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HPV Q&A

Chengjie SHEN, OBGYN Physician, Associate Chief Physician

Q: Do we need to detect HPV infection before inoculation of HPV vaccine (cervical cancer vaccine)?

According to CDC’ recommendation: HPV vaccination can be administered without special evaluation. Serologic or HPV DNA testing is not warranted prior to immunization. If the female has not started the sexual life at the time of inoculation, it is certainly not necessary to undergo HPV detection; if the female has sex, especially with multiple sexual partners, I think a knowledge about whether she is infected with HPV and the possible infected subtype helps to select the type of vaccine. After all, HPV vaccine brings about no effect on the existent HPV infection.

Q: Is there a remedy available if you missed the inoculation of HPV vaccine (cervical cancer vaccine)?

Have no idea what kind of situation ‘missed’ refers to? If it refers to the missing of the inoculation, it means the failure to receive immunization according to the schedule. For example, a female should have had 3 inoculations but not received the remaining 2 inoculations after the 1st inoculation. In this case, the opinion of ACIP is that: no matter how long the interval of vaccine inoculation chain is, the inoculation can proceed without a restart. For the female illustrated in the aforementioned case, she only needs to complete 2 inoculations.Besides, if possible, the same vaccine shall be used to complete inoculation chain. That is to say, if you received the first injection of 4-valent vaccine, then the preferred option is 4-valent vaccine regardless of the time you accept injections later.

Q: Many years after the recommended schedule has been finished, is the repetitive inoculation necessary?

Presently, there are no studies suggesting the necessity of repetitive booster injection, it is no more than finishing the inoculation schedule according to regulations. The duration of protection by cervical cancer vaccine is still in study now. Reports suggest that the females still retain the persistent antibody concentration and are protected by anti HPV infection even 10 years after the inoculation.

Q:Is there any contraindication for HPV vaccine (cervical cancer vaccine)?

The definite contraindication include:

1:Pregnant women: Many studies have confirmed that cervical cancer vaccine has no adverse effect on pregnant women and fetus. As studies are under way, there is no definite conclusion yet. Therefore, vaccination is NOT recommended to pregnant women

2:Vaccination is NOT recommended to females in active stage of any severe disease.

3:For females allergic to all contents of vaccines, the vaccination is not recommended; for females having immediate anaphylaxis to yeast, the inoculation of 4 and 9-valent vaccines is not suitable; for females allergic to latex gloves, the inoculation of 2-valent vaccine is not suitable

Q: Is the HPV vaccine (cervical cancer vaccine) for children or adolescents effective?

Authorities including AAP recommend that: The optimal timing of HPV immunization is prior to the first sexual behavior of the individual. Inoculation of HPV vaccine for female or male at 11 to 12 years old is recommended, and even started from the age of 9. Studies show that: Antibody titer of females at 9 to 15 years old after inoculation usually is 2 times that of females at 16 to 26 years old.

Q:Can females who have had sexual life be inoculated with HPV vaccine (cervical cancer vaccine)?

Though the best time for inoculation of HPV vaccine is before the first sexual behavior of individual, studies show that individuals who have had sexual life should still receive the recommended inoculation according to corresponding age for HPV still has protective effect.

Q:Is it still beneficial for the women who is already HPV infected?

It is very clear that for the existent HPV subtypes or related diseases that vaccines are intended for, the existent HPV vaccine can neither cure nor eliminate it sooner.However, it still has protective effect on the uninfected subtype of HPV vaccine, therefore, the vaccine still recommended. For example: If a woman has been infected with HPV-16, she still can be inoculated with any kind of HPV vaccines. If she choses 4-valent vaccine (aiming at HPV-16,18,6,11), she still can prevent 3 other types of HPV virus infection besides HPV-16. But for female infected with HPV-16, the vaccine has no effect.

Q:Can HPV infection be cured by the HPV vaccine (cervical cancer vaccine)?

It is very clear that for the existent HPV subtypes or related diseases that vaccines are intended for, the existent HPV vaccine can neither cure nor eliminate it sooner.

Q:Is cervical screening still necessary for the woman who has already got HPV vaccine? (cervical cancer vaccine)?

Though HPV vaccine can prevent cervical cancer to a large extent, this vaccine is not intended for all HPV virus subtypes which may cause cervical cancer. Therefore, woman who has had HPV vaccination she still need to have regular cervical cancer screening test on a regular basis.

Q: How long can the protection by the HPV vaccine (cervical cancer vaccine) last?

The duration of protection by cervical cancer vaccine is still in study now. Reports suggest that the females still retain the persistent antibody concentration and are protected by anti HPV infection even 10 years after the inoculation. Presently, there are no studies suggesting the necessity of repetitive booster injection, it is no more than finishing the inoculation schedule according to regulations.

Q: Will cervical cancer occur even after the inoculation of HPV vaccine (cervical cancer vaccine)?

Studies have confirmed that: Close to 70% of cervical cancer cases are caused by HPV-16 and 18, and 20% are caused by HPV31,33,45,52 and 58. That is to say, the other 10% of cervical cancer cases are results of the subtype besides the above common high risk HPV. The current 9-valent vaccines (including HPV-6,11,16,18,31,33,45,52,58) are intended for the most seen HPV subtypes which can result in cervical cancer. Nevertheless some subtypes are still not targeted, the occurrence of cervical cancer can be greatly reduced by the inoculation of HPV vaccine, but can not be completely eradicated. That is to say, the regular cervical cancer screening is still needed.

Q: Is HPV vaccine (cervical cancer vaccine) safe?

Virus-like particles similar to viral capsid are used in all HPV vaccines. Genetic material is not contained. Vaccines are produced by the biological system with fully definite safety record, the safety of all HPV vaccines are proved in the large-scale clinical tests. The common adverse reactions are local swelling, pain, dizziness and low heat, and even syncope in few extreme cases. So, maintaining sitting position for 15 minutes after inoculation is suggested

Q:Can HPV vaccine (cervical cancer vaccine) cause HPV infection?

There is no virus particle in HPV vaccine, so HPV infection can not be caused.

Q:Is the inoculation of HPV vaccine (cervical cancer vaccine) possible during pregnancy?

Many studies have confirmed that cervical cancer vaccine has no adverse effect on pregnant women and fetus. As studies are under way, there is no definite conclusion yet. Therefore, inoculation is not recommended to pregnant women If a female finds herself pregnant after inoculation, there is no need of worrying that the vaccine has potential adverse effect on embryonic development. The unfinished inoculation schedule can be performed after delivery. Pregnancy test shall not be performed before the inoculation of HPV vaccine in America.

Q:Is the HPV vaccine (cervical cancer vaccine) safe for the lactating women?

HPV vaccine can be safely administrated for women who is breastfeeding.

Q:Does the inoculation of HPV vaccine (cervical cancer vaccine) influence fertility function?

The major purpose of HPV vaccine is to reduce HPV virus infection, and lesions and canceration of vulva, uterine neck, vagina and other sites caused by HPV virus. It is not related to fertility function, there is no influence at all.

Q:What is the difference among 2, 4 and 9-valent HPV vaccines (cervical cancer vaccine)? How to choose HPV vaccine (cervical cancer vaccine)?

The main difference lies in the intended HPV subtypes:

2-valent: aiming at HPV 16 and 18, it is not suitable for females who are allergic to latex gloves;

4-valent: aiming at HPV 6, 11, 16 and 18, it is not suitable for females who have immediate anaphylaxis to yeast;

9-valent: aiming at HPV 6, 11, 16, 18, 31,33,45,52 and 58, it is not suitable for females who have immediate anaphylaxis to yeast;

the more the subtypes are covered, the wider the scope of prevention of HPV is, the better the protection to the body is. Only 9-valent vaccines are used in America as of 2017.