Human Papillomavirus (HPV) and HPV Vaccine

Human Papillomavirus
(HPV) and HPV Vaccine
Epidemiology and Prevention of Vaccine-

Preventable Diseases
National Center for Immunization and

Respiratory Diseases
Centers for Disease Control and Prevention
Revised May 2009
1
Human Papillomavirus (HPV)
• Small DNA virus

• More than 100 types identified based
on the genetic sequence of the outer
capsid protein L1
• 40 types infect the mucosal
epithelium
2
Human Papillomavirus Types
and Disease Association
mucosal/genital nonmucosal/cutaneous
(~40 types) (~60 types)
high-risk types
16, 18, 31, 45 low-risk types skin
(and others) 6, 11
(and others) warts
(hands
and feet)
•low grade cervical •low grade cervical

abnormalities abnormalities
•cancer precursors •genital warts
•anogenital cancers •laryngeal papillomas
3
HPV-Associated Disease
Type Women Men

16/18 70% of Cervical Cancer 70% of Anal Cancer
70% of Anal/genital Transmission to women
Cancer
6/11 90% of Genital Warts 90% of Genital Warts
90% of RRP lesions 90% of RRP lesions
Transmission to women
4
Natural History of HPV Infection
Within 1 Year 1-5 Years Up to Decades
Persistent CIN Cervical

Infection 2/3 Cancer
Initial
HPV
Infection
CIN 1
Cleared HPV Infection

5
HPV Clinical Features
• Most HPV infections are asymptomatic

and result in no clinical disease
• Clinical manifestations of HPV infection
include:
– anogenital warts
– recurrent respiratory papillomatosis
– cervical cancer precursors (cervical
intraepithelial neoplasia
– Cancer (cervical, anal, vaginal, vulvar,
penile, and some head and neck cancer)
6
HPV Epidemiology
• Reservoir Human
• Transmission Direct contact,

usually sexual
• Temporal None
pattern
• Communicability Presumed to be
high
7
HPV Disease Burden in the United States
• Anogenital HPV is the most common

sexually transmitted infection in the US
– Estimated 20 million currently infected
– 6.2 million new infections/year
• Common among adolescents and young
adults
• Estimated 80% of sexually active women
will have been infected by age 50
• Infection also common in men
8
Cervical Cancer Disease Burden in
the United States
• The American Cancer Society

estimates that in 2008
– 11,070 new cervical cancer cases
– 3,870 cervical cancer deaths
• Almost 100% of these cervical cancer
cases will be caused by one of the 40
HPV types that infect the mucosa
9
Cervical Cancer Screening
• Cervical cancer screening – no change

– 30% of cervical cancers caused by HPV
types not prevented by the quadrivalent
HPV vaccine
– Vaccinated females could subsequently
be infected with non-vaccine HPV types
– Sexually active females could have been
infected prior to vaccination
• Providers should educate women about
the importance of cervical cancer
screening
10
Human Papillomavirus Vaccine
• HPV L1 major capsid protein of the
virus is antigen used for
immunization
• L1 protein expressed in yeast cells
using recombinant technology
• L1 proteins self-assemble into virus-
like particles (VLP)
• VLPs are noninfectious and
nononcogenic
11
HPV Vaccine Efficacy*
Endpoint Efficacy
HPV 16/18-related 100
CIN2/3 or AIS
HPV 6/11/16/18 95
related CIN
HPV 6/11/16/18 99
related genital warts
*Among 16-26 year old females. CIN – cervical intraepithelial neoplasia; AIS –
adenocarcinoma in situ 12
HPV Vaccine Efficacy
• High efficacy among females without

evidence of infection with vaccine
HPV types
• No evidence of efficacy against
disease caused by vaccine types or
which participants were infected at
the time of vaccination
• Prior infection with one HPV type did
not diminish efficacy of the vaccine
against other vaccine HPV types
13
Routine HPV Vaccination
Recommendations
• ACIP recommends routine vaccination
of females 11 or 12 years of age
• The vaccination series can be started
as young as 9 years of age at the
clinician’s discretion
• “Catch-up” vaccination recommended
for females 13 through 26 years of age
MMWR 2007;56(RR-2):1-24 14
HPV Vaccination Schedule
• Routine schedule is 0, 2, 6 months
• Third dose should follow the first
dose by at least 24 weeks
• An accelerated schedule using
minimum intervals is not
recommended
• Series does not need to be restarted
if the schedule is interrupted
15
Human Papillomavirus Vaccine
• Quadrivalent HPV vaccine is not

currently* approved for males, or for
females younger than 9 years or
older than 26 years
• Off-label use is not recommended
• Studies of safety and efficacy among
males and females older than 26
years are ongoing
*as of May 2009 16

HPV Vaccine
Special Situations*
• Equivocal or abnormal Pap test
• Positive HPV DNA test
• Genital warts
• Immunosuppression
• Breastfeeding
*Vaccine can be administered
17
HPV Vaccine
Adverse Reactions
• Local reactions 84%
(pain, swelling)
• Fever 10%*
• No serious adverse reactions
reported
*similar to reports in placebo recipients (9%)
18
Syncope Following Vaccination
• An increase in the number of reports of

syncope has been detected by the
Vaccine Adverse Event Reporting System
(VAERS)
• 11-18 year old females have contributed
most of the increase
• Serious injuries have resulted
• Providers should strongly consider
observing patients for 15 minutes after
they are vaccinated
19
HPV Vaccine
Contraindications and Precautions
• Contraindication
– Severe allergic reaction to a
vaccine component or following a
prior dose
• Precaution
– Moderate or severe acute illnesses
(defer until symptoms improve)
20
HPV Vaccination During Pregnancy
• Initiation of the vaccine series should be

delayed until after completion of pregnancy
• If a woman is found to be pregnant after
initiating the vaccination series, remaining
doses should be delayed until after the
pregnancy
• If a vaccine dose has been administered
during pregnancy, there is no indication for
intervention
• Women vaccinated during pregnancy
should be reported to the Merck registry
(800.986.8999)
MMWR 2007;56(RR-2):1-24 21
HPV Vaccine
Storage and Handling
• Store at 36°F-46°F (2°C-8°C)

• Protect from light
• Do not expose to freezing
temperature
• Remove from refrigeration
immediately before administration
22
CDC Vaccines and Immunization
Contact Information
• Telephone 800.CDC.INFO
• Email nipinfo@cdc.gov
• Website www.cdc.gov/vaccines
23

Human Papillomavirus (HPV) and HPV Vaccine

Uploaded by

Copyright:

Available Formats

Human Papillomavirus (HPV) and HPV Vaccine

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Human Papillomavirus (HPV) and HPV Vaccine

Uploaded by

Copyright:

Available Formats

Human Papillomavirus

(HPV) and HPV Vaccine

Epidemiology and Prevention of Vaccine-

National Center for Immunization and

• Small DNA virus

•low grade cervical •low grade cervical

Type Women Men

Within 1 Year 1-5 Years Up to Decades

Persistent CIN Cervical

Cleared HPV Infection

• Most HPV infections are asymptomatic

• Transmission Direct contact,

• Anogenital HPV is the most common

• The American Cancer Society

• Cervical cancer screening – no change

• High efficacy among females without

• Quadrivalent HPV vaccine is not

*as of May 2009 16

*Vaccine can be administered

*similar to reports in placebo recipients (9%)

• An increase in the number of reports of

• Initiation of the vaccine series should be

• Store at 36°F-46°F (2°C-8°C)

You might also like