Thomas Jefferson University Hospital - Questions and Answers: The HPV Vaccine

Questions and Answers: The HPV Vaccine

Norman G. Rosenblum, MD, PhD

Jefferson gynecologic oncologist addresses common concerns

In June 2006, the United States Food and Drug Administration (FDA) approved the Gardasil® vaccine, which protects against certain types of Human Papillomavirus (HPV). In this article, Norman G. Rosenblum, MD, PhD, Director of the Division of Gynecologic Oncology in the Department of Obstetrics and Gynecology at Thomas Jefferson University Hospital, answers some frequently asked questions about the new vaccine.

First, what is Human Papillomavirus?
Human Papillomavirus, or HPV, is a family of viruses that can cause abnormal tissue growth or other changes to cells. In all, there are about 100 different kinds of HPV. Some of the strains are linked to genital warts; others are linked to pre-malignant and malignant diseases of the lower genital tract, including the cervix, vagina and vulva.

HPV infection is extremely common. The Centers for Disease Control and Prevention (CDC) has reported that HPV is the most common sexually transmitted disease in the United States. More than 20 million men and women are currently infected, and there are 6.2 million new infections every year. According to the American Cancer Society, there will be an estimated 9,710 new cases of cervical cancers and 3,700 cervical cancer deaths in the U.S. this year.

Globally, the problem is even more severe. In fact, cervical cancer is the second leading cause of cancer death in women worldwide. In 2006, there will be an estimated 500,000 new cases and 275,000 deaths from cervical cancer.

What exactly does the new vaccine protect against?
The first approved vaccine is Gardasil®, which was developed by Merck. This vaccine is quadrivalent, which means that it protects against the acquisition of four strains of HPV in women who have not been previously exposed to the virus.

Specifically, Gardasil protects against strains 16 and 18, which are associated with 70 percent of cervical cancers, as well as strains 6 and 11, which are associated with 90 percent of genital warts. In other words, the Gardasil vaccine doesn’t provide total protection – but it does guard against the majority of the HPV strains that can lead to cancer or warts.

How is the vaccine administered?
The Gardasil vaccine is delivered via a series of three injections over six months. Patients receive the initial injection, then the second injection two months after the first, and the third one six months after the first.

Who should receive this vaccine?
Although the FDA has approved the vaccine for females between the ages of nine and 26, the federal Advisory Committee on Immunization Practices is recommending that girls receive the vaccine between the ages of 11 and 12. In other words, it’s ideal to vaccinate them before they have any sexual exposure.

Nevertheless, women up to age 26 can be vaccinated. Even if a woman already has one strain of HPV, the vaccine could prevent her from becoming infected with one of the other types. For specific advice, consult your physician.

What are some of the practical limitations of the vaccine?
The biggest limitation right now is the cost. The Gardasil vaccine costs $120 per injection, for a total of $360. Currently, insurance companies aren’t covering that cost. However, the insurance companies are awaiting some guidance from the federal government, at which point they are likely to begin covering it.

The other practical limitation is just getting people to go and get themselves or their children vaccinated. Also, because the vaccine is targeted to girls between the ages of 11 and 12, it will be up to pediatricians, not gynecologists, to administer it to those patients.

Finally, what do people need to know about the first approved HPV vaccine?
There’s no question that this vaccine is a major advancement in the prevention of pre-malignant and malignant diseases of the lower genital tract. In the United States, the Pap smear has helped us to decrease the incidence and mortality of cervical cancer by some 74 percent. With the Gardasil vaccine and others like it that are in development, we’re going to reduce that even more. Almost any disease is curable in the precancerous stages, and now we’re going to be able to prevent even the precancerous growths.

That being said, it’s critically important for women to understand that getting this vaccine doesn’t mean they can skip the Pap smear. The Pap smear remains very important and should be obtained as directed by your physician.

For more information about the HPV vaccine, visit the American College of Obstetricians and Gynecologists.

For more information about cervical and other gynecologic cancers, read this report from the Gynecologic Cancer Foundation.

For an appointment with a Jefferson physician, call 1-800-JEFF-NOW.