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HPV vaccines

Can you tell me about the vaccine to prevent HPV (human papilloma virus)? 

This page is about the vaccines to prevent HPV which prevents cervical cancer. There is information about

 

What the human papilloma virus (HPV) is

There are over 100 different types of human papilloma virus (HPV). It is sometimes called the wart virus or genital wart virus because some types of HPV cause genital warts. A number of HPV types are passed on from one person to another through sexual contact. Many women will be infected with the HPV virus at some point during their lifetime. Often the virus causes no harm and goes away without treatment.

 

HPV and cancer

Some types of HPV can increase the risk of developing cervical cancer. Cervical cancer is cancer of the neck of the womb. Almost 3,400 women are diagnosed with this type of cancer every year in the UK. Most women infected with HPV don’t go on to develop cervical cancer. But for some, infection with HPV can go on to cause

  • Genital warts
  • Changes in the cervix, which may develop into cervical cancer
  • Changes in the vaginal tissues, which may develop into vaginal cancer

Of the different types of HPV, types 16 and 18 cause about 7 out of 10 (70%) cancers of the cervix. Most of the remaining 30% of cervical cancers are associated with other high risk HPV types. HPV types 6 and 11 cause genital warts but are rarely linked to cancer. You can find out more about the risks and causes of cervical cancer in our cervical cancer section. HPV is also a risk factor for other types of cancer including vulval cancer, anal cancer, cancer of the penis and mouth and oropharyngeal cancers.

 

Research into vaccines to prevent HPV

Several research trials have tested vaccines as a way of preventing infection with HPV. There are 2 cervical cancer vaccines, Gardasil and Cervarix. A trial testing Gardasil called FUTURE II reported its results in October 2005. This phase 3 trial involved over 12,000 women aged between 16 and 26. These women did not have HPV before the start of the trial. The women were divided into 2 groups. Half the women were given Gardasil and the other half had a dummy vaccine (placebo). Both groups of women had 3 injections of either the vaccine or placebo over 6 months. 

Over the following 2 years the women had regular checks to see if they had got HPV, or had any pre cancerous changes to the cells of the cervix, which could develop into a cancer. The group who had the vaccine showed no pre cancerous changes. Of the 5,258 women who had the placebo, 21 had pre cancerous changes, which is 0.4%. The researchers found that Gardasil protected against HPV types 6 and 11 (which cause about 90% of genital warts), as well as 16 and 18. Gardasil was licensed in the UK in September 2006 for girls and women aged between 9 and 26.

Two phase 3 trials have tested the vaccine Cervarix. The first was for women under 26. It involved over 18,000 women from all over the world, including the UK. This study was called PATRICIA (PApilloma TRIal to prevent Cervical cancer In young Adults). The second was for women of 26 and over. The trials found that Cervarix was useful in preventing HPV infection. Cervarix was licensed in the UK in 2007 for the prevention of pre cancerous changes in the cervix in girls and women between the age of 10 and 25. 

There is not enough evidence at the moment that the vaccine prevents other types of cancer. Research has shown that Gardasil can prevent the development of anal warts which are caused by HPV types 6 and 11. At the moment we don’t know whether the vaccine will prevent HPV infection in the mouth. There is research going on to look at the link between HPV and these other types of cancer and how to prevent it.

 

The HPV vaccination programme

In the UK, girls in year 8 at school (aged 12 to 13) are offered the HPV vaccine. Girls have three injections over 6 months. A letter about the vaccine and a consent form is sent to the parents of the girl before she has the vaccine. It is up to her whether she has the vaccine.

From September 2012, the vaccination programme will use Gardasil. This vaccine protects against genital warts as well as cervical cancer. 

It is possible to have the vaccination privately. The cost for private treatment varies from doctor to doctor. We are hearing reports of about £400 being charged for a course of 3 injections.

If girls take up the vaccination at school, the programme will prevent at least 7 out of 10 cancers of the cervix (70%) and possibly even more in the future. But it takes between 10 and 20 years for a cancer to develop after HPV infection. So any benefits in reducing cervical cancer won’t be seen for quite a long time. But the number of cases of pre cancerous changes in the cervix (CIN) will fall quite rapidly.

It is not certain how long the vaccination gives protection for. So far the trials have followed people up for about 8 years so we know that it lasts at least this long. It is expected that the vaccines should last for life but more research is needed to find out if this is the case. It may be that women will need a booster dose at some time.

 

Men and boys and the vaccine

The HPV vaccine is not licensed for men in the UK at the moment. HPV does increase the risk of other types of cancer including penile and anal cancers in men. However it is not the only cause of these cancers and we don’t know how many of these cancers would be prevented by having the vaccine. They are rare cancers and vaccinating all men would be very expensive. It is thought that by vaccinating girls it will reduce the number of men getting HPV because you become infected through sexual contact.

 

Research into views about HPV

A large project called The HPV (Human Papilloma Virus) Core Messages Study is looking at the scientific evidence about HPV as well as finding out people’s views about HPV testing. Based on this, the project aims to develop messages that could help people make informed decisions about HPV testing and vaccination. You can find information about HPV trials on our clinical trials database.

 

If girls are sexually active before having the vaccine

The vaccine is being offered to girls from the age of 12 because they are unlikely to be sexually active and to have caught HPV. The research so far has shown that the vaccine works best at preventing HPV infection in younger women. If you are sexually active before you have the vaccine you may already have HPV and the vaccine won’t get rid of it. But there are still benefits from having the vaccine. There are many different types of HPV so even if you have HPV it may not be HPV 16 or 18. Types 16 and 18 are the types that are most likely to cause cancer of the cervix and it is these high risk types that the vaccines protect against.

If girls become sexually active during the course of the vaccine injections it is important to complete the course of injections. It is only after the 3 injections that we know the vaccine is protective. However a recent study in Costa Rica suggested that women who had only 2 doses of Cervarix may have as much protection from HPV 16 and 18 as those who'd had 3 doses. But more research is needed before we will know if fewer than 3 doses gives enough protection and for as long.

 

Side effects of the vaccine

The side effects are usually mild and include

  • Headache
  • Aching muscles
  • Redness and soreness around the site of the injection
  • Fever
  • Feeling and being sick
  • Stomach pain
  • Diarrhoea
  • Itching, rash
  • Dizziness
 

Do we still need cervical cancer screening?

Yes, we will definitely still need the cervical screening programme in the UK. The vaccines don't prevent infection with all types of HPV. Also from the research so far, we don't think the vaccines will help prevent cervical cancer in women already infected with HPV. And it takes about 10 to 20 years after HPV infection for a cervical cancer to develop. So it’s very important to remember that women will still need cervical cancer screening (smear tests) for many years to come. There is more information about cervical cancer screening in our cervical cancer section.

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Updated: 17 September 2012