1. Human Papillomavirus (HPV) Vaccination
Help beat
cervical cancer
Vaccine Preventable Disease Programme September 2014

2. What is HPV?
Human Papillomavirus (HPV) is a very common virus that infects the deeper layers of the skin
There are over 100 types of HPV, 40 of which affect the genital area
You can catch it by having intimate sexual contact with someone who has the virus.
There are low risk and high risk types of HPV
HPV causes 99% of cancers of the cervix
Cause also more well known warts, verruca and genital warts
High risk if left untreated can cause cancers.
Sexual contact includes close skin to skin contact
Once infected 1/3 of females remain infected for over 1 year. Most clear the virus, but if it is not killed off by the body’s immune system it can damage the lining of the cervix.
Vaccine Preventable Disease Programme September 2014

3. What is cervical cancer?
Cervical cancer is cancer of the cervix
HPV infections can’t be treated but if pre- cancerous changes caused by HPV are detected by screening (smear test) the damaged tissue can be removed.
Smear testing has saved many lives but in the UK more than 2 women die every day from cervical cancer
Smear testing is a procedure that involves taking a sample of the cells from the cervix. You will be invited to attend for cervical screening (smear testing) every 3 years from the age of 25 in Wales. The cells are then sent to a laboratory to be examined under a microscope for any abnormal cell changes.
HPV vaccination does not protect against all causes of cervical cancer so it is still very important to have smear tests even if you have had the vaccination.
Cancer Research  UK women died from cervical cancer in the UK
Vaccine Preventable Disease Programme September 2014

4. Where is the cervix ?
The cervix is the entrance to the womb which is found at the top of the vagina
Vaccine Preventable Disease Programme September 2014

5. Cells damaged by HPV Normal Damaged
Vaccine Preventable Disease Programme September 2014

6. Is there a lot of HPV about?
YES – HPV is very common
Many people will be infected with HPV at some time in their lives
HPV has been found in up to 4 out of 10 women aged years old
Half of women have evidence of infection at some time in their lives
Most people infected with HPV have no symptoms and don’t know they are infected
Factors affecting immunity –your body’s defence against infection -smoking,
You can be exposed to HPV at first intimate sexual contact, both boys and girls can get and pass on the HPV virus without realising it.
Vaccine Preventable Disease Programme September 2014

7. About the vaccine
The HPV vaccine is routinely offered to girls aged years old (School Year 8)
All girls up to 18 years of age are still able to have the HPV vaccination course
HPV vaccine is not offered to boys or girls after their 18th birthday
In September 2012 there was a change to the vaccine offered from Cervarix to Gardasil
Gardasil offers protection against 4 HPV types
You may have heard about changes to the HPV vaccine -
If you know of anyone sister/friend or cousin encourage them to speak to their school nurse or GP
>18’s and boys not offered as part of national programme but some GPs may give to over 18s and is available privately (cost of vaccine £85 per dose)
Cervarix previously only protected against 2 HPV types – highlight differences in next slides
Vaccine Preventable Disease Programme September 2014

8. What does Gardasil protect against?
Cervical Cancer
HPV types 16 and 18
Causes over 70% of cervical cancer
Does not protect against all cervical cancer so screening is still necessary
Genital Warts
HPV types 6 and 11
Causes over 90% of genital warts
It does not protect you against any other sexually transmitted diseases or pregnancy
So far protection has proven to last for at least 10 years, research study is ongoing .
Cervarix (offered as part of the national programme between September 2008 and August 2012) offered protection against the two types of HPV 16 and 18, but no protection against genital warts
Vaccine Preventable Disease Programme September 2014

9. Why is the HPV vaccine being given to 12-13 year old girls?
Girls should be vaccinated before they are likely to come in contact with the HPV virus.
From the age of 14 the number of girls infected begins to increase and therefore giving the vaccine in school year 8 offers the best protection.
Girls who have already had sex should still have the vaccine because it isn’t possible to say if she has been infected with HPV or not.
HPV is a sexually transmitted infection
The vaccine works best if it is given to girls before they become sexually active – before they might get infected
Vaccine Preventable Disease Programme September 2014

10. How is the vaccine given?
In most cases the vaccine is a course of two injections usually offered a year apart
The vaccine is an injection
Given into the muscle in the upper arm
A full course is needed to ensure full protection
VPDP 2011
Vaccine Preventable Disease Programme September 2014

11. What do you need to do? Read the information leaflet
Return the completed consent form to school
Wear suitable clothing
Have breakfast
Know when/where to attend
Don’t be nervous!
May wish to discuss self consent here- gillick competence/ age of consent dependent on HB policy
Polo shirts fine but if school uniform is regular school shirts may be difficult to get to top of arm so T Shirt/vest advised.
Tell them where they normally take place date and how they will be called
Scare stories circulate and there is no truth in them – reassure using examples: exactly the same vaccine given for the course of injections, if it was that bad we’d never be able to do 300 in a morning, most girls think it will be worse than it actually is- ”is that it?”
Vaccine Preventable Disease Programme September 2014

12. Are there any side effects?
May sting a little during and immediately after injection
Arm may be a bit red and sore afterwards
Mild temperature
Headache
Aching muscles
If you or your parents are worried-speak to your school nurse.
All vaccines can cause side effects
Some girls do not even feel it and don’t realise it is done.
Re: fainting.
This can happen with any injection or procedure and is more common in the age group being offered the HPV vaccine
Vaccine Preventable Disease Programme September 2014

13. Will this save lives? Yes it will.
In Wales in 2012 there were 170 new cases of cervical cancer and over 40 deaths from the disease
Girls who have the vaccination will reduce their risk of getting cervical cancer by over 70%.
The most recent data that is available shows 170 women were diagnosed with Cervical cancer in Wales in of these were women under the age of 35 years (WCISU). Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales:
Vaccine Preventable Disease Programme September 2014

14. Will I still need a smear test when I am older?
Yes
The vaccine does not protect against all types of HPV which cause cervical cancer so regular smear tests will still be very important.
This slide can be used as a Q&A to encourage group participation before questions
By identifying any abnormal changes early can prevent cancer developing
Vaccine Preventable Disease Programme September 2014

15. How many doses of vaccine are needed?
Two injections of the HPV vaccine are usually offered
The second injection can be given anytime from 6 months to two years after the first
Two doses less than 6 months apart will not offer sufficient protection and a third dose should be given
The full course is needed to ensure full protection
As long as the first dose was received before the age of 15 years the two dose schedule can be followed. If the course is interrupted, it should be resumed (using the same vaccine) but not repeated, even if more than 24 months have elapsed since the first dose.
Clarify that the same vaccine is offered through the course as stories circulate about the last being the worst.
This is a further Q&A if required or recap
Vaccine Preventable Disease Programme September 2014

16. Why are some girls offered more than 2 doses?
A HPV vaccination course of 3 doses is offered to girls:
Who have a weakened immune system
Who received the first dose after their 15th birthday
Who have already started a 3 dose course of HPV vaccine
The three dose schedule is offered at 0, 1 and 4 to 6 months
Girls with a weakened immune system may not respond as well to the two dose schedule therefore a 3 dose schedule is offered to ensure protection.
The response to the vaccine is not as good in older girls therefore the three dose schedule is offered.
The two dose schedule is as effective as the three dose schedule if the first vaccine is offered before the girls 15th birthday.
Girls who have already started the 3 dose HPV vaccination course should where possible complete the course as planned 0, 1 and 4-6 months schedule. If the course is interrupted, it should be resumed (using the same vaccine) but not repeated, ideally allowing the appropriate interval between the remaining doses.
Vaccine Preventable Disease Programme September 2014

17. Ideally 3rd dose should be given within a year
My sister in year 9 has had the first two doses of the three-dose schedule last year – does she still need the third one now?
Yes, girls who have started a three-dose schedule should complete it as originally planned.
Ideally 3rd dose should be given within a year
Speak to the School Nurse
Further Q&A question for recap
No need to restart course for missed doses
Missed doses can be given at any time
Vaccine Preventable Disease Programme September 2014

18. Look out for information
Information on HPV for reading and download are available from-
Request HPV leaflets -
Speak to your School Nurse
Note that some information on the HPV webpages applies to England and will not always be relevant for Wales.
Further information on HPV and a slideset for Health care professionals is available from VPDP website HPV vaccination page
Vaccine Preventable Disease Programme September 2014

19. Acknowledgements Amended slide set from
Ashton Leigh Wigan PCT
Aneurin Bevan Health Board
Leah Millinship Images (unless otherwise stated)
Vaccine Preventable Disease Programme September 2014