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Top 8 Q&A about HPV Vaccine

Chengjie SHEN, OBGYN Physician, Associate Chief Physician

Recently, the HPV vaccine has become a hot topic, and the outpatient department almost every day gives consultations about HPV, the cervical cancer vaccine and abnormal cervical cancer screening results. There are also many tense and anxious women who lack a correct understanding of such problems, and their misunderstanding often follows from comments such as, “it said that on the Internet,” “my mum said that,” and even “my doctor said that.” I would like to present a summary of the common questions about HPV and the HPV vaccine that are the most confusing and misleading for people, to hopefully give you a proper understanding of how to maintain your health and avoid unnecessary panic.

For easier reference, I’ll explain in the form of Q&A.

1. I pay much attention to my personal hygiene,so how did I still get HPV? Is it because my husband had an “affair”?

Answer: This is probably the first response most women find out they are infected with HPV.

According to a US CDC statistical report, at present, there are 79 million people infected with genital HPV in the States, and it is estimated that there soon will be a newly infected population of about 1.4 million.Studies show that almost every man or woman will get HPV for a certain period of time during his/her lifetime. Since there are no specific symptoms for HPV infection, and 90% of infections will spontaneously clearwithin 1-2 years, most individuals will not even be aware that they were once infected. HPV tends to spread between sexual partners, but current testing methods still cannot confirm which partner is the original host, and infection with HPV does not necessarily mean that one has had other sexual relationship. Maintaining fewer sexual partners can indeed lower the risk, but both men and women can still be infected with HPV even he/she has only one sexual partner in their lifetime. In short, HPV infection is very common, and both men and women who are sexual active are at risk of HPV infection.

2. Five years ago, I was tested HPV-31 positive, and in year later it was cleared.  I am so confused that now I have another type of HPV infection.

Answer:HPV is a big family of viruses, and according to studies, there have been more than 120 different subtypes identified so far. Each subtype is coded with a number, and classified as low-risk type and high-risk type based on its risk with cervical cancer.At present, there are at least 13 high-risk types of HPV. If a person is infected with a certain subtype of HPV, and it clears up after a period of time, this does not mean that person is also immune to other subtypes of HPV. Therefore, it is quite possible that the body can be infected with other subtypes. Moreover, a woman can be infected with more than one subtypes of HPV simultaneously. For this reason, even though a woman has completed the standard HPV vaccination, she still needs regular cervical screening, because at present, there is no cervical cancer vaccine that covers all high-risk types of HPV.

3. If I insist on the proper use of condoms and avoid using public toilets and public pools, I will not get infected with HPV, right?

Answer:Most HPV types are spread through contact with skin infected with HPV, including through vaginal/anal/oral sex, direct skin contact, as well as finger-vagina and finger-anus sexual activity. Using a condom can help to reduce the risk of HPV infection, but the condom cannot prevent all skin contactduring sexual intercourse.  Therefore, the condom cannot completely prevent HPV infection.At present, there are no studies proving that humansare susceptible to HPV infection through surfaces in the environment, such as the toilet, so it is unnecessary to worry about this.

4. I’ve heard that girl may get HPV vaccine at 9 year old, but my daughter is 20 years old.Is it too late to get the vaccine?

Answer: Ideally, it would be the best to have HPV vaccine before being sexually active.In the U.S., HPV vaccine is routinely recommended for adolescent age 11-12. Vaccination is also recommended for females age 13 through 26 years and males age 13 through 21 years who are not adequately vaccinated when they were younger. Since the risk of exposure to HPV increases with age, and the valence of antibodies stimulated by the vaccine will somewhat decrease, early vaccination is highly recommended.Unlike the previous 3-dose vaccination schedule,since 2016, the American CDC recommends that if an individual receives the first HPV vaccine before the 15th birthday, then he/she should receive the second one after 6-12 months, which is called a 2-dose schedule. If someone receives the first vaccination after age 15, he/she must complete 2 subsequent vaccinations, also referred to as the 0, 1-2 and 6 month schedule, which is called a 3-dose schedule. This is because a large number of studies revealed that the vaccine’s efficacy for the adolescent who had first dose of any type of HPV vaccine before the 15th birthday and 2 doses are 6-12 months apart, is equivalent to or even better than that of 3 vaccinations.This benefit, however, has not been found in the population who receives first vaccine after age 15.

5. I have HPV-31 positve at the moment, will I still benefit from the HPV vaccine?

Answer: HPV-31 belongs to the high-risk HPV subtype group, and 9-valent HPV vaccine Gardasil 9 covers this subtype. It should be noted that the HPV vaccine does not have any theraputic effect on existing HPV infection and resultant genital warts or cervical lesions. Nevertheless, after vaccination, the body can still acquire protection against non-infected HPV subtypes.For this lady, if she receives the 9-valent vaccine, she will still be protected against HPV-16,18,33,45,52 and 58 subtype. Therefore, the vaccination can still be beneficial.

6. I am prone to allergic reactions and have many allergies. Can I receive the vaccination?

Answer: The HPV vaccine is not suitable for everyone even at the proper age, and it also has some contraindications.For example, those suffering from moderate to severe disease should consider vaccination after the condition has improved. Those with allergies should be treated separately:

  • People allergic to all vaccine components are not suitable for HPV vaccine;
  • People who tend to have immediate allergic reactions to yeast are not suitable for 4-valent and 9-valent vaccines;
  • People allergic to latex are not suitable for 2-valent vaccines.

7. I found I was pregnant after I got the first dose of HPV vaccine. Will it affect my baby? When should I get the rest vaccines?

Answer: Although there are no studies proving that the HPV vaccine can cause birth defects or negative impact on fetal development, it is still not recommended for pregnant women to receive the HPV vaccine. In this example, the woman discovered she was pregnant following the first vaccination. First of all, she does not have to worry about negative effects on fetal growth and development, and no additional genetic screening is needed. Secondly, the subsequent HPV vaccine can be administered after her delivery. Lastly, it should be noted that lactating woman can safely receive the HPV vaccine. 

8. A year ago, I received the first vaccination while I was studying overseas. Then I came back home without completing the whole course. Now do I have to start all over again and receive 3 vaccinations?

Answer: At present, there is a recommended and prescribed minimum interval for the HPV vaccination. As mentioned, the 3-vaccination schedule has specified vaccination intervals of 0, 1-2 and 6 months, respectively. If the 3 vaccinations must be completed within in a shorter term for some reason, the interval from the first vaccination to the second one should be at least 4 weeks. The interval between the second to the third must be more than 12 weeks, and the overall time period from the first to the third vaccinations must be more than 5 months. Is there any recommendation on the maximum interval? The answer is NO. That is to say, if the vaccinations are interrupted unexpectedly, you don’t have to start all over again.  Once you continue, you only need to complete the remaining vaccinations at the specified time.

Some important advice for all women about the HPV vaccine:

  1. Presently, the HPV vaccine is the optimal and most effective way to prevent cervical cancer, and I highly recommend all women to get it at a best timing;
  2. Please go to a qualified medical institutions to havethe vaccine, and have a specialized consultation before receiving the vaccination;
  3. Even though you have completed the HPV vaccination, please stick to annually women’s check-up, and have your Pap smear done every 3 years.