HPV Immunisation

What is HPV?

Human papillomavirus (HPV) is a virus that can affect the skin and mucosa. The mucosa are the moist membranes that line different parts of the body, including the mouth, throat and genital area. There are over one hundred types of HPV and about 40 of these can affect the genital area. Some types of HPV can cause skin warts and verrucas but many types do not cause any problems or harm at all. The majority of women will have an HPV infection at some time during their life, usually without even knowing it. Some types of HPV are known to increase the risk of developing particular cancers. Within two years, 9 out of 10 infections with HPV will clear completely from the body.

What is the link between HPV infection and cancer of the cervix?

Cancer of the cervix is the second most common type of cancer in women in the UK. It kills just over 1,000 women every year in the UK. Most types of HPV do not cause any symptoms or diseases. However, two types, HPV 16 and 18, are involved in the development of most cases of cancer of the cervix.

HPV infection with types 16 and 18 can cause cells in the cervix to change gradually over time. This may lead to precancerous cells or even cancer forming. The precancerous cells are known as CIN (cervical intraepithelial neoplasia) and are discussed in a separate leaflet called 'Cancer of the Cervix'. Having these types of HPV infection does not mean that you will definitely go on to develop cancer of the cervix in the future. However, your risk of developing cancer of the cervix is much increased with these infections.

HPV infection with types 16 and 18 are passed to other people by sexual contact, usually through sexual intercourse. It is more common, therefore, in those people who have had several different sexual partners. The use of condoms reduces but does not completely remove the risk of sexual transmission of the virus.

Is the HPV vaccine effective?

Studies have shown that the HPV vaccine is very effective at stopping cancer of the cervix developing. In clinical trials, the vaccine was over 99% effective at preventing CIN or cancer of the cervix associated with HPV types 16 or 18 in young women. The vaccine has been shown to work better for people who are given the vaccine when they are younger, before they are sexually active, compared to when it is given to adults. However, the HPV vaccine still does not completely protect against HPV infection. It is not a treatment for HPV. Trials have shown that the HPV vaccine is effective against HPV for up to six years. More trials are being done to find out if it is effective for longer than this.

What are the current recommendations regarding the HPV vaccine?

The Department of Health recommends that the HPV vaccine is first given to girls aged 12-13 years in September 2008. There will be a catch up programme starting in 2009 for girls up to the age of 18 years. The vaccine is usually given in the upper arm or thigh. Three doses are needed to provide maximum protection. The second and third doses should, ideally, be given two months and six months after the first. Although there are two types of HPV vaccine currently available (which are similar), the Department of Health has chosen the Cervarix® vaccine for the national immunisation campaign.

Are there any side effects from the vaccine?

The HPV vaccine is generally very safe. Serious problems caused by the vaccine are rare.

At least one in 10 people who have the vaccine have mild side effects which include some pain, swelling and redness around the site of the injection, headache, aching muscles and tiredness. Occasionally, there is some bleeding or itchiness around the area of the injection. Less common side effects include slightly raised temperature, sickness, dizziness, diarrhoea and muscle aches. More rarely, people can develop hives (urticaria).

You should not have the vaccine if you are have had an allergic reaction to a previous HPV vaccine. It is safe in people who have egg, yeast or nut allergies. You should not have it if you have a high temperature or are generally ill. However, it is still possible to be immunised with the HPV vaccine if you have a common cold. Taking the contraceptive pill does not interfere with the vaccine.

Do I still need to have cervical screening tests?

Yes. You should still attend for your regular cervical screening tests, even if you have received the HPV vaccine. This is because the vaccine does not guarantee complete protection against cervical cancer. Cervical screening tests are still important as:

• Immunisation with the HPV vaccine will take several years to reduce cervical cancer.
• The vaccine does not protect against all HPV types.
• Women who do not have the vaccine will not be protected at all against cancer of the cervix or CIN.

It can take between 10 and 20 years for cancer of the cervix to develop after having an infection with HPV. This means that the benefits of the HPV immunisation programme will take many years to be demonstrated.

Further help and information

NHS immunisation information - www.immunisation.nhs.uk
Department of Health - www.dh.gov.uk (search for 'HPV' on their site for documents about national policy)