What changes to HPV immunisation happened from 1 January 2017?
From 1 January 2017, HPV immunisation is funded for everyone aged 9–26 (inclusive) including boys and young men.
Gardasil 9 will replace the existing Gardasil vaccine. The vaccine is given as two doses to those aged 14 years and under, and three doses to those aged 15 years and older.
The vaccine is offered to boys and girls through participating schools at Year 8, around age 12. HPV immunisation is also available free through general practices from 9 years of age.
Gardasil 9 is being used in schools from the beginning of 2017, and in general practices later in the year once stocks of the existing Gardasil vaccine have run out. Those who have begun immunisation with the existing Gardasil vaccine should complete the course with that vaccine while it is available (see below for further details).
Why is HPV vaccine now being offered to boys?
HPV causes cancers in men as well as women. An increasing proportion of mouth and throat cancers, which affect men at higher rates than women, are caused by HPV. HPV can also cause penile and anal cancers in men. HPV immunisation has been recommended (but not funded) for boys for several years in New Zealand and many other countries.
HPV vaccines are relatively expensive and were initially funded to prevent the most common HPV-related cancer, cervical cancer, which affects only women. Immunising young women can help decrease the spread of HPV among young men through community immunity. Over 72 countries provide HPV vaccine to girls through their national immunisation programmes.
As HPV vaccines can be provided as two rather than three doses to those aged 14 and under, it is now possible to extend HPV immunisation to boys in New Zealand. Australia, Austria, Brazil, Israel and some Canadian provinces also offer free HPV immunisation for boys.
What is the Gardasil 9 vaccine?
Gardasil 9 is one of three HPV vaccines available worldwide. Its predecessor Gardasil (or HPV4 for short, because it protects against four strains of HPV) has been used in New Zealand since 2008. Gardasil 9 (or HPV9) has replaced HPV4 in the United States and will do so in New Zealand from 2017.
Immunisation with Gardasil 9 can prevent infection with:
- the seven HPV types that cause nine out of ten HPV-related cancers
- the two HPV types that cause nine out of ten cases of genital warts.
Gardasil 9 will not be offered in general practices until stocks of the existing HPV4 vaccine have run out. Many people being immunised in general practices in early 2017 will therefore be given HPV4 vaccine. HPV types 16 and 18, which are common to both vaccines, are responsible for around nine out of ten HPV-related cancers in men, which means that for men there is little practical difference between the protection offered by the two vaccines. Both vaccines also protect against nine out of ten cases of genital warts.
How is the vaccine given?
The vaccine is given by injection in the upper arm. Two injections are given at least six months apart for those aged 14 and under. Those aged 15 and over will need three doses to be fully protected.
Why are the number of doses reducing from three to two for those aged 14 and under?
Those vaccinated at a younger age have a stronger immune response to protect against infection. In trials of Gardasil 9, those aged 9 to 14 produced as many antibodies following two doses of the vaccine (spaced at least six months apart) as those aged 15 and over following three doses.
The vaccine is recommended and provided through schools at age 11–12 because it is more effective when it is given at this age.
If a person has begun immunisation with the existing Gardasil vaccine, can they complete the course with Gardasil 9?
People who have begun immunisation with the HPV4 vaccine should complete with HPV4 while it is available, which is expected to be until early 2017.
Once stocks of HPV4 have run out, people will complete their course with Gardasil 9.
Gardasil 9 protects against nine types of HPV, whereas HPV4 protects against four types. It is not known whether a mixed schedule gives any protection against the five additional HPV types included in Gardasil 9.
Do those who have been fully immunised with the older vaccine need to be revaccinated with the newer one?
How long has HPV immunisation been available in New Zealand?
The HPV Immunisation Programme started in New Zealand in September 2008, for girls and young women up to their 20th birthday. Over 200,000 girls and young women have been fully immunised against HPV in New Zealand.
HPV vaccines were first approved by the United States FDA in 2006. Over 165 million doses have been distributed worldwide since then.
How safe is the vaccine?
The first HPV vaccines were approved in 2006, following large clinical trials involving more than 20,000 people. Since then, research covering hundreds of thousands of vaccinations shows a similar safety profile to other childhood vaccines. The safety data for Gardasil 9 is consistent with the HPV4 safety studies.
All applications seeking consent to distribute a medicine in New Zealand are evaluated by Medsafe. This evaluation is performed to internationally defined standards and requirements. Gardasil 9 was evaluated by Medsafe and approved in 2016. Gardasil 9 is also approved in the United States, Europe, Canada, Australia and the United Kingdom. In New Zealand, as in other countries, there is ongoing monitoring of vaccine safety.
The reactions reported from Gardasil 9 are similar to other immunisations. The most common reactions are injection site pain, redness, and swelling. Nausea and fainting have also been reported. The only known severe reaction is a serious allergic reaction called anaphylaxis, which usually occurs within minutes of the immunisation being given. Anaphylaxis is rare – about three anaphylactic reactions per 1 million doses of vaccine administered. Every vaccinator is trained and equipped to deal with an anaphylactic reaction if one occurs. For this reason, patients are asked to wait 20 minutes after a vaccine is given, so that medical treatment can be provided.
Medsafe have further information about Gardasil 9 on their website:
- Consumer information - Gardasil 9 Questions and Answers
- Gardasil 9 consumer medical information (PDF, 233 KB)
- Gardasil 9 New Zealand data sheet (PDF, 675 KB)
Are those who have had only two doses of the existing Gardasil vaccine protected?
There is some evidence that two doses of HPV4 vaccine, spaced at least six months apart, may be protective in those aged 14 or under. However, the timing of the vaccine doses is important, and most vaccinated New Zealand children would have received their first two doses about two months apart. It is not known whether this confers any lasting protection, so a third dose is required if the first two doses were given less than six months apart.
Are there any groups who should not get HPV vaccine, or should wait?
There are a few people for whom the vaccine is not recommended, including:
anyone who has had a serious allergic reaction (anaphylaxis) to a previous dose or any component of the vaccine
pregnant women – published data have not found any safety concerns among pregnant women who have been inadvertently vaccinated. If a vaccine dose is inadvertently administered during pregnancy, no intervention is needed. However, once a woman knows she is pregnant it is recommended that the remaining doses of HPV vaccine are delayed until completion of pregnancy.
Anyone who has a bleeding disorder or an immune disorder should talk to their doctor or nurse before having the HPV vaccine.
People with moderate or severe illnesses should wait until they recover to receive their HPV immunisation. People who are mildly ill can still get their immunisation as scheduled. Your doctor or nurse will be able to advise if you are unsure.
Can adults older than 26 get the vaccine?
The vaccine is offered to boys and girls through participating schools at Year 8, around age 12. HPV immunisation is also available free through general practices from 9 to 26 years of age (inclusive).
Up to three doses of vaccine is funded for patients aged 27 years or older who are undergoing a transplant or for vaccination after chemotherapy.
In other situations, clinicians may recommend a course of HPV vaccines for individuals aged 27 years or older but the person will need to pay for the vaccine.
What information will be collected about HPV immunisation?
Most immunisations, including HPV, are recorded on the National Immunisation Register so that authorised health professionals can find out what immunisations have been given. It helps identify people who are due for immunisations or who have missed out. Information that does not identify individuals is used for research purposes.
For more information about the use of information, privacy and data-sharing, see the National Immunisation Register page.
To find out more about HPV immunisation, talk to your doctor, practice nurse or health clinic, or call the free helpline 0800 IMMUNE (0800 466 863).