Human papillomavirus (HPV)

HPV infection can cause cancer in men and women. From 1 January 2017, immunisation is free for everyone age 9 to 26 inclusive.

HPV stands for human papillomavirus, a group of very common viruses that infect about four out of five people at some time in their lives.  HPV causes cells to grow abnormally, and over time, these abnormalities can lead to cancer.

 

Summary

HPV immunisation protects against infection from the types of HPV that cause most cervical, anal and genital cancers, as well as some mouth and throat cancers. 

For those aged 9 to 14 years, HPV vaccine is provided as two doses in the upper arm, spaced at least six months apart.  This age group develops a stronger immune response than those vaccinated when they are older, which is why it is recommended for both boys and girls at age 11 to 12.  Those aged 15 and older will need three doses.  The immunisation is expected to provide long-lasting protection.

Find out more about why HPV immunisation is important for boys as well as girls.

Video title: HPV Immunisation - now free for boys and young men

[Graphic - HPV Vaccine (Human papillomavirus Vaccine) Helps prevent cancers caued by HPV infection]

Voiceover: Human papillomavirus or HPV, is a common disease which can lead to serious health issues for some people in later life.

[Various shots of young people with doctors and nurses preparing to receive their immunisation.]

Fortunately, girls and now boys as well can be vaccinated against HPV.

[Title: A doctor's view of HPV]

[Dr Kiriana Bird sitting in her clinic.]

Dr Kiriana Bird: Kia ora! I’m Dr Kiriana Bird. We’ve had HPV immunisation for New Zealand girls since 2008, but now it’s free for boys and young men as well. So I’m here today to tell you why HPV immunisation is important for our tāne. Let’s start by understanding just what HPV is.

HPV is a really common virus that lives in our skin cells and is passed on through intimate contact.

[Shots of kids playing football.]

Without immunisation about four out of five of us, men and women, will catch HPV, usually in our late teens or early adulthood. Most of the time it gets better on its own and we don’t even notice - but we can still pass it on to others, and if it doesn’t get better, it can lead to cancer later in life. HPV can also cause genital warts.

[Boy sitting with nurse preparing to be immunised.]

The good news is you can immunise against HPV, and the really good news is that it’s now free for boys as well as girls.

[Graphic shows the parts of the body affected if HPV is contracted.]

Cervical cancer is the most common cancer caused by HPV, which is why HPV immunisation was provided first for girls. But the virus causes cancers in other body parts as well. About a third of all HPV cancers affect men, most commonly in the throat and mouth, and rates for male HPV cancers are rising. HPV cancer can also affect the genital area.

[Title - A patient's experience with HPV]

[Dr Andrew Miller arriving at his hotel, sitting in Doctor's clinic]

Voiceover: Dr Andrew Miller has arrived in Auckland for cancer surgery. It will be invasive, but he’s decided to let us in as a warning about the need to vaccinate against the cancer-causing virus HPV.

[Graphic showing 80% of the population infected with HPV]

80% of New Zealanders at some point will acquire HPV. 4 out of 5. The only real way of protecting is to be immunised.

Of that 80%, all but around 10% will shake that infection off, but those that don’t are the worry.

[Graphic showing HPV affecting both women and men.]

And what most of us don’t know is that HPV isn’t just a cancer risk to women, it’s a cancer risk to men as well.

Dr Andrew Miller: There is a very obvious and well-known link between an HPV and causing cervical cancer, but you know if you talk to head and neck surgeons they’ll be seeing a big rise in head and neck cancers caused by HPV as well.

I’ve been diagnosed with a thing called a squamous cell carcinoma inside my nose. Umm it’s ended up going from the inside of my nose down into my jawbone and round the other side there, and it’s going to require some fairly extensive treatment to get it out.

[Andrew being weighed on an electronic scale]

Voiceover: But what he didn’t expect was the likely culprit, HPV.

[External shot of the Gillies McIndoe Research Institute building]

Voiceover: Dr Miller’s not alone. Health professionals and researchers are increasingly becoming aware of HPV’s role in cancers affecting men as well as women.

[Shots of Dr Swee Tan in his office and laboratory.]

Dr Swee Tan: Compared with other throat cancers, HPV positive throat cancers typically effect younger men. On average these men die 10 years younger than those with cancers not caused by HPV.

[Dr Swee Tan working in the lab, looking at a computer screen.]

Radiotherapy and chemotherapy is currently the standard treatment for throat cancers.

This profoundly effects the quality of life and the daily functioning of the effected individuals. They lose the sense of taste and smell and often have difficulty in swallowing and speaking.

The thing is these HPV induced cancers are preventable. The decision to include boys in the HPV immunisation programme wills save lives, prevent suffering and reduce the huge cost of treatment. we need to protect our children now for their future.

[Title: A Māori health advisor's view of HPV]

[Arthur Selwyn sitting at his desk, on the computer. External shots of the Ministry of Health building]

Arthur: Ko te aroha o tēnei mate pukupuku HPV, ko te pāmamae ki runga i o tātau whānau.

He mate kei te pā i o tātau mātua, i te wā e manaaki ana i o rātau whānau.

Kia kore e pā ēnei mate pukupuku HPV, otirā, kia wawe te whai oranga mo ēnei mate, ka roa ake, ka noho ora ake tātau katoa.  

Mehemea ka whāngaihia o tātau tamariki ki te rongoa i tēnei rā, ka noho ora mo ake ngā whānau whānui i ngā rā ki mua.

[Nurses sitting with children about to get their immunisation]

Voiceover: The HPV vaccine has an excellent safety record, with very few risks, similar to other childhood vaccines. You can find out more about the vaccine’s safety and common reactions on the Ministry of Health website.
    
Dr Kiriana: The best time to be immunised is at age 11 or 12, before our young people are at risk of getting HPV.

[Kids playing on a playground.]

At that age, their immune systems are really effective at making antibodies in response to the vaccine. Protection from the vaccine is long-lasting and is not expected to wear off over time.

[Graphic showing reduced disease rates for HPV infection, genital warts, High-grade Cervical Cell Changes and Low-grade Cervical Cell Changes.]

Over the last decade, diseases caused by HPV have fallen significantly among young people in countries like New Zealand that offer HPV immunisation.

That’s why, as health professionals, we recommend HPV immunisation, as does the Ministry of Health.

[Various shots of kids sitting with nurses preparing to be immunisied.]

The HPV vaccine is available free at school for Year 8 girls and boys. It is also available free at your local doctor or health clinic for anyone, male or female, aged from 9 – 26 years of age.

[Title: To find out more, talk to your doctor, practice nurse or health clinic, or phone 0800 IMMUNE (466 863)]

For more information, talk to your doctor, practice nurse or health clinic; visit www.health.govt.nz/hpv or phone 0800 IMMUNE.

[Graphic showing Immunise logo and 'our best protection' slogan.]

"The Story of HPV" (below) was produced in 2011, and explains HPV immunisation as it was originally introduced in New Zealand.

Symptoms

Four out of five people become infected with HPV at some time in their lives. The peak incidence of HPV infection is between the ages of 16 and 20. 

HPVs infect the deeper layers of the skin and internal passages such as the the cervix (at the lowest part of the uterus and at the top of the vagina), genital area and the mouth.

Usually HPV infections get better on their own.  Some HPV infections don’t get better and over time cause abnormal cells to grow. If these cells go undetected (for example, by cervical screening) and untreated, over time, usually many years, they can lead to cancer.

The types of HPV that can cause cervical cancer and genital warts are spread through intimate skin to skin contact (not just sexual intercourse).  Types 16 and 18 are responsible for around 70 percent of HPV-related cancers, and types 31, 33, 45, 52 and 58 are responsible for about a further 20 percent.

Genital warts are caused by low-risk types of HPV (6 and 11) and are not associated with cervical cancer. Genital warts are the most commonly reported sexually transmitted viral infection in New Zealand, but rates among young women and men have fallen significantly since HPV immunisation was introduced in 2008.

Prevention

Immunisation, safer sex, and regular cervical screening are the most important ways to prevent diseases caused by HPV.  Condoms may not completely eliminate the risk of HPV infection because the virus can be contracted through skin-to-skin contact beyond the covered area. 

Women who have had the HPV immunisation still need to have regular cervical screening. The vaccine doesn’t protect against all the types of HPV that can cause cervical cancer or other sexually transmitted diseases.

Where to get immunised

Schools

The HPV vaccine is provided to children in school year 8 through most schools. If the HPV vaccine is available through your school, a consent form will come home from school.  The HPV vaccine will only be given at school if the consent form is completed, signed and returned to school.

Participating schools may provide the district health board or public health nurse with specific information about their students (such as names, addresses, dates of birth, ethnicity and room numbers) to help with the administration of school based immunisation.

Information from the consent form and details of each immunisation given or declined will be recorded on the School-Based Vaccination System (or another system held by your district health board) and some of it will be passed to the National Immunisation Register.

Other places to get immunised

The vaccine is also available free from family doctors, local health clinics and some Family Planning clinics for those who are no longer at school, who do not attend a participating school or who do not want to have it at school.

If you are not eligible for free immunisation, you may be able to purchase the vaccine.  Your family doctor or local health clinic can advise about costs and whether the vaccine is clinically appropriate for you. 3 doses will cost about $500.00.

About the HPV vaccine

Gardasil 9 is the HPV vaccine included in the New Zealand Immunisation Schedule and provided in schools from 2017.  It will also be provided through general practices when stocks of the older Gardasil vaccine run out.

Gardasil 9 was approved in New Zealand by Medsafe in 2016.  The Consumer Medicine Information and Datasheet are available to read on the Medsafe website.

How the HPV vaccine works

Effectiveness

The vaccine has been shown to be very effective in preventing infection from the types of HPV it targets.

Length of protection

Protection is expected to be long lasting.  As studies are ongoing, the exact period of protection is unknown. So far, they show that more than 9 years after immunisation, protection from HPV infection remains high with no sign of weakening.

Studies have also shown evidence of ‘immune memory’ which indicates protection may be life-long. Similar results were seen with studies of the hepatitis B vaccine, where long-term immunity is internationally accepted.

The Ministry of Health is continuing to monitor international research on the duration of protection from the vaccine.

What’s in the vaccine

The vaccine contains tiny virus-like protein particles that mimic HPV but cannot cause infection.

There is no virus in this type of vaccine – you cannot become infected with HPV when you have the vaccine.

Each 0.5 ml dose of the vaccine also contains a small amount of aluminium, which stimulates the immune response. Aluminium has been safely and effectively used in vaccines for more than 70 years.

The vaccine also contains tiny amounts of sodium chloride (salt), L-histidine (an amino acid), Polysorbate 80, sodium borate and sterile water.

The vaccine does not contain preservatives, antibiotics or any human or animal materials.

After vaccination, the body quickly starts making antibodies that protect against the types of HPV the vaccine targets.

People who should not receive the vaccine

The vaccine should not be given to anyone who has had a life-threatening reaction (hypersensitivity or anaphylaxis) to any component of the vaccine or has had a reaction to the previous dose of the vaccine. 

Anyone who has a bleeding condition or an immune disorder should talk to their doctor or nurse before having the HPV vaccine.

The safety of HPV vaccine in pregnancy is unknown. Published data has not found any safety concerns among pregnant women who have been inadvertently vaccinated.

Possible reactions

Reactions experienced following the HPV immunisation are similar to those from other vaccines.

As with all immunisations, people may have a sore arm and get redness, pain and swelling at the injection site.

Other less common reactions include vomiting or fainting. These can follow any immunisation and people should remain seated for 20 minutes (to reduce the risk of injury from falling if they faint).

It’s also a good idea for people to eat breakfast and lunch and avoid excessive exercise on the day they receive the immunisation.

Other possible reactions that can occur, usually within 1–2 days, include:

  • a fever (feeling hot)
  • headache
  • general discomfort (feeling unwell, aches and pains)
  • skin reaction, rash.

Very rarely, a serious allergic reaction (like a peanut allergy) called anaphylaxis occurs, usually within 10 minutes of immunisation. Anaphylaxis can occur with any medicine or vaccine.

Based on clinical studies and experience from overseas we can expect around 3 anaphylactic reactions per 1 million doses of vaccine administered. This is similar to the rates for other vaccines given to children and adolescents.

If anaphylaxis does occur, it can be treated. For this reason, children are asked to wait for 20 minutes after immunisation. Every vaccinator is trained and equipped to deal with such a reaction.

If you’re concerned about reactions

If you have concerns about reactions following the immunisation, contact the nurse or your general practice.

It is important you tell the nurse or doctor if there have been reactions to any previous immunisations, before having the HPV immunisation.

It is also important to report any unexpected side effects following immunisation as there is ongoing monitoring of the safety of the vaccine.

As vaccines are given to large numbers of people in a population, many events occur around the same time as a vaccine is delivered. This does not necessarily mean the vaccine was the cause of the events.

Both international and New Zealand safety monitoring databases record and monitor events to assess whether they are likely to have been caused by the immunisation or whether they were simply chance associations in time.

To date the only known very severe side effect associated with the HPV vaccine is immediate allergic reaction (anaphylaxis) in rare cases. International regulators are continuing to monitor and watch for any very rare possible events following immunisation.

Reactions that occur after being given a vaccine in New Zealand are reported to the Centre for Adverse Reactions Monitoring (CARM) at the University of Otago by health professionals, or members of the public can report directly.

If you are unsure whether a symptom is related to the vaccine, discuss this with the nurse or your doctor.

Safety

The vaccine’s safety profile is well documented.

The safety and effectiveness of the vaccine have been assessed against international guidelines and the requirements of the Medicines Act 1981.

HPV vaccines has been approved for use in more than 125 countries, including Australia, the USA, Canada and the European Union. More than 165 million doses of HPV vaccine have been distributed worldwide.

The World Health Organization’s Global Advisory Committee on Vaccine Safety has been reviewing the safety of HPV vaccines since they were first licensed in 2006, and have concluded that they have good safety profiles.  For more information, see HPV vaccination safety.

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