1. World Health Organization
Essential Training Package for HPV Vaccine Introduction
6 December, 2018
Module 3
HPV vaccine eligibility and contraindications
GardasilTM

2. Learning objectives
At the end of the module, you will have learned to:
Describe the recommended immunisation schedule for GardasilTM
Describe when a girl is eligible for HPV vaccine and when she is not eligible
Describe the absolute contraindications for vaccination
Duration
60’

3. Key issues 1 2 3 4 What is the schedule and dosage for GardasilTM?
How do you determine a girl’s eligibility for HPV vaccine? 2
What to do when…? 3
What are the precautions and contraindications? 4
Explain to the participants the key issues raised in this module:
What is the schedule and dosage for GardasilTM?
How do you determine a girl’s eligibility for HPV vaccine?
What to do when…?
What are the precautions and contraindications?

4. What is the schedule for GardasilTM vaccine administration?
Example schedule
Dose 1
Dose 2
Minimum interval of 6 months
HPV vaccine, GardasilTM, is a 2 dose schedule with a minimum interval of 6 months between the first and second dose.
Each dose is administered intramuscularly using 0.5ml of liquid suspension
The second dose is at least 6 months after the first dose
Attention: if the second dose is administered too early (an interval of less than 5 month) then a third dose will be needed to achieve full protection. The third dose should be given at least 6 months after the first dose
There is no maximum recommended interval between doses. However, an interval no greater than 12–15 months is suggested.

5. Who should get HPV vaccine? 
Ask the audience to point to the image of girls who they think should get HPV vaccine. The answer will appear by a mouse click in animations.
Pic 1: The target population for HPV vaccination are girls who are 9 – 13 years old
Pic 2: The vaccine is not recommended for girls younger than 9 years of age
For the HPV vaccine to work best, it is very important for adolescent girls to get all 2 doses (shots) long before any sexual activity with another person begins. It is possible to be infected with HPV the very first time that a person has sexual contact with another person. Also, the vaccine produces higher antibody levels when given at early age compared to older ages

6. Are there contraindications to HPV vaccination?
HPV vaccine is not recommended for:
SEVERE FEBRILE ILLNESS
Pic 1: HPV vaccines are not recommended for use in people who have experienced severe allergic reactions after a previous vaccine dose, or to a component of the vaccine (for example, yeast in Gardasil)
Pic 2: HPV vaccines are not recommended for use in pregnancy. If a girl becomes pregnant after initiating the vaccination series, the remainder of the 2-dose regime should be delayed until after completion of the pregnancy. In the event that the HPV vaccine is inadvertently administered to a girl who is pregnant, no intervention is necessary. No health problems in mother or child have been observed to date after accidental HPV vaccination during pregnancy
Pic 3: Girls with severe febrile illness should not be vaccinated
A minor infection such as a cold is not a contraindication

7. What should you do in this scenario?
The girl is pregnant when she returns for second dose
of HPV vaccine.
In the event that a girl is pregnant after initiating the vaccintion series, the remainder of the 2 dose regimen should be delayed until after completion of the pregnancy.

8. What should you do in this scenario?
The girl is immunocompromised due to HIV/AIDS.
HPV vaccination is safe and immunogenic and does not cause problems for HIV-infected persons who get the vaccine. HPV vaccine is not contraindicated in HIV-infected girls. However, the immune response and vaccine efficacy might be less than in persons who are immunocompetent.
Therefore, HIV-infected girls should be given 3 doses – following a 0, 2, 6 month schedule

9. What should you do in this scenario?
The girl came in to an immunization session for her second dose. Ten months have passed since she received the first dose.
Give the second dose of HPV vaccine.

10. Key messages
GardasilTM is a 2 dose schedule, administered with a minimum interval of 6 months
between 1st and 2nd dose: minimum interval of 6 months
Girls between 9 and 13 years old are eligible for HPV vaccination
Contrindications for HPV vaccination are:
Allergy after a previous vaccine dose, or to a component of the vaccine
Pregnancy
Severe febrile illness
For Gardasil, a minimum interval of 6 months between the 1st and 2nd doses
The target population for HPV vaccination are girls who are between 9 and 13 years old
Contrindications for HPV vaccination are:
Allergy after a previous vaccine dose, or to a component of the vaccine
Pregnancy (delay until pregnancy is over)
Severe febrile illness

11. End of module for your attention! Thank you
This is the end of the module, thank you for your attention!

12. References
Comprehensive Cervical Cancer Control. A guide to essential practice (C4 GEP). WHO 2014
HPV vaccine introduction into national immunization programmes: Information for programme managers and health workers. WHO 2014