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Human Papillomavirus Vaccine

By William D. Surkis, MD, Clinical Associate Professor of Medicine; Director, Internal Medicine Residency Program, Jefferson Medical College; Lankenau Medical Center ; Jerome Santoro, MD, Clinical Professor of Medicine; Chief, Department of Medicine, Jefferson Medical College; Lankenau Medical Center

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Patient Education

Preparations

Three vaccines protect against HPV:

  • A 9-valent vaccine that protects against HPV types 6 and 11 (which cause > 90% of visible genital warts), types 16 and 18 (which cause most cervical cancers), and types 31, 33, 45, 52, and 58

  • A quadrivalent vaccine (HPV4) that protects against types 6, 11, 16, and 18

  • A bivalent vaccine (HPV2) that protects against types 16 and 18

Only the 9-valent vaccine is now available in the US.

Recombinant DNA technology is used to prepare HPV vaccines from the major capsid (L1) protein of HPV. The L1 proteins self-assemble into noninfectious, nononcogenic virus-like particles (VLPs).

Indications

The HPV vaccine is a routine childhood vaccination (see Table: Recommended Immunization Schedule for Ages 7–18 yr).

HPV4 or HPV2 is recommended for females at age 11 or 12 yr and for females up through age 26 yr if they were not previously vaccinated.

HPV4 is recommended for males at age 11 or 12 yr and previously unvaccinated males through age 26 yr; HPV4 is recommended for all men who are in this age group and who have sex with men.

Vaccination is recommended for all people who are immunocompromised, including HIV patients, through age 26 if they were not vaccinated at a younger age.

Contraindications and Precautions

Contraindications include

  • A severe allergic reaction (eg, anaphylaxis) after previous dose or to a vaccine component

  • Pregnancy

Although HPV vaccines are not recommended for pregnant women, pregnancy testing is not needed before vaccination. If pregnancy is diagnosed after the vaccination series has been started, no intervention is needed, but the remaining doses of the series should be delayed until pregnancy is completed.

The main precaution is

  • Moderate or severe acute illness with or without fever (vaccination is postponed until the illness resolves)

Dose and Administration

The dose is 0.5 mL IM, given in a 3-dose series at 0 mo, at 2 mo, and at 6 mo.

Adverse Effects

No serious adverse effects have been reported. Mild effects include pain, redness, swelling, and tenderness at the injection site.