Malagon T. et al., 2012. Cross-proective efficacy of two human papillomvirus vaccines: a systematic review and meta-analysis. The Lancet Infectious Diseases 12, 781-789.
- Cuzick J, Castanon A, and Sasieni P. 2010. Predicted impact of vaccination against human papillomavirus 16/18 on cancer incidence and cervical abnormalities in women aged 20–29 in the UK. British Journal of Cancer 102, 933-939.
The Vaccination Program.
- Paavonen J. et al., 2009. Efficacy of human papillomavirus (HPV) -16/18 AS04- adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA): final analysis of a double-blind, randomised study in young women. The Lancet, 374 (9686), 301-14.
- Szarewski A. 2012. Cervarix®: a bivalent vaccine against HPV types 16 and 18, with cross-protection againstother high-risk HPV types. Expert Rev. Vaccines 11(6), 645–657.
- Dillner J. et al., 2010. Four year efficacy of prophylactic human papillomavirus quadrivalent vaccine against low grade cervical, vulvar, and vaginal intraepithelial neoplasia and anogenital warts: randomised controlled trial. BMJ 341: c3493. Available online: https://www.bmj.com/content/341/bmj.c3493. Accessed 03.05.2013.
- Kjaer S. et al., 2009. A pooled analysis of continued prophylactic efficacy of quadrivalent human papillomavirus (Types 6/11/16/18) vaccine against high-grade cervical and external genital lesions. Cancer Prevention Research 2 (10), 868-878.
Side Effects Caused by Vaccination.
- Schiller JT. et al. 2008. An update of prophylactic human papillomavirus L1 virus-like particle vaccine clinical trial results. Vaccine, 26 (10), K53-61.
- NHS choices website: https://www.nhs.uk/Conditions/HPV-vaccination/Pages/Side-effects.aspx. Accessed 03.05.2013.