Human papillomavirus vaccines

Shainoor J. Ismail; Shelley L. Deeks

doi:10.1503/cmaj.150465

Human papillomavirus (HPV) can lead to cancer

Human papillomavirus is the most common sexually transmitted infection. Persistent infection with a high-risk HPV type causes virtually all cases of cervical cancer and has been associated with 90% of anal, 70% of vaginal, 40% of vulvar and 65% of penile cancers,1 as well as up to 70% of oropharyngeal cancers, which is on the rise.2

HPV vaccines can prevent cancer

Large randomized controlled trials of bivalent (Cervarix), quadrivalent (Gardasil) and nonavalent (Gardasil9) vaccines show that these vaccines prevent about 70% of anogenital cancers. Nonavalent vaccine prevents up to an additional 14% of anogenital cancers caused by the additional five HPV types. Quadrivalent and nonavalent vaccines also prevent 90% of anogenital warts.1

HPV vaccines are safe

Data from clinical trials and safety surveillance show no evidence of increased frequency of systemic or serious adverse events.1^,3 After systematic investigations, the World Health Organization’s Global Advisory Committee on Vaccine Safety4 and the Institute of Medicine issued reports concluding that there is no evidence to support an association between HPV vaccine and serious adverse events.5

Canada’s National Advisory Committee on Immunization recommends use of HPV vaccine for females and males

The National Advisory Committee on Immunization has recommended HPV immunization for females aged 9 years and older since 2007 and for males between 9 and 26 years of age since 2012 (see Appendix 1, available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.150465/-/DC1).6 Two doses of HPV vaccine among immunocompetent 9- to 14-year-olds provide similar protective efficacy as three doses in immunocompetent 9- to 26-year-olds.7

HPV vaccination rates are suboptimal

By 2010, all Canadian jurisdictions had implemented school-based immunization programs for girls, and some also have programs for boys. However, only 74.6% of 13- to 14-year-old girls across Canada have received at least one dose of HPV vaccine.8 Physicians can increase vaccine coverage by recommending this vaccine to their patients.

Footnotes

Competing interests: None declared.
This article has been peer reviewed.

References

↵
Updated recommendations on human papillomavirus (HPV) vaccines: 9-valent HPV vaccine and clarification of minimum intervals between doses in the HPV immunization schedule: An Advisory Committee Statement (ACS) National Advisory Committee on Immunization. Ottawa: Public Health Agency of Canada; 2016. Available: www.canada.ca/en/public-health/services/publications/healthy-living/9-valent-hpv-vaccine-clarification-minimum-intervals-between-doses-in-hpv-immunization-schedule.html (accessed 2017 Apr. 30).
↵
1. Gooi Z,
2. Chan JY,
3. Fakhry C
. The epidemiology of the human papillomavirus related to oropharyngeal head and neck cancer. Laryngoscope 2016;126:894–900.
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↵
Update on human papillomavirus (HPV) vaccines. Can Commun Dis Rep 2012;38:1–62. Available: www.phac-aspc.gc.ca/publicat/ccdr-rmtc/12vol38/acs-dcc-1/index-eng.php (accessed 2017 Apr. 30).
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↵
Safety of HPV vaccines: extract from report of GACVS meeting of 2–3 December 2015, published in the WHO Weekly Epidemiological Record of January 22, 2016. Geneva: World Health Organization; 2016. Available: www.who.int/vaccine_safety/committee/topics/hpv/Dec_2015/en/ (accessed 2017 Apr. 30).
↵
IOM (Institute of Medicine). Adverse effects of vaccines: evidence and causality. Stratton K, Ford A, Rusch E, et al., editors. Washington: National Academies Press; 2012:505–21. Available: www.nap.edu/catalog/13164/adverse-effects-of-vaccines-evidence-and-causality (accessed 2017 Jan. 30).
↵
Updated Recommendations on Human Papillomavirus (HPV) Vaccines: 9-valent HPV vaccine 2-dose immunization schedule and the use of HPV vaccines in immunocompromised populations: An Advisory Committee Statement (ACS) National Advisory Committee on Immunization. Ottawa: Public Health Agency of Canada; 2017. Available: https://www.canada.ca/en/public-health/services/publications/healthy-living/updated-recommendations-human-papillomavirus-immunization-schedule-immunocompromised-populations.html (accessed 2017 May 30).
↵
Update on the recommended human papillomavirus (HPV) vaccine immunization schedule: An Advisory Committee Statement (ACS) National Advisory Committee on Immunization. Ottawa: Public Health Agency of Canada; 2015. Available: www.canada.ca/en/public-health/services/publications/healthy-living/update-recommended-human-papillomavirus-vaccine-immunization-schedule.html (accessed 2017 Apr. 30).
↵
Statistics Canada. Childhood National Immunization Coverage Survey 2015. Available: www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SDDS=5185 (accessed 2017 Aug. 16).