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 the story of HPV immunisation here:

 

 

 

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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