Human Papillomavirus (HPV) Prevention and HPV Vaccine: Questions and Answers

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• What is HPV?
• How can you protect yourself from getting HPV?
• Who should get the vaccine?
• What does the vaccine protect against?
• How effective is the vaccine?
• Is the vaccine safe?
• Will girls/women who have been vaccinated still need cervical cancer screening?
• How long does vaccine protection last? Will a booster shot be needed?
• How do I obtain the vaccine? Do I need to pay for the vaccine?

What is HPV?

There are over 100 types of human papillomavirus (HPV). HPV is a virus that can infect many parts of the body. Some types of HPV are sexually transmitted and can cause warts or other consequences such as cancer (for example cervical, penile and anal) in the anogenital region of women and men. The types of HPV that infect the anogenital area are not the same as the ones that infect other areas of the body such as the fingers, hands and face. The types which cause anogenital warts do not usually cause cancer.

The various types of HPV are often classified into low and high risk according to their association with cancer. The “low-risk” types are rarely associated with cancer. The “high-risk” types are more likely to lead to the development of cancer.

How can you protect yourself from getting HPV?

For females, four of the common types of HPV can be prevented through vaccination. This is important given that there is no treatment available which can cure an HPV infection. HPV vaccines have been in development for many years and one of the vaccines was approved for use in Canada in July 2006. This vaccine protects from infection with 4 of the most common types of HPV (Types 6, 11, 16 and 18). HPV vaccines are currently being studied for use in men.
To reduce the risk of acquiring an HPV infection, always use a condom during sex. While condoms don't eliminate the risk of infection, using a condom consistently and properly during vaginal, anal and oral sex will decrease the chance that you will get HPV or pass it on to your partner. You need to remember that a condom can only protect the area it covers so it may be possible to become infected by any uncovered warts (for example, on the scrotum).

Using a condom will also help to protect you from other sexually transmitted infections and reduce the chances of unintended pregnancies.

Other ways to reduce your risk of infection are to delay sexual activity (waiting until you are older), limit your number of sexual partners and to consider your partners' sexual history as this can create a risk to yourself. (eg. if they have had multiple previous partners).

Who should get the vaccine?

Canada
The vaccine has been approved for use in Canada for females 9-26 years of age. The vaccine requires 3 doses to be given over the course of 6 months (0, 2 and 6 months). Recommendations for use, which come from the National Advisory Committee on Immunization (NACI), were released in February 2007. The primary age group recommended for vaccination according to NACI is females aged 9 to 13. HPV is a sexually transmitted infection, and ideally, the vaccine should be administered to females before they become sexually active in order to ensure maximum benefit. They also recommend the vaccine for females 14 to 26 years of age as there still is the potential for benefit regardless of previous sexual activity, Pap abnormalities, cervical cancer, anogenital warts or a known HPV infection.  The vaccine is not recommended for pregnant women, females under nine years of age, or males. Although no recommendations were made for women older than 26 years, its use can be considered in individual circumstances. For more details see http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/07vol33/acs-02/index_e.html

What does the vaccine protect against?

The vaccine will protect against infection with two high-risk types of HPV (16 and 18) and two low risk types (6 and 11). HPV types 16 and 18 cause approximately 70% of cervical cancers. HPV types 6 and 11 cause approximately 90% of anogenital warts.

The vaccine does not protect against any other types of low or high risk types of HPV. The HPV vaccine will not have an impact on an existing infection or any of the outcomes of an existing HPV infection, such as anogenital warts.

How effective is the vaccine?

The HPV vaccine has demonstrated a very high efficacy in preventing the four types of HPV infection mentioned above (HPV types 6, 11, 16 and 18).

The vaccine does not protect against any of the other low or high risk types of HPV. However, if you are infected with one of the four HPV types in the vaccine, the vaccine will still protect against the other types in the vaccine. For example, if you are infected with HPV type 6, the vaccine will still protect you from types 11, 16, and 18. HPV DNA testing is not recommended prior to vaccination.

Is the vaccine safe?

Yes, the vaccine is safe. Few side effects were reported among the participants in the recent studies for the vaccine. The most common side effect was a brief soreness at the site of injection. Also, you cannot become infected with HPV from the vaccine and the vaccine does not contain any antibiotics or preservatives, including mercury or thimerosal.

Will girls/women who have been vaccinated still need cervical cancer screening?

The HPV vaccine does not protect against all types of HPV, it only protects against the four most common types of HPV that cause cervical cancer and anogenital warts. Even when someone is vaccinated it is still possible to become infected with one of the less common types of HPV that the vaccine does not protect against. Therefore, it is important that vaccinated girls/women continue to have regular Pap tests. For more information, see the “It's Your Health” Fact Sheet on screening for cervical cancer
[ http://www.hc-sc.gc.ca/iyh-vsv/diseases-maladies/cervical-uterus_e.html ]. The recommendations for Pap screening vary depending on the province or territory you live in. Ask your local health care provider about the recommendations in your region.

How long does vaccine protection last? Will a booster shot be needed?

Recent studies have indicated good protection against HPV for five years of follow-up. Studies are ongoing to determine if further immunization or a booster dose is necessary for vaccinated females to have continued protection.

How do I obtain the vaccine? Do I need to pay for the vaccine?

The provision of free medications, vaccines and health services is a decision that is made within each individual province and territory. They are currently considering if and how they would introduce a pubic health program that would pay for the vaccine for select age groups. Please check with your provincial/territorial public health department.