There are over 100 types of human papillomavirus (HPV), with some high-risk types causing cervical cancer and other cancers and diseases. Two HPV vaccines, Gardasil and Cervarix, protect against high-risk HPV types 16 and 18, which cause 70% of cervical cancers. Gardasil also protects against low-risk types 6 and 11, which cause 90% of genital warts. The vaccines are recommended for females ages 11-26 and males ages 11-26, with a 3 dose schedule, to protect against HPV infections and related diseases. Cervical cancer screening is still important for vaccinated females due to other high-risk HPV types not covered by the vaccines.

1. Adult Immunization 2010
Human Papillomavirus Vaccine
Segment
This material is in the public domain
This information is valid as of May 25, 2010

2. Human Papillomavirus
• More than 100 types
– More than 60 cutaneous types
 Can lead to skin warts
– 40 mucosal types
 high risk types (particularly 16 and 18)
– cervical cell abnormalities
– certain anogenital cancers
 Low risk types (particularly 6 and 11)
– cervical cell abnormalities- usually
resolve spontaneously and do not
lead to cancer
– genital warts
– respiratory papillomatosis

3. Natural History of HPV Infection
Up to Decades
Within 1 Year
Initial
HPV
Infection
1-5 Years
Persistent
Infection
CIN 1
Cleared HPV Infection
CIN
2/3
Cervical
Cancer

4. Natural History of HPV Infection
Up to Decades
Within 1 Year
Initial
HPV
Infection
1-5 Years
Persistent
Infection
CIN 1
Cleared HPV Infection
CIN
2/3
Cervical
Cancer

5. HPV-associated Conditions
HPV 16, 18
Cervical cancer
High/low grade cervical
abnormalities
Anal, Vulvar, Vaginal,
Penile
Head and neck cancers
HPV 6, 11
Low grade cervical
abnormalities
Genital warts
RRP
Estimated %
70%
30%-50%
10%
10%
90%
90%

6. Human Papillomavirus Vaccines
• HPV4 (Gardasil)
– contains types 16 and 18 (high risk)
and types 6 and 11 (low risk)
• HPV2 (Cervarix)
– contains types 16 and 18 (high risk)
• Both vaccines are supplied as a
liquid in a single dose vial or syringe
• Neither vaccine contains an antibiotic
or a preservative

7. Human Papillomavirus Vaccines
• HPV4 vaccine is approved for
– females 9 through 26 years of age for
the prevention of cervical cancers,
precancers and genital warts
– males 9 through 26 years of age for the
prevention of genital warts
• HPV2 vaccine is approved for
– females 10 through 25 years of age for
the prevention of cervical cancers and
precancers
– not approved for males or for the
prevention of genital warts

8. HPV Vaccine Schedule and Intervals
• HPV4- 0, 2, 6 months
• HPV2- 0, 1, 6 months
• ACIP recommends- 0, 1 to 2, 6
months
• ACIP has not defined a maximum
interval between HPV vaccine doses
• If the interval between doses is
longer than recommended continue
the series where it was interrupted

9. Correct and consistent condom
use may have a protective effect
on HPV acquisition, reduce the
risk for HPV-associated diseases,
and mitigate the adverse
consequences of infection
with HPV.
This statement is required by section 317 of
the Public Health Service Act, 42 U.S.C., 243

10. HPV Vaccine Recommendations
• Recommended age for routine HPV
vaccination is 11 or 12 years
• Vaccination is recommended for
females 13 through 26 years of age
not previously vaccinated or who
have not completed the full 3-dose
series
• The 3 dose series of HPV4 may be
administered to males 9 through 26
years of age to reduce their likelihood
of acquiring genital warts

11. HPV Vaccine Special Situations
• Females 26 years of age or younger with
equivocal or abnormal Pap test, positive
HPV DNA, or genital warts may be
vaccinated
– vaccine will have no effect on existing
disease or infection
• Females 26 years of age or younger who
are lactating and breastfeeding, or are
immunocompromised may be vaccinated
• Vaccination not recommended for
pregnant women
– pregnancy testing is not needed before
vaccination

12. HPV Vaccine
Contraindications and Precautions
• Severe allergic reaction to a vaccine
component or following a prior dose
– yeast (HPV4)
– latex (HPV2 prefilled syringe)
• Moderate or severe acute illness

13. HPV Vaccine
Adverse Reactions
• Local reaction
20% - 90%
(pain, redness, swelling)
• Temperature 100°F
10% - 13%
or higher
• Serious adverse events
None

14. HPV Vaccine and Cervical Cancer Screening
• Cervical cancer screening
recommendations have NOT changed for
females who receive HPV vaccine
• Females who are vaccinated could
subsequently be infected with a high-risk
HPV type not in either vaccine
• Females who were sexually active prior to
vaccination could have been infected with
a vaccine-type HPV before vaccination
• Healthcare providers who administer HPV
vaccine should educate women about the
importance of cervical cancer screening

15. National Center for Immunization
and Respiratory Diseases
Contact Information
• Telephone
• Email
• Website
(800) CDC-INFO
nipinfo@cdc.gov
http://www.cdc.gov/vaccines/
• Broadcast Updates and Resources
Web Page
http://www.cdc.gov/vaccines/ed/webcasts.htm