HPV Vaccine (Human Papillomavirus Vaccine)

Key vaccine facts

This vaccine gives protection against some strains of the Human Papillomavirus (HPV), including ones which cause cervical cancer and mouth cancers. About 3,200 women are diagnosed with cervical cancer every year in the UK. It is currently the most common cancer in women under 35, and kills around 850 UK women every year.

The HPV vaccine used in the UK is called Gardasil (see the Patient Information Leaflet ). It protects against four strains of HPV: types 6, 11, 16 and 18. Types 16 and 18 are responsible for almost 75% of the cases of cervical cancer in Europe. Type 16 also causes oral cancer. Types 6 and 11 are responsible for around 90% of the cases of genital warts. The vaccine does not contain any live viruses and cannot cause HPV infection.

Who should have the vaccine, and how many doses are needed?

In the UK the vaccine is routinely offered to girls who are aged 12-13 years. The first dose is offered during school year 8, with the second dose either 12 months or 6 months later. There should be at least a 6 month gap between the first and second doses. Girls aged 15 or older who have not been vaccinated at 12-13 years should have three doses of the vaccine to ensure good protection.

On 24 July 2018 the UK government announced that the HPV vaccine would also be offered to all boys aged 12-13 years. This follows updated evidence from the Joint Committee on Vaccination and Immunisation (JCVI) , the body that advises the Department of Health in the UK. In their updated statement the JCVI advised that the existing HPV vaccination programme for girls should be extended to boys as well. A start date for the boys' programme has not yet been announced.

HPV vaccination in the UK is offered through schools. If a girl is not in school or misses one or both doses of the vaccine, catch-up vaccination can be provided by the GP surgery.

Since April 2018 the HPV vaccine has also been offered to all men aged 45 or younger who have sex with men. This follows a successful pilot programme that has run since 2016. The vaccine will be offered at routine check-ups at sexual health (GUM) clinics and HIV clinics. See the Public Health England news item .

What protection does the vaccine give?

In clinical trials, the vaccine was over 99% effective at preventing pre-cancer caused by HPV types 16 or 18 in young women. The vaccine also gives some cross-protection against HPV strains that are not in the vaccine itself. It is expected that vaccination will reduced the number of cases of the most common kind of cervical cancer by at least 70%. However, it is important that girls who are vaccinated continue to take up the offer of cervical smear testing later in life, so that other kinds of cervical cancer can be picked up.

HPV vaccine programmes around the world are currently being evaluated. Evidence from these shows falling numbers of young people with HPV infection and pre-cancerous cells (the cells that can go on to cause cervical cancer). Studies have shown that protection against HPV lasts at least 10 years, and this is expected to be long-term. See 'Does the vaccine work?' towards the bottom of this page.

HPV vaccine safety

There is no evidence that the HPV vaccine is linked to serious side effects such as chronic fatigue syndrome. See 'Is the vaccine safe?' at the bottom of this page.

Carron’s story – cervical cancer and the HPV vaccine

In this short film Carron Hulme talks about her experience of surviving cervical cancer, and her daughters Charlotte and Mollie talk about the HPV vaccine. Thanks to Jo’s Cervical Cancer Trust for their help in making this film.

In the film Charlotte talks about receiving three doses of the HPV vaccine, but in 2014 the schedule changed. Girls now receive two doses, as long as they get the first dose when they are aged 12-13.

Ingredients

The HPV vaccine used in the UK is called Gardasil. This vaccine does not contain any live viruses and cannot cause HPV infection. It contains individual proteins from four types of HPV virus, which produce an immune response. Apart from the active ingredients (the antigens), it contains very small amounts of these ingredients:

  • Aluminium, which strengthens and lengthens the immune response to the vaccine
  • a tiny trace (a few millionths of a gram) of sodium borate (borax), used as an acidity regulator

Yeast is used in the production of Gardasil. However no yeast remains in the vaccine itself, so it can be given to those with yeast allergies.

Other brands of HPV vaccines used in other countries may contain different ingredients. If you are not in the UK, ask for the Patient Information leaflet for the vaccine you are offered.

Side effects

Very common (affecting more than 1 in 10 people at each dose):

  • Pain, swelling and redness at the injection site
  • Headache

Common (affecting up to 1 in 10 people at each dose):

  • Bruising or itching at the injection site
  • Raised temperature (fever)
  • Feeling sick (nausea)

Rare (affecting up to 1 in 1000 people at each dose):

  • Hives (urticaria)

Very rare (affecting fewer than 1 in 10,000 people at each dose):

  • Difficulty breathing (bronchospasm)

It is quite common for teenagers to have panic attacks before vaccination, or to faint during vaccination. These should not be confused with reactions to the vaccination itself.

There is no evidence that the HPV vaccine leads to an increased risk of chronic fatigue syndrome, POTS (postural orthostatic tachycardia syndrome) or CRPS (Complex Regional Pain Syndrome). See 'Is the vaccine safe?' at the bottom of this page.

As with any vaccine, medicine or food, there is a very small chance of a severe allergic reaction (anaphylaxis). Anaphylaxis is different from less severe allergic reactions because it causes life-threatening breathing and/or circulation problems. It is always serious but can be treated with adrenaline. In the UK between 1997 and 2003 there were a total of 130 reports of anaphylaxis following ALL immunisations, but all of these people survived. Around 117 million doses of vaccines were given in the UK during this period, making the overall rate around 1 in 900,000. Depending on the cause of the reaction, and following expert guidance, the person may be able to have vaccinations in the future.

Reactions listed under ‘possible side effects’ or ‘adverse events’ on vaccine product information sheets may not all be directly linked to the vaccine. See Vaccine side effects and adverse reactions for more information on why this is the case.

If you are concerned about any reactions that occur after vaccination, consult your doctor. In the UK you can report suspected vaccine side effects to the Medicines and Healthcare products Regulatory Agency (MHRA) through the Yellow Card Scheme . You can also contact the MHRA to ask for data on Yellow Card reports for individual vaccines . See more information on the Yellow Card scheme and monitoring of vaccine safety.

More information about the vaccine

In the UK in 2015, there were 3126 new cases of cervical cancer and 854 women died from cervical cancer (see cervical cancer statistics from Cancer Research UK ). Cervical cancer is the most common cancer among women who are 15 to 34 years old. Unlike the majority of cancers, it is mainly a disease of the young, with 62% of cases occurring in women who are less than 50 years old.

The vaccine currently used in the UK is called Gardasil. It was chosen over an alternative vaccine called Cervarix because it gives wider protection. (Cervarix was used in the UK from September 2008, when the programme started, until August 2012.)

Before September 2014, girls in the UK were given three doses of the HPV vaccine. However, from September 2014 the number of doses was reduced from three to two for those who first receive the vaccine aged 12-13. This was because research has shown that two doses of the vaccine give a level of protection that is just as good and lasts just as long as three doses, as long as girls are aged 12-13 when they receive the first dose. For those who start the vaccination course aged 15 or older, it is recommended that they continue to receive the three doses. See the Public Health England letter about this change .

Although there is no evidence that the vaccine is unsafe during pregnancy, it is not routinely given to pregnant women. The three-dose course should be completed following pregnancy.

In some countries the HPV vaccine is given to teenage boys as well as to girls. As stated above, on 24 July 2018 the UK government announced that the HPV vaccine would also be offered to all boys aged 12-13 years. In the UK the HPV vaccine is already offered to men who have sex with men, as they received very little indirect protection from the girls' vaccination programme.

A new HPV vaccine which protects against nine types of HPV is being considered for use in the UK.

Does the vaccine work?

As the HPV vaccine is relatively new, it is still being monitored to see how long protection lasts. The actual impact on cervical cancer cases will not be known for certain until the first cohort of girls who received the HPV vaccine become old enough to develop cervical cancer. However, there is growing evidence that the vaccine has long-term effectiveness against the types of HPV that cause most cases of cervical cancer.

In June 2018, Public Health England published research on the impact of the UK's HPV vaccine programme . It found a significant fall in HPV infections in young women. HPV type 16 and 18 infections, which cause the majority of cervical cancer cases, decreased by 86% in women aged 16 to 21 who were eligible for the vaccination as teenagers between 2010 and 2016 in England. In addition the study found a reduction in HPV types 31, 33 and 45, which can also cause cancer. This shows that the vaccine gives some cross-protection against HPV strains which are not in the vaccine. There was also a decline in genital wart diagnoses in sexual health clinics. Between 2009 and 2017 numbers of cases in girls aged 15 to 17 fell by 89%, and in boys of the same age they fell by 70% as a result of herd immunity.

These early findings support the view that the HPV vaccination programme will have an impact on the numbers of cases of cervical cancer in future. A 2016 study from the USA showed similar results. In April 2017, researchers at Health Protection Scotland reported a 90% fall in levels of the HPV virus in Scottish women since the vaccine was introduced in 2008 (see this BBC News story ).

In May 2018, the Cochrane Library published a systematic review of 26 HPV vaccine trials involving over 73,000 participants . Cochrane is a global independent network whose aim is to gather and summarize the best health evidence from research to help people make informed choices about treatment. On the question of whether the HPV vaccine works, the review said: 'There is high-certainty evidence that HPV vaccines protect against cervical precancer in adolescent girls and women who are vaccinated between 15 and 26 years of age. The protection is lower when a part of the population is already infected with HPV. Longer-term follow-up is needed to assess the impact on cervical cancer.'

A long-term Scandinavian study on Gardasil showed in 2015 that the majority of vaccinated young women still had high levels of antibodies against HPV for at least 9 years after vaccination. A follow-up study published in 2018 concluded that 'vaccine effectiveness remains above 90% for at least 10 years'. This is strong evidence of long-term protection against the HPV types that cause most cases of cervical cancer.

A 2015 Public Health England report also shows that the HPV vaccine has had a very high level of coverage in England. In the three years 2011/12, 2012/13 and 2013/14, 86% of girls received the full three doses of HPV vaccine. In 2015/16, 85% of girls received the full two-dose course. (Doses were reduced to two from September 2014; see 'More Information' above.)

Is the vaccine safe?

Between 2009 and 2016 more than 8.5 million doses of HPV vaccine were given in the UK, with an uptake of nearly 90%. When a vaccine is given to a very large number of people in a population, it is likely just by chance that a few of them will develop some kind of medical problem around the time of vaccination; it does not prove that the vaccine caused the condition.

In the UK, side effects reported after the HPV vaccine have been monitored by the MHRA (Medicines and Healthcare products Regulatory Authority). They have found no evidence that the HPV vaccine leads to an increased risk of chronic fatigue syndrome (also called myalgic encephalomyelitis or ME). See the results of a study by the MHRA in 2013 .

There is also no evidence that the HPV vaccine leads to an increased risk of POTS (postural orthostatic tachycardia syndrome) or CRPS (Complex Regional Pain Syndrome). The European Medicines Agency (EMA) carried out a full review of the evidence in 2015. Read their November 2015 press release and the full EMA report . See also our blog piece from June 2015 about this story.

In December 2012 the MHRA (Medicines and Healthcare products Regulatory Authority) published a 4-year safety report on Cervarix, the HPV vaccine used in the UK until September 2012. This included a breakdown of all the adverse events reported after HPV vaccination. Read the MHRA report here.

In May 2018, the Cochrane Library published a systematic review of 26 HPV vaccine trials involving over 73,000 participants . Cochrane is a global independent network whose aim is to gather and summarize the best health evidence from research to help people make informed choices about treatment. On the question of HPV vaccine safety, the review said: 'The vaccines do not increase the risk of serious adverse events, miscarriage or pregnancy termination. There are limited data from trials on the effect of vaccines on deaths, stillbirth and babies born with malformations.'

Page last updated: 
Monday, November 19, 2018

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