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. There are currently 3 HPV vaccines available in Canada: 9-valent, bivalent, and quadrivalent. The 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 the bivalent vaccine containing the 2 most common virus types associated with anogenital cancer (16, 18) or the 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 aged 9 to 12 years, prior to the onset of sexual activity, and is approved for women ≤45 years and men ≤26 years. Certain at-risk populations outside these age groups may also benefit from HPV vaccine (eg, MSM). All women should be routinely monitored and screened for cervical cancer regardless of HPV immunization.

3. Contraindications: Hypersensitivity to vaccine components, pregnancy.

4. Immunization schedule: The primary vaccination series may be given in 2-dose (for those starting between 9-14 years) or 3-dose schedules (≥15 years) administered IM in the deltoid muscle. The second dose is administered ≥1 month after the first dose, and the third dose, when needed, is administered ≥4 months after the first dose. Barriers to vaccination include 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.