Human Papillomavirus (HPV) Vaccines
Vaccination against human papillomavirus (HPV) is recommended to prevent new HPV infections and HPV-associated diseases, including cancers, says the WHO.
There are safe and effective HPV vaccines to protect males and females against cancers caused by HPV. These vaccines include 9vHPV, 4vHPV, and/or 2vHPV, says the US Centers for Disease Control and Prevention (CDC). The current HPV vaccine recommendations are found on this CDC website.
The American Cancer Society updated its guideline for HPV vaccination on July 8, 2020. The new recommendations are for healthcare providers to routinely offer the HPV vaccine series to boys and girls between ages 9 and 12.
A study published by the NEJM on October 1, 2020, found among Swedish women between 10 to 30 years old, the quadrivalent HPV vaccination was associated with a substantially reduced risk of invasive cervical cancer at the population level.
HPV Preventive Vaccines - Approved
Gardasil - Merck's Gardasil vaccine consists of 4 proteins of HPV types 6, 11, 16, and 18. Gardasil is highly efficacious in preventing infection from virus types 16 and 18, which are together responsible for approximately 70% of cervical cancer cases globally. The quadrivalent vaccine is also highly efficacious in preventing anogenital warts, a common genital disease that is virtually always caused by infection with HPV types 6 and 11.
Gardasil 9 - Gardasil 9 consists of HPV proteins, Types 6, 11, 16, 18, 31, 33, 45, 52, and 58. HPV infections can lead to certain cervical cancers. Many females with cervical cancer were probably exposed to cancer-causing HPV types in their teens and early 20s. Additionally, males can get HPV, causing anal and throat cancers and genital warts.
Cecolin - Innovax's Cecolin HPV Vaccine protects women against HPV 16 and 18, two HPV types causing 70 percent of all cervical cancers, the third most common cancer among women. Starting May 18, 2020, the HPV vaccine developed by Chinese researchers is available in provincial Maternity and Child Healthcare Hospital in Wuhan.
Cervarix - GlaxoSmithKline's Cervarix is a non-infectious recombinant, AS04-adjuvanted vaccine that contains recombinant L1 protein, the major antigenic protein of the capsid, of oncogenic HPV types 16 and 18. This HPV vaccine was pulled from the US market on 10/2016.
HPV Therapeutic Vaccines - Candidates
TG4001 - TG4001 is Transgene's vaccine candidate using an attenuated and modified poxvirus as a vector expressing the HPV16 E6 and E7 proteins interleukin-2.
VGX-3100 - Inovio's investigational immunotherapy vaccine includes DNA plasmids targeting the E6 and E7 proteins of HPV types 16 and 18.
INO-3107 - Inovio's DNA medicine is evaluated in a Phase 1/2 trial to treat recurrent respiratory papillomatosis, a rare disease caused by human papillomavirus types 6 and 11 infections.
VTP-200 - Vaccitech’s immunotherapy for high-risk HPV infection and associated low-grade cervical intraepithelial neoplasia.
HPV Vaccine News 2021
April 5, 2021 - According to a study published by the JAMA Network Open, women who received the human papillomavirus (HPV) vaccine inadvertently in early pregnancy show the vaccine did not cause miscarriages adverse birth outcomes. This study suggests that, in an insured population, adverse events after exposure to the 9vHPV vaccine during or around the time of pregnancy were uncommon and not associated with small-for-gestational-age or selected adverse birth outcomes.
March 30, 2021 - The Irish Pharmacy Union announced students who received their first dose of the HPV vaccine, which protects girls against cervical cancer, fell from 80% in 2019 to just 53% in 2020. According to the union, school closures and the redeployment of school vaccination teams to Covid-19 vaccine roll-out centers have interrupted school HPV vaccination programs. Around 300 women are diagnosed with cervical cancer each year in Ireland, with more than nine in ten cervical cancer diagnoses from HPV infections, leading to around 90 deaths every year.
March 25, 2021 - This CDC report adds to the robust data on the national HPV vaccination program's impact, including herd effects. In addition to decreases in the prevalence of vaccine types, decreasing rates of cervical precancers and anogenital warts also have been demonstrated in the United States and other countries after the introduction of HPV vaccination. In addition to significantly lower 4vHPV-type prevalence among sexually experienced vaccinated females than those in the prevaccine era, the 4vHPV-type prevalence was also lower among unvaccinated females: 87% in females aged 14–19 years and 65% in those aged 20–24 years.
March 18, 2021 - Oxford-based Vaccitech Ltd announced the dosing of the first patient as part of the HPV001 clinical study, a randomized, placebo-controlled Phase 1/2 clinical trial designed to evaluate the safety and preliminary efficacy of VTP-200, Vaccitech’s immunotherapy for high-risk HPV infection and associated low-grade cervical intraepithelial neoplasia.
March 11, 2021 - PLOS published: Human papillomavirus vaccination for adults aged 30 to 45 years in the United States: A cost-effectiveness analysis. HPV vaccination of women and men aged 30 to 45 years provides limited health benefits at the population level, at a substantial cost (at current HPV vaccine prices). Public health decision-makers considering the option to extend HPV vaccination to adults up to age 45 years should consider this evaluation of the value—and the opportunity costs—of adopting such a policy.
March 10, 2021 - Transgene, a French biotech company that designs and develops virus-based immunotherapeutics against cancer, announces the expansion of a randomized, controlled study with TG4001 combination with avelumab versus avelumab monotherapy in patients with HPV16-positive anogenital tumors.
March 4, 2021 - “It’s far better to prevent cancer than treat cancer,” says Andrew Kung, Chair of the Department of Pediatrics at Memorial Sloan Kettering Cancer Center MSK Kids. This Vaccine Can Protect Your Child Against Cancer: Get the Facts about the HPV Vaccine.
March 4, 2021 - A global partnership of over 80 organizations led by the International Papillomavirus Society has mobilized to raise awareness and understanding about HPV worldwide. Partners of the HPV Awareness Campaign ‘think globally and act locally,’ using social media and community events to get people of all ages and backgrounds talking about HPV, learning how it affects them, and taking action to reduce their risks.
February 9, 2021 - A Research Brief published by the American Academy of Pediatrics reported 'Adolescents’ receipt of the human papillomavirus (HPV) vaccine is primarily a decision of their parents. Despite a health provider recommendation, parents of 60.6% of unvaccinated adolescents had no intention to initiate the HPV vaccine series. Overall, there was 7.3 million HPV vaccine eligible U.S. adolescents who were unvaccinated in 2018, the study's data showed.'
February 5, 2021 - WHO Request: Technical Support for updating the WHO/UNICEF HPV vaccine coverage and the WHO cervical cancer screening coverage estimates in the period 2021-2023. In November 2020, the Global strategy towards eliminating cervical cancer was launched. HPV vaccination and screening coverage estimates contribute towards the monitoring of the cervical cancer strategy. Given the comprehensive nature of cervical cancer prevention, further work will be carried out in developing a complete and integrated monitoring framework for cervical cancer elimination. This will include additional exploration and development of a comprehensive cervical cancer protection index across the primary and secondary prevention pillars.
February 1, 2021 - The results of a new study focused on Oral Human Papillomavirus infections in children during the first six years of life indicate that HPV infection can be acquired non-sexually and is already common at an early age. This longitudinal study found children develop their first oral HPV infection at an early age.
January 29, 2021 - The U.S. CDC published Volume 27, Number 3—March 2021: Research: Oral Human Papillomavirus Infection in Children during the First 6 Years of Life, Finland. This study reported oral HPV prevalence for children varied from 8.7% (at a 36-month visit) to 22.8% (at birth), and 18 HPV genotypes were identified. HPV16 was the most prevalent type to persist, followed by HPV18, HPV33, and HPV6. Persistent, oral, high-risk HPV infection for children was associated with the mother's oral HPV carriage at birth and seroconversion of the mother to high-risk HPV during follow-up. This data indicates HPV status of the mother has a major impact on the outcome of oral HPV persistence for her offspring.
January 29, 2021 - Research: Association between human papillomavirus vaccination and serious adverse events in South Korean adolescent girls: a nationwide cohort study. In this national cohort study, with more than 500 000 doses of HPV vaccines, no evidence was found to support an association between HPV vaccination and serious adverse events using cohort analysis and self-controlled risk interval analysis. Inconsistent findings for migraine should be interpreted with caution considering its pathophysiology and interest population.
January 26, 2021 - Study: Impact of the human papillomavirus vaccine supply shortage on Tanzania’s national HPV vaccine introduction. In 2018, WHO issued a call to action toward global cervical cancer elimination with a global target of 90% of girls vaccinated with HPV vaccine by 15 years of age. As the international community responds to this call to action, the vaccine supply needs to be increased concurrently to reach eligible girls through planned HPV vaccine national introductions, particularly among countries with the highest cervical cancer burden—also most impacted by vaccine supply constraints. While additional vaccine manufacturers and single-dose vaccination strategies might relieve the supply constraints in the future, country programs and the global community must work together now to align efforts and utilize the currently available resources optimally.
January 22, 2021 - "Given the effect that HPV vaccination has had on cancer prevention, it is important to identify factors influencing HPV vaccination coverage," said Bernard Fuemmeler Ph.D., associate director for population science, the Gordon D. Ginder, M.D., Chair in Cancer Research and co-leader of the Cancer Prevention and Control research program at VCU Massey Cancer Center. Fuemmeler and his team conducted the first-ever systematic review of area-level data reported in the United States between 2006 and 2020 to determine how geography, neighborhoods, and sociodemographic factors impact HPV vaccination rates among adolescents and young adults. The study was published in Cancer Epidemiology, Biomarkers, and Prevention. "Our findings demonstrate the need to adopt geospatial, standardized, and collaborative approaches in future studies that allow for the effective mapping, detection, and reporting of geographic areas with low HPV vaccination coverage," Fuemmeler said.
January 20, 2021 - Robert L. Coleman, MD, chief scientific officer of The US Oncology Research, explained that the year 2021 is expected to be a banner year for cervical cancer treatment. “Other essential things that are happening in cervical cancer this year would be the continuous move of immunotherapies into earlier lines of treatment, all the way up to not only in the adjuvant setting but also with chemoradiation or radiation plus [immunotherapy], followed by maintenance therapy. [There is] the concept of moving maintenance therapy into cervical cancer and into earlier therapy lines, which will be an important addition. We'll hear data starting to emerge from those kinds of strategies. That's going to be really exciting for cervical cancer; we just haven't had anything for quite a while for that space.”
January 14, 2021 - the American Cancer Society published Special Section: Cancer in Adolescents and Young Adults - Cancer Facts 2020.
January 8, 2021 - From bad to worse II: Risk amplification of the HPV vaccine on Facebook. Conclusion: Nearly four out of every ten Facebook posts about the HPV vaccine contained messages that amplified the risk of the HPV vaccine, and the data suggest that these posts had momentum over time. Research must continue to address the perception of vaccine safety. The vaccine is perceived as the health threat, with deep research into online communities to discover the perceived ripples and impacts.
January 7, 2021 - The NEJM reported 'Two cases of pediatric lung cancer (in 23-month-old and 6-year-old boys) resulting from mother-to-infant transmission of uterine cervical tumors were incidentally detected during routine next-generation sequencing of paired samples of tumor and normal tissue. Spontaneous regression of some lesions in the first child and the slow growth of the second child's tumor mass suggested alloimmune responses against the transmitted tumors. Immune checkpoint inhibitor therapy with nivolumab led to a strong regression of all remaining tumors in the first child.'
January 6, 2021 - The U.S. Department of Health and Human Services, Office of the Assistant Secretary for Health (OASH), Office on Women's Health is launching the HPV VAX NOW campaign with the long-term goal of increasing human papillomavirus (HPV) vaccination rates among young adults ages 18–26. The campaign will specifically target young adults and healthcare providers in Mississippi, South Carolina, and Texas — states with some of the country's lowest HPV vaccination rates. Currently, fewer than half of young adults in the United States have received one or more doses of the HPV vaccine, and only 22% have completed the vaccine series. According to the Centers for Disease Control and Prevention, HPV causes nearly 36,000 cases of cancer in men and women each year in the U.S.
January 5, 2021 - Monique Luisi, an assistant professor at the University of Missouri School of Journalism, has studied more than 6,500 public HPV vaccine-related posts on Facebook from 2006 to 2016. In a previous study, Luisi used these Facebook posts to identify a negative trend on Facebook related to how people perceive the HPV vaccine. She suggests this negative trend on Facebook may also cause people to develop a false perception of the vaccine's health risk. After looking at the percentage of posts that made the vaccine seem more dangerous, less dangerous, or neither, Luisi found nearly 40% of Facebook posts about the HPV vaccine amplified a perceived risk. The data suggest these posts had momentum over time.
January 1, 2021 - American Academy of Pediatrics study: Antibody responses persisted through 2 to 2.5 years after the last dose of a 2-dose 9vHPV vaccine regimen in girls and boys. In girls and boys, antibody responses generated by 2 doses administered 6 to 12 months apart may be sufficient to induce high-level protective efficacy through at least 2 years after the second dose.
Click here to see 2020 HPV News Articles.
HPV Vaccination Overview
The CDC recommends individuals should receive the complete HPV vaccine series, regardless of the age group. The CDC recommends that 11- to 12-year-olds receive two doses of HPV vaccine at least six months apart, rather than the previously recommended three doses to protect against cancers caused by HPV infections.
Teens and young adults who start the series later, at ages 15 through 26 years, will continue to need three doses of HPV vaccine to protect against cancer-causing HPV infection. Young women can get the HPV vaccine through age 26, and young men can get vaccinated through age 21.
HPV vaccination is also recommended for men and women with compromised immune systems (including people living with HIV/AIDS) through age 26 if they did not get fully vaccinated when they were younger.
The U.S. FDA approved an expanded indication for GARDASIL9 to prevent oropharyngeal cancers caused by HPV types 16, 18, 31, 33, 45, 52, and 58 on June 13, 2020.
The oropharyngeal and head and neck cancer indication is approved under accelerated approval based on effectiveness in preventing HPV-related anogenital disease.
HPV is a group of more than 150 related viruses. Each HPV virus in this large group is given a number called its HPV type. HPV is named for warts (papillomas) some HPV types can cause.
Some other HPV types can lead to cancer, especially cervical cancer. More than 40 HPV types can infect the genital areas of males and females. But some vaccines can prevent infection with the most common types of HPV.
HPV is transmitted through intimate skin-to-skin contact. You can get HPV by having vaginal, anal, or oral sex with someone who has the virus. It is most commonly spread during vaginal or anal sex.
HPV is the most common sexually transmitted infection (STI). Anyone sexually active can get HPV, even if you have had sex with only one person.
HPV is so common that nearly all sexually active men and women get it at some point in their lives. HPV can be passed even when an infected person has no signs or symptoms. You can develop symptoms years after you have sex with someone infected, making it hard to know when you first became infected.
In most cases, HPV goes away on its own and does not cause any health problems. But when HPV does not go away, it can cause health problems like genital warts and cancer, says the CDC.
Genital warts usually appear as small bumps or groups of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. A healthcare provider can usually diagnose warts by looking at the genital area.
Cervical cancer usually does not have symptoms until it is quite advanced, very serious, and hard to treat. For this reason, women need to get regular screening for cervical cancer. Screening tests can find early signs of disease so that problems can be treated early before they ever turn into cancer.
Other HPV-related cancers might not have signs or symptoms until they are advanced and hard to treat. These include cancers of the vulva, vagina, penis, anus, and oropharynx (cancers of the back of the throat, including the base of the tongue and tonsils).
Cancer often takes years, even decades, to develop after receiving HPV. The types of HPV that can cause genital warts are not the same as the types of HPV that can cause cancers.
There is no way to know which people who have HPV will develop cancer or other health problems. People with weak immune systems (including individuals with HIV/AIDS) may be less able to fight off HPV and more likely to develop health problems.
Most people with HPV do not know they are infected and never develop symptoms or health problems. Some people find out they have HPV when they get genital warts. Women may find out they have HPV when they get an abnormal Pap test result (during cervical cancer screening).
There is no test to determine a person’s “HPV status.” Also, there is no approved HPV test to find HPV in the mouth or throat.
There are HPV tests that can be used to screen for cervical cancer, says the CDC. These tests are recommended for screening only in women aged 30 years and older. They are not recommended to screen men, adolescents, or women under 30 years.
The American Cancer Society published simplified guidelines on July 30, 2020, that state women with a cervix should start molecular HPV testing at age 25 -- 4 years later than previous guidelines suggest. According to the new recommendations, if primary HPV testing is not available, either a Pap test every 3 years or co-testing (i.e., combined cytology and HPV tests) every 5 years is acceptable.
Approximately 33,700 cancers are caused by HPV in the USA each year, including 12,900 oropharyngeal cancers among men and women, 10,800 cervical cancers among women, and 6,000 anal cancers among men and women; vaginal, vulvar, and penile cancers are less common.
HPV vaccination for adolescents has been routinely recommended for females since 2006 and for males since 2011, says the CDC.
The existing HPV vaccination program for adolescents can prevent most of these cancers. The mean age at acquisition of causal HPV infection for cancers is unknown but is estimated to be decades before cancer is diagnosed.
CONTENT SOURCES: World Health Organization, US Centers for Disease Control and Prevention, FDA, research studies, manufacturer announcements, and the Precision Vax news network, which has been reviewed by healthcare providers, such as Dr. Bob Carlson.