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HPV: Who Should Be Vaccinated and Why?

February 19, 2024

HPV: Who Should  Be Vaccinated and Why? - featured image

Human Papilloma Virus is a sexually transmitted infection that causes cervical cancer. There are multiple genotypes, but 70% of all cervical cancers are due to HPV type 16 and 18. They are also implicated in causing Anal, Oropharyngeal, Vulvar, Vaginal and Penile cancers. HPV causes a spectrum of disease – with anogenital warts being caused by Genotypes 6 and 11.
 
The 3 types of vaccines targeting the most common genotypes involved in causing malignancies are:

  • Quadrivalent vaccine (Gardasil) – against types 6, 11, 16 and 18
  • 9-Valent vaccine (Gardasil 9) – against 6, 11, 16, 18, 31, 33, 45, 52 and 58
  • Bivalent vaccine (Cervaix) – against types 16 and 18

 

Who should be vaccinated?

  • All females and males between the ages of 11 and 12 years should be vaccinated. Children from as old as 9 years can also be vaccinated.
  • Catch-up vaccinations can be done up to 26 years of age.
  • Patients older than 26 years should be individualized, as they have most likely already been exposed. Screening for cancers should rather take preference.
  • Healthcare workers who are at high risk of being exposed to the HPV aerosols, i.e. Dermatologists or gynecologists and their theatre personnel, can be vaccinated, although this subgroup have not been included in any studies

One study in the USA suggested that if all the girls in the USA of age 12 were vaccinated, it would prevent 200,000 new HPV infections, 100,000 abnormal Pap smears, and 3300 cervical cancers every year.

The best time to vaccinate is before being exposed. Studies show that being vaccinated at an early age lowers the incidence of malignancy.

Patients who have been exposed can also still vaccinate, as they can still be protected from other subtypes. So this means, patients who have abnormal Pap smears or urogenital warts can still be vaccinated.

Females have been the most widely studied, which is why they are included in most government roll-outs throughout the world. Studies have shown a Herd Immunity effect – whereby the incidence of malignancies have been decreased in the male population, when all the females have been vaccinated. But this can also be shown if all males are vaccinated and not females. Herd Immunity will not protect males who are sexually active with other males, if females alone have been vaccinated. It all depends on the population and socio-economic status of the population.
 

Schedule:

  • In general, 2 doses are given at month 0 and then again 6-12 months later. If vaccinating patients older than 15 years, or immune-compromised individuals, 3 doses are given at month 0, 2 and 6. This is just in accordance with the studies that were done.

The vaccine can be given together with other vaccinations, and there are no required blood tests before or after the vaccine. Pregnancy does not need to be excluded first. Patients who are already known to be pregnant should be vaccinated after pregnancy, simply as these patients were not included in the trials. It can also be given during breastfeeding.
 

Side effects:

  • The vaccine contains proteins that mimic the virus, and does not contain any actual virus particles.
  • The main side effects include local injection site reactions of pain and redness. Other side effects that have been reported are headaches, some nausea and vomiting and syncope after the injection.
  • Studies have not shown any increase in Guillain-Barre Syndrome or an increased risk of thromboembolic events.
  • As with any medication, there is a risk of having an allergic reaction.

Once the vaccine has been received, patients should continue with the normal screening protocol as outlined in international/national guidelines. As there are multiple subtypes that can lead to malignancy, screening should still continue. The vaccine only protects against specific subtypes, not all.
 

What we can do:

The South African HPV vaccine program was initiated in 2014 in schools, targeting Grade 4 girls in the public schooling system(2). This was unfortunately hindered by the Covid-19 pandemic. The challenge now lies in the stigmata of receiving vaccinations after all the Covid-19 vaccination propaganda and misinformation. The vaccines are still available and anyone can receive an HPV vaccine if they would like to as outlined in the age groups above, and both males and females will benefit.

It remains our responsibility as healthcare providers in educating the general population regarding the importance of receiving the HPV vaccine, not only for the individual, but also for the good of the greater population. 1 in 43 South Africans are diagnosed with Cervical Cancer (3). This affects us all, and if we work together, we can vaccinate and eradicate Cervical Cancer (and a multitude of other cancers caused by the same virus) one person at a time.

 

References

Dr. Andrea Morphis

Dr. Andrea Morphis

Busamed Bram Fischer

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