Overview

It is estimated that 36,500 individuals in the United States are diagnosed with HPV-related cancer each year, including both men and women. Although cervical cancer is the most well-known of these cancers, there are other types as well. HPV vaccinations have the potential to prevent over 90% of these cancer cases, which would be approximately 33,700 cases each year in the United States.¹ Cervical cancer is the only HPV-related cancer with a recommended screening test for early detection. Other HPV-related cancers may not be detected until they progress to a later stage and cause health problems. Even with screening efforts, HPV causes roughly 11,000 cases of cervical cancer and 4,000 deaths from cervical cancer each year in the United States.² Additionally, there are an estimated 196,000 cases of cervical precancer each year in the United States.³ Treatment for cervical cancer and precancer may potentially impact an individual’s ability to have children. In addition to cervical cancer, there are other types of HPV-related cancer, including oropharyngeal, anal, vulvar, vaginal, and penile. Recommended cancer screening tests are not yet available for these cancers, and they may go undetected until they cause severe health problems.⁴

Vaccine Information

The CDC suggests that children aged 11 or 12 years receive HPV vaccination to safeguard against HPV infections that may lead to some cancers later in life. Vaccination can also commence at age 9 and is advised for individuals up to 26 years of age who failed to receive adequate vaccination during their early years. Recent studies indicate that healthcare professionals are the most reliable source of information regarding the HPV vaccine, according to parents. Therefore, the CDC encourages health care professionals to suggest HPV vaccination the same way they suggest other vaccinations for adolescents, on the same day in the same manner.⁵

HPV Vaccine Recommendations

The HPV vaccine is typically recommended for individuals aged 11 or 12 years, and can be initiated from as early as 9 years of age. The Advisory Committee on Immunization Practices (ACIP) also advises vaccination for anyone up to 26 years old if they have not received sufficient vaccination doses in their youth. The number of doses required for the HPV vaccine is dependent on age.⁶ Adults over 26 years old are normally not recommended for this vaccine. However, people aged 27 to 45 who were not adequately vaccinated when younger might consider receiving the HPV vaccine after consulting their health care provider. Nevertheless, individuals in this age group may receive fewer benefits due to exposure to HPV. Clinicians are advised to discuss the possibility of HPV vaccination for adults aged 27 to 45 who are at higher risk of contracting HPV. It is vital to note that while HPV vaccination can aid in preventing new HPV infections, it does not address present HPV infections or diseases. The HPV vaccine is most effective when administered before HPV exposure. While sexually active adults are expected to have contracted HPV, not all forms can be prevented, although individuals in long-term, monogamous relationships are less likely to contract the virus.

Dosing Schedules

Most individuals who choose to undergo the HPV vaccine series before they turn 15 years old are expected to complete it in two doses. The second dose should be given 6 to 12 months after the initial one. If an adolescent receives 2 doses less than 5 months apart, they will require a third dose to complete the HPV vaccination series. However, individuals aged 15 to 26 years and those who are immunocompromised must complete the 3-dose HPV vaccination series. The recommended schedule for this series is 0, 1-2, and 6 months. People aged 9-26 years who are immunocompromised, including individuals with HIV infection, are required to have 3 doses of the HPV vaccine.

HPV Vaccination and Pregnancy

The HPV vaccine is not recommended for administration during pregnancy. Individuals who are pregnant should postpone initiation of the vaccination series until after their pregnancy is over. However, there is no need for pregnancy testing prior to vaccination. Although there is no evidence linking HPV vaccines to adverse pregnancy outcomes or adverse events to the developing fetus in case of inadvertent vaccination during pregnancy, pregnant individuals have not been studied in clinical trials regarding HPV vaccinations. If an individual discovers that they are pregnant after commencing their HPV vaccine series, they should delay their second and/or third doses until after their pregnancy is over.

Vaccine Safety

Scientific research has shown that HPV vaccines are highly safe. Although they have possible side effects, the benefits of HPV vaccination surpass the potential risks, as with all medical interventions. The U.S. Food and Drug Administration (FDA) mandates comprehensive safety testing of all vaccines utilized in the United States, including HPV vaccines, before licensing them. During clinical trials conducted before licensure, the 9-valent HPV vaccine Gardasil 9 was evaluated in more than 15,000 males and females and declared to be safe and potent.⁷

Adverse Vaccine Reactions

During clinical trials, local reactions at the injection site were the most frequently reported adverse effects of HPV vaccines. Pain, redness, or swelling were reported by 20% to 90% of recipients during prelicensure clinical trials. Around 10% to 13% of HPV vaccine recipients reported a temperature of 100°F in the 15 days post-vaccination, with a similar proportion of placebo recipients reporting similar symptoms. Systemic adverse reactions like nausea, dizziness, myalgia, and malaise have been reported by vaccine recipients. However, these symptoms occurred with equal frequency among the HPV vaccine and placebo recipients. Local reactions were found to increase in frequency with increasing doses, but fever reports didn’t increase significantly with increasing doses. Notably, no severe negative events such as deaths are associated with HPV vaccines. The Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration (FDA) supervise ongoing monitoring and surveillance. Any medical procedure, including vaccination, can cause syncope (fainting). Adolescents should be seated or lying down throughout the vaccination process and stay like that for 15 minutes after vaccination. This is intended to prevent any injuries that may result from falling during a syncopal event.

References

1. National Center for Immunization and Respiratory Diseases (NCIRD). https://www.cdc.gov/ncird/index.html. Reviewed July 6, 2020. Accessed June 29, 2023.
2. How Many Cancers Are Linked with HPV Each Year? https://www.cdc.gov/cancer/hpv/statistics/cases.htm. Reviewed October 3, 2022. Accessed June 29, 2023.
3. McClung NM, Gargano JW, Park IU, et al. Estimated number of cases of high-grade cervical lesions diagnosed among women — United States, 2008 and 2016. MMWR Morb Mortal Wkly Rep. 2019;68:337-343. doi:10.15585/mmwr.mm6815a1
4. HPV-Associated Cancer Statistics. https://www.cdc.gov/cancer/hpv/statistics/cases.htm Reviewed October 3, 2022. Accessed June 29, 2023.
5. Human Papillomavirus (HPV): Cancers Caused by HPV. https://www.cdc.gov/hpv/parents/index.html. Reviewed February 28, 2022. Access June 29, 2023.
6. Advisory Committee on Immunization Practices (ACIP): ACIP Shared Clinical Decision-Making Recommendations. https://www.cdc.gov/vaccines/acip/acip-scdm-faqs.html. Reviewed June 28, 2023. Accessed June 29, 2023.
7. Human Papillomavirus (HPV): HPV Vaccine Safety and Effectiveness Data. https://www.cdc.gov/hpv/hcp/vaccine-safety-data.html. Reviewed November 1, 2021. Accessed June 29, 2023.