Despite overwhelming evidence of the safety and effectiveness of the human papillomavirus (HPV) vaccine, vaccination rates remain low. The American Academy of Family Physicians (AAFP) urges physicians to strongly recommend the HPV vaccine to their patients.
Physicians give consistent, strong recommendations for the H PV vaccine. A physician's recommendation is the single best predictor of vaccination. It is recommended that physicians "bundle," and not single out the HPV vaccine in discussions with patients on the importance of receiving vaccinations. The bundling approach has been shown to normalize and increase acceptance of the HPV vaccine and demonstrate the importance of the HPV vaccine. The current HPV immunization schedule is provider- and patient-friendly and is consistent with adolescents’ well visits.
The currently available HPV vaccine is the 9-valent human papillomavirus (9vHPV) vaccine. This vaccine protects against the most common HPV types, which cause 90% of cervical, vaginal, vulvar, anal, and penile cancers. Additionally, this vaccine prevents HPV types that cause genital warts in both males and females.
The 9vHPV vaccine is routinely recommended for children 11 or 12 years of age.
Children ages 11-12 years old: Are recommended to get 2 doses of 9vHPV vaccine, given 6 to 12 months apart. 9vHPV can be given starting at age 9. Only 2 doses are needed if the first dose is given before their 15th birthday.
Children ages 9-14 years old: Who have received 2 doses of 9vHPV vaccine less than 5 months apart will need a 3rd dose.
People 15-26 years old who started the series later need 3 doses of 9vHPV vaccine:
People with weakened immune systems: Are recommended to get 3 doses if they are 9 through 26 years old.
People older than 26 years: Vaccination is not recommended for everyone older than 26 years:
Patients who began a series with 4vHPV may complete the series with 9vHPV. Repeat vaccination with 9vHPV is not recommended in patients who have completed three-dose courses of 2vHPV or 4vHPV vaccines.
More than 205 million doses of the HPV vaccine have been distributed worldwide and nearly 90 million doses of HPV vaccines have been distributed in the United States from June 2006 through March 2016. More than 10 years of post-licensure vaccine monitoring in the U.S. provide evidence of the safety of 4vHPV. Data available from post-licensee monitoring in other countries for 2vHPV and 4vHPV provide additional evidence of the safety of these vaccines. Gardasil 9 (a 9-valent HPV vaccine) was studied in more than 15,000 females and males. These clinical trials showed HPV vaccines to be safe and effective. Each vaccine continues to be monitored for any safety problems. Syncope can occur among adolescents who receive any vaccine, including the HPV vaccines. It is recommended that clinicians consider observing patients for 15 minutes after vaccination.
Among women who have not been previously infected with a targeted HPV type, 2vHPV, and 4vHPV have over 95% efficacy in preventing cervical pre-cancers caused by HPV16 and HPV18.
In males, 4vHPV demonstrated 90% efficacy in preventing genital warts, and 75% efficacy in preventing anal pre- cancers in men caused by HPV16 and HPV18.
The 9vHPV was compared to the 4vHPV. Few cases of disease caused by HPV types 6, 11, 16, and 18 were seen in either group. The immunogenicity of HPV 9 was comparable to HPV4, which inferred efficacy for HPV types 6, 11, 16, and 18. In subjects who were not infected at the start of the study and received all three doses (per protocol), efficacy for prevention of genital pre-cancers caused by the five additional HPV types covered in HPV 9 was 96.7%.
Sources
Ylitalo KR, Lee H, Mehta NK. Health care provider recommendation, human papillomavirus vaccination, and race/ethnicity in the US National Immunization Survey. Am J Public Health. 2013;103(1):164-169.
Petrosky E, Bocchini JA, Hariri S, et al. Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV vaccination recommendations of the Advisory Committee on Immunization Practices. MMWR. 2015;64(11):300-304.