MD - Internal Medicine, MBBS
Hpv vaccine update
Three different vaccines, which vary in the number of HPV types they contain, are available
A bivalent vaccine, targets hpv types 16 and 18
A quadrivalent hpv vaccine, targets hpv types 6, 11, 16, and 18
A 9-valent vaccine, targets the same hpv types as the quadrivalent vaccine (6, 11, 16, and 18) as well as types 31, 33, 45, 52, and 58
If cost and availability are not issues, use 9-valent vaccine for individuals for whom hpv vaccination is indicated
Infection with human papillomavirus (hpv) types 16, 18, 31, 33, 45, 52, and 58 is implicated in approximately 90 percent of invasive cervical cancers.
Two types associated with genital warts are (6 and 11)
Routine immunization should be offered to boys and girls aged 11 to 12, but can be administered as early as nine years of age. Catch-up vaccination should be offered to males between the ages of 13 to 21 and females between 13 to 26 years who have not been previously vaccinated. Repeat vaccination with the 9-valent vaccine is likely not warranted for individuals who have completed a series with a different HPV vaccine.
Persistent viral infection with carcinogenic HPV types causes virtually all cancer of the cervix and most cases of anal cancer. The carcinogenic types, HPV 16 and HPV 18, which are targeted by the current HPV vaccines, cause approximately 70 percent of all cervical cancers worldwide and 72 percent of anal cancers. Hpv types 31, 33, 45, 52, and 58 are estimated to cause an additional 19 percent of invasive cervical cancers. Hpv 6 and HPV 11 cause approximately 90 percent of genital warts.
Hpv immunization is most effective among individuals who have not yet been infected with HPV (eg, before sexual debut).
The quadrivalent vaccine and 9-valent are administered in three doses at time zero and at two and six months of follow-up. The bivalent vaccine is administered in three doses at time zero, and at one and six months of follow-up.
Cervical cancer screening is recommended for any woman 21 years of age or older.
Clinicians should be aware that HPV immunization is not effective in clearing cytologically evident disease or HPV infection that is already present.