Vaccines: Human Papillomavirus

Consultation with local immunization guidelines is required as recommendations and coverage differ. In most provinces in Canada vaccination is provided free of cost to boys and girls before grade 8 with catch-up programs in high school and to men who have sex with men (MSM) and are <27 years old.

Specific vaccination recommendations vary among countries or even within a given country. Local or country-specific guidelines should be consulted.

1. Vaccines: Human papillomavirus (HPV) vaccines are noninfectious vaccines containing recombinant HPV proteins. The currently recommended 9-valent vaccine covers virus types 16, 18, 31, 33, 45, 52, and 58 (responsible for most anogenital cancers), as well as virus types 6 and 11 (responsible for genital warts). In some countries only a bivalent vaccine containing the 2 most common virus types associated with anogenital cancer (16, 18) or a quadrivalent vaccine covering virus types 6, 11, 16, and 18 may be available.

2. Indications: HPV vaccination is recommended as primary prophylaxis of cervical cancer, anal cancers, vulvar and vaginal cancers, head and neck cancers, and oropharyngeal cancers, as well as precancerous lesions and genital warts. Vaccination is recommended for both girls and boys and women and men aged 9 to 26 years, ideally prior to the onset of sexual activity, and is licensed for individuals aged ≤45 years. All women should be routinely monitored and screened for cervical cancer regardless of HPV immunization.

3. Contraindications: Hypersensitivity to vaccine components.

4. Immunization schedule: The primary vaccination series may be given in a 1-dose, 2-dose, or 3-dose schedule, administered IM in the deltoid muscle. Jurisdictional vaccine schedules should be consulted. Barriers to vaccination include cost, perception that the vaccine is not needed, and concerns regarding safety, which could be addressed by a health care provider following an HPV vaccine communication plan.

5. Adverse events: The most common adverse events following immunization are mild to moderate injection-site reactions and muscle pain, which resolve within a few days. Systemic adverse events such as fatigue, myalgia, and headache are unlikely to be vaccine related. Serious adverse events are rare and not clearly associated with vaccination. There is no evidence to support increased sexual activity in children or adolescents who have received the vaccine, and there is no increased risk of autoimmune disorders.