Are you hesitant about taking the HPV vaccine? Uncomfortable to discuss with anyone because of the "sexually transmitted" tag? Unsure because it is not part of the mandatory immunization schedule? Is the dilemma because you think you are past the HPV vaccine age limit or you are a male? Read on to know the facts and make an informed decision.
(The information provided in this article is relevant as of April 11th, 2022)
What is HPV?
Human papillomavirus (HPV) is a small, non-enveloped deoxyribonucleic acid (DNA) virus with over 100 known variations (serotypes). It spreads through direct contact with infected body parts (genitalia and mouth) or shared surfaces (public showers/swimming pools). HPV infection is extremely common in sexually active men and women. The risk of contracting an infection is high among smokers, people with a weak immune system and those with many sexual partners. Most cases are asymptomatic and the bodies can get rid of the virus.
So what is the big deal?
If your body does not get rid of it, visible symptoms, such as genital warts and oral warts, can appear within a few weeks. These are caused by low-risk HPV types and are treatable.
However, some high-risk serotypes are known to cause persistent infections and cervical cancer in the long run, with a 1% chance among the overall HPV-infected population. HPV is the cause of more than 70% of all cervical cancer cases besides increasing the risk of penile, anal, vulva, mouth and throat cancers.
Hmm.. What can I do to prevent HPV infections?
Of the 14 strains of HPV associated with cancer, effective vaccines are available against nine: Cervarix (bivalent), Gardasil (quadrivalent) and Gardasil-9 (nonavalent). They have been most effective when administered between 9–13 years of age, essentially before one becomes sexually active.
The routine dosage in children under 15 is two doses at an interval of 6 months. Above 15 years and under certain special conditions for under 15, a three-dose regimen at 0, 1-2, and 6 months is advised depending on the type of vaccine used.
A comparison of available HPV vaccines.
Effective primary (HPV vaccination) and secondary prevention approaches (regular PAP smears in sexually-active women and treating precancerous lesions) will prevent most cervical cancer cases. Effective communication with healthcare providers has been shown to help families make vaccine decisions.
**The decision to vaccinate kids still hinges on the parents since the vaccine is optional as of now in most countries. Please consult your Paediatrician/Gynaecologist for specific advice and prescription**
Who should get vaccinated?
HPV vaccination is recommended for all girls and boys at age 11–12 years (latest upto 26 years), so they are protected from HPV infections that can cause cancer later in life.
The vaccine is not generally recommended for people above 26 years of age. However, women with an existing HPV infection and/ or an abnormal Pap test results in the appropriate age group (13-45 years) may still get the shots on medical advice for protection against the high-risk HPV types that they have not acquired until then. But then, this will not treat or cure the existing HPV-related conditions.
The Indian Academy of Pediatrics Committee on Immunization recommends Cervarix or quadrivalent Gardasil.
Why boys?! They don’t even have a cervix!
In the early 2000s, it was widely believed that only girls and young women needed the vaccine. The myth was debunked by population studies, which suggested that up to half of adult men in the US, Mexico, and Brazil could be HPV-infected, homo- and heterosexuals alike. The wake-up call to include men in the vaccination programs came about when HPV was established as a major player in increasing number of anal and oral cancers in men.
Though this has been recommended for a while in developed countries, in developing countries like India, the vaccine is yet to be licensed and the concept is slowly gaining support.
This is how HPV vaccine works:
Are the HPV vaccines readily available?
According to WHO, 100 countries have introduced the HPV vaccine in their National schedule (as of October 2019). These include most of the developed countries (You can check these links for EU, US, UK and Australia) and some low- and middle-income countries in South America, Africa and Asia as well. You can check out this
However, the vaccines are not well-received in some countries due to cultural inhibitions and economic reasons.
Efforts are underway to include the vaccine as a routine in India. However, the high cost and stock shortage (as it is imported) are major barriers in making it widely accessible. Currently, these are available only in the private sector except for a few states, where they have been included in the public vaccination program. Besides government involvement, some NGOs are also working towards creating awareness, prevention and early screening.
How effective and safe are these?
New research indicates that even a single vaccine dose is sufficient for effective protection and is recognized by WHO.
Several reviews on HPV vaccine performance over the past decade show that Gardasil and Cervarix have high efficacy, preventing infection and lesions for between five and 10 years after immunization. Data indicate that the proven benefits outweigh the reported side effects.
Information on vaccine safety can be found here. The safety of HPV vaccine has been reaffirmed by the Australian government.
Parts of this article have been reproduced from the article written by the author for Biotechinasia.com
References:
Gleneagles global hospitals, National Cancer Institute, Indian Academy of Pediatrics, The Lancet, Science Daily, CDC, WHO
Bruni L, Albero G, Serrano B, Mena M, Gómez D, Muñoz J, Bosch FX, de Sanjosé S. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in India. Summary Report 17 June 2019. [Access date: 19 September 2020]
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This article is written by Ayshwarya Ravichandran