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HPV Vaccine

Survivors of pediatric cancer should get a vaccine to prevent human papillomavirus (HPV) infection. HPV can cause several types of cancer in both males and females.

Several studies have shown that as childhood cancer survivors become older, they have a slightly higher risk of developing (a second) cancer compared to people their same age in the general, healthy population.

The HPV vaccine is most effective when given before exposure to the virus, which is spread through sexual contact. The best time to vaccinate against HPV is ages 11-12. The immune response is best at these ages, and children should not have been exposed to the virus. Children have the strongest immune response before age 16. Children should get this vaccine even if it is not required for school attendance.

Childhood cancer survivors should get the HPV vaccine. The best time to vaccinate against HPV is ages 11-12.

Childhood cancer survivors should get the HPV vaccine. The best time to vaccinate against HPV is ages 11-12.

Some parents don’t consider the vaccine because they feel their child is too young for a vaccine against a sexually transmitted infection (STI) and also may not be ready to have the “sex talk” with them. Even though HPV is sexually transmitted, parents don’t have to discuss sexual topics with their child before getting the vaccine. It is for the protection of their health just like vaccines for whooping cough and measles.

If vaccination did not occur as a pre-teen, vaccination is approved for up to age 26.

For healthy children ages 9-15, HPV vaccination is given through 2 injections over a 6-month period if the first shot is given before age 15. However, cancer survivors, other children with weakened immune systems, and people ages 15-26 require 3 doses.

HPV is the leading cause of cervical cancer in women. After tobacco and alcohol, HPV causes more cases of oropharyngeal (throat) cancer in men. It is also associated with a number of rarer cancers, such as anal, vaginal, and vulvar cancers.

HPV is the most common STI. It infects about 14 million people each year in the U.S. The second most common STI is chlamydia with about 3 million new cases annually.

There are two types of sexually transmitted HPV:

  • High-risk HPVs: These types can cause cancer. HPV types 16 and 18 cause more than half of cervical, anal, mouth, throat, and vaginal cancers. HPV types 31, 33, 45, 52, and 58 cause an additional 14% of cancer in females and 4% in males. These types are all covered by the HPV vaccine.
  • Low-risk HPVs: These types do not cause cancer. They can cause skin warts in the genital, anal, lips, mouth, tongue, and throat areas. HPV types 6 and 11 cause 90% of genital warts cases and most cases of recurrent respiratory papillomatosis (warts in the airways). These two types are also covered by the HPV vaccine.

About 90 percent of HPV infections go away within a year or two, occur without any symptoms, and do not cause cancer. A strong immune response will help to clear most HPV infections.

However, some immune systems are not able to fight HPV. If the infection persists for many years, it can lead to cancer.

HPV Types Covered by the Vaccine

The HPV vaccine protects against 9 types of HPV (6, 11, 16, 8, 31, 33, 45, 52, 58).

In the United States:

  • Types 6 and 11 – cause 90% of genital warts
  • Types 16 and 18 – cause 68% of cervical cancers, and most of other HPV-related cancers (including 81% anal, 61% of oropharyngeal, 57% vaginal, 51% penile, 50% vulvar, 23% mouth, and 8% laryngeal cancers).
  • Types 31, 33, 45, 52, and 58 – cause 25% vaginal, 19% cervical, 15% penile, 14% vulvar, 10% anal, 8% oropharyngeal, 7% laryngeal, and 6% oral cavity cancers

How HPV Is Spread

More than 200 human papillomaviruses exist. Of those, 40 are easily spread through sexual contact, including vaginal, anal, or oral sex or finger-to-genital contact. Direct sexual contact of the skin and mucous membrane causes the virus to transfer from an infected person to his or her partner.

An infected person can still pass HPV to other people even if the infected person’s immune system eventually clears the infection. The other person’s immune system may not be able to. People who do not have symptoms of HPV can spread HPV to another person and symptoms may develop in that person.

The Centers for Disease Control (CDC) estimates that 80% of sexually active women and more than 90% of sexually active men will become infected with HPV– half with a high-risk type of HPV. About half of the population (both males and females) are currently infected with HPV (42.5% of females aged 14-59, 53.8% females aged 20-24, 52-69% of males aged 18-70).  

HPV Types and Cancer

High-risk HPVs cause several types of cancer.

  • Cervical cancer: Virtually every case of cervical cancer is caused by HPV infection. According to the National Cancer Institute, HPV types 16 and 18 are responsible for about 70% of cases.
  • Anal cancer: About 95% of anal cancers are caused by HPV. HPV type 16 causes most of these cases.
  • Oropharyngeal cancers (mouth and throat): HPV causes an estimated 70% of oropharyngeal cancers. In the U.S., more than half of these cancers are caused by HPV type 16.

HPV also causes over three quarters of vaginal cancers, two thirds of vulvar and penile cancers. HPV type 16 is responsible for the majority of these cancers.

Other Ways to Prevent HPV

Along with the HPV vaccine, survivors should:

  • Use condoms during sexual intercourse.
  • Participate in routine Pap tests to screen for cervical cancer. Women between the ages of 21 and 29 should be tested every 3 years. Women ages 30 through 65 can be tested every 5 years with the combined Pap and HPV, or every 3 years with the Pap test alone.

Myths and Facts about HPV Vaccine

Because HPV is associated with sexual activity, there are a number of myths about the infection, how it is spread, and the effects of the vaccine itself.

  1. Fact: The HPV vaccine is one of the safest vaccines on the market.

    According to the National Cancer Institute, no serious side effects have been shown from HPV vaccines. The most common problems are similar to those experienced with other vaccines — pain, tenderness, redness, or swelling at the injection site. A headache may also occur.

    By law, the Food and Drug Administration (FDA) determines that any vaccine must be safe and effective before it is licensed and used.

    The CDC and the FDA are continually monitoring the safety of all vaccines on the market to ensure no new or late-onset side effects are occurring in the population. The Vaccine Adverse Event Reporting System (VAERS) captures information regarding reactions from vaccines. Contact your healthcare provider and use the online form or downloadable form to report a reaction.

    People who are currently ill should wait until the infection has cleared and have not had fever for at least 24 hours prior to receiving the vaccine.

    Pregnant women should not have the vaccine because it has not been sufficiently tested during pregnancy. Anyone with a severe allergy to yeast or aluminum should not receive the vaccine. Allergic reactions to the vaccine may include hives, breathing difficulties, and weakness. Other reactions to the vaccine that would warrant immediate healthcare attention would be a high fever or change in behavior.

    The most common side effects were dizziness, fainting, headache, nausea, and fever. Additionally, in the shot arm, pain, redness and swelling were reported.

    As fainting can be associated with any vaccination, it is recommended that the vaccinated patient be seated or lie down for up to 15 minutes after vaccination.

  2. Fact: The vaccine has been available since June 2006. Continued studies and monitoring of the vaccine show only rare side effects and late effects.

    Over 100 million doses of the HPV vaccine were distributed in the United States from June 2006 through December 2017. In a 10-year follow-up study, the vaccine was found to be extremely safe. Dozens of additional studies have looked into possible associations with a number of autoimmune disorders, such as Multiple Sclerosis (MS), as well as Guillian-Barre Syndrome, postural orthostatic tachycardia syndrome (POTS), chronic regional pain syndrome (CPRS), and chronic fatigue syndrome and have found no increased risk for those who receive the HPV vaccine.

  3. Fact: There is no increased risk of death following the HPV vaccine.

    The CDC and the Vaccine Safety Datalink have conducted studies investigating reported deaths following the HPV vaccine. The majority of deaths following vaccine were confirmed to be unrelated to the vaccine (e.g., accidents, suicide, etc.) and that there was no evidence to suggest HPV vaccine can cause death.

  4. Fact: Men get HPV-related cancers, too, and also need the vaccine.

    More than 12,000 men get cancers caused by HPV every year in the U.S. which is 38% of all HPV-related cancer cases. These figures are on the rise in young adult males. The most common HPV-related cancer for men is oropharyngeal (throat) cancer, but men can also get cancers of the anus and rectum, mouth, and penis. And unlike cervical cancer, there are no screening tests for many of these cancers. That means they are often detected at a later stage when the cancers become more difficult to treat. Additionally, there is no treatment for the HPV itself.

    Males also get the type of HPV (types 6 and 11) that cause genital warts.

    Males can pass HPV to their partner, even if they aren’t showing any signs or symptoms of HPV. 

  5. Fact: The vaccine is most effective when given before sexual activity begins.

    HPV vaccines offer the best protection to boys and girls who complete the series of immunizations and have time to develop a strong immune response well before they begin sexual activity with another person.

    Vaccination prior to sexual activity provides the strongest correlation to prevention. Most new infections are found among those who are newly sexually active.

  6. Fact: Each dose is exactly the same.

    No matter the sex of the patient or the timing when a patient receives a dose of the vaccine, doses 1, 2, and 3 are the same each time.

  7. Fact: Clinical evidence finds no connection between increased sexual activity and the HPV vaccine.

    A number of respected studies have looked closely at this issue. Each have concluded that the HPV vaccine does not have any effect on sexual behavior and should not keep parents from vaccinating their children.

  8. Fact: The HPV vaccine is on the CDC schedule of recommended vaccines.

    Because schools don’t require the vaccine, doesn’t mean it’s not necessary. It is important to vaccinate at ages 11-12 if possible or as soon as practicable.

  9. Fact: There isn’t a need to discuss specifics with children when they get this vaccine.

    As with other shots such as Hepatitis B (Hep B), MMR (Measles, Mumps and Rubella), TDaP (tetanus, diphtheria, and pertussis also known as whooping cough), inform children that the shots are being provided to keep them healthy and cancer-free.

  10. Fact: Studies find no evidence of a link between fertility issues and the vaccine.

    CDC studies specifically reviewed amenorrhea (when a woman of reproductive age doesn’t have a period) and primary ovarian insufficiency (premature menopause). There were no differences in rates of amenorrhea between the females who received the HPV vaccine and those who did not. From 2009-2015, more than 60 million doses of Gardasil were distributed for use in the United States. During this time period, the Vaccine Adverse Event Reporting System (VAERS) received 17 reports of primary ovarian insufficiency. Fifteen reports were considered hearsay which did not provide enough information to confirm diagnosis. Two reports were from physicians. 

  11. Fact: No correlation has been shown that the vaccine causes cancer. Rather, it prevents cancer.

    The vaccine series prevents infection from the HPV types that most commonly cause cervical cancer.

How to Get HPV Vaccine

Ask your child’s primary care provider about getting the vaccine or contact the local health department.

The vaccine costs about $150 a dose, according to the CDC. It is covered by most private insurance plans.

The Vaccines for Children (VFC) program provides vaccines for children ages 18 years and younger, who are uninsured, Medicaid-eligible, American Indian or Alaska Native. There is no charge for vaccines given by a VFC provider to eligible children.

Any child who is younger than 19 years of age and meets one of the following requirements is eligible for the program:

  • Medicaid-eligible
  • Uninsured
  • American Indian or Alaska Native
  • Underinsured*

*Underinsured means your child has health insurance, but it doesn’t cover the vaccine. There are more than 40,000 health care providers enrolled in the VFC program.

Additional Information

For more information about the HPV vaccine and its effectiveness in preventing cancer, go to:

Reviewed: June 2018