Human papillomavirus (HPV) – immunisation

Human papillomavirus (HPV) infections occur in both men and women. It is common to be infected withone or more types of genital HPV shortly after becoming sexually active.

Most HPV infections cause no symptoms and are cleared naturally from the body in one to two yearswithout the person knowing they were infected. 

Some types of HPV can cause genital warts and other types can cause some cancers. These cancers includecervical cancer in women, and cancers of the genital area, mouth and throat in men and women.

The HPV vaccine (GARDASIL®9) protects against seven types of HPV. These cause over 90 per cent ofcervical cancers in women and over 90 per cent of HPV-related cancers in men. The vaccine also protectsagainst another two HPV types which cause 90 per cent of genital warts. 

HPV and cancer

Depending on their ability to cause cancer, some types of HPV are classified as:

• low risk – some low risk types of HPV can cause minor changes to cells orcause genital warts. Low-risk infections cannot lead to cancer. Infections caused by low-risk HPV typesare usually cleared naturally from the body within one to two years
• high risk – some high-risk types of HPV (including types 16 and 18) cantake longer to clear from the body. In some people, infection with these HPV types remains for a longtime. In these cases, there is a higher risk of developing significant cell changes (dysplasia).Dysplasia can progress to invasive cancer if it is not detected and treated.

It is rare for HPV infection to lead to cervical cancer. If it does, it usually takes ten years ormore.

In December 2017 the Cervical Screening Test replaced the Pap test in screening for cervical cancer. ThePap test used to look for cell changes in the cervix. The Cervical Screening Test looks for HPV, which can lead to cell changes in the cervix.

Immunisation against HPV

The HPV vaccine GARDASIL®9 protects against seven types of HPV, which cause:

• over 90 per cent of cervical cancers in women 
• over 90 per cent of HPV-related cancers in men. 

The vaccine also protects against another two types of HPV which cause 90 per cent of genital warts. 

The HPV vaccine is most effective when given to all young people before they become sexually active andare exposed to HPV. The recommended age for vaccination is 12 to 13 years. This is when the bodyproduces the greatest immune response to the vaccine. The vaccine prevents disease but does not treatexisting HPV infections.

Since the introduction of the HPV vaccination program in 2007:

• the number of young Victorian women (under 18 years) with high-grade cervical abnormalities hasalmost halved
• the incidence of genital warts in heterosexual men and women less than 21 years has been reducedby 90 per cent. 

The vaccine's impact on cancers will not be seen for some decades, as HPV-related cancers can takeover 10 years to develop.

Immunisation against HPV using Gardasil®9 involves:

• a course of two injections a minimum of six months apart for children under 15 years of age,or 
• a course of three injections over a six-month period for people from 15 years of age. 

Immunisation is also recommended for people who are at increased risk, such as adults withcompromised (weakened) immune systems. 

People with a compromised immune system need three doses of the HPV vaccine to be adequately protected,regardless of their age. The doses should be given with a minimum interval of two months between dosesone and two, and a minimum of four months between doses two and three.

How long will vaccine protection last?

Recent studies have shown good continuing protection against HPV lasting for over 10 years to date. Studies are ongoing to determine if a booster dose will be necessary in the future but this is not thought to be likely.

How safe is the HPV vaccine?

It is safe and well tolerated. Worldwide over 200 million doses have been given over the last decade. The vaccine does not contain HPV but appears similar enough to the virus so that the body produces antibodies, which prevent HPV infection.

Will girls need cervical screening tests later in life?

Yes, because the vaccine doesn’t prevent all types of HPV infection that cause cervical cancer, cervical screening tests are still essential for women later in life. Having regular cervical screening tests further reduces the risk of developing cervical cancer.

Who is eligible for the free HPV vaccine?

In Victoria, the HPV vaccine is available for free to all adolescents in year seven of secondaryschool (aged 12 to 13 years) under the National Immunisation Program. The two-dose course of the vaccineis given at school. It can also be given by a local doctor or at a council immunisation session. Contactyour state or territory health department for more information about HPV vaccination at your school.

People under 20 years of age who missed the vaccine at secondary school can access free catch-updoses at their local doctor or at a community immunisation session. From 15 years of age theGardasil®9 vaccine is given as a three-dose course. 

• Find  my local council
• Find my nearest immunisationprovider

People from 20 years of age are not eligible for free vaccination through the National Immunisation Program, so they will have to pay for thevaccine. The HPV vaccine is licensed for males aged 9 to 26 years and females aged 9 to 45 years.

Pregnancy and HPV immunisation

Immunisation against HPV is not recommended for women who are pregnant. If you become pregnant afterstarting the HPV vaccination course, you should not receive any further doses of the vaccine whilepregnant. You can complete the course of vaccination after the birth of your baby. The HPV vaccine canbe given to women who are breastfeeding.

Pre-immunisation checklist

Before receiving the vaccine, tell your doctor or nurse if the person having the vaccination:

• is unwell (temperature over 38.5 C)
• has allergies to any other medications or substances
• has had a serious reaction to any vaccine
• has had a serious reaction to any component of the vaccine
• has had a severe allergy to anything
• has a disease, or is having treatment, that causes low immunity
• is taking any prescription or non-prescription medication
• is pregnant or intend to become pregnant.

Side effects of the vaccine against HPV

Immunisation against HPV is effective and safe, although all medication can have unwanted sideeffects. Common side effects following immunisation are usually mild and temporary (occurring in thefirst few days after vaccination). Specific treatment is not usually required.

Side effects may include:

• localised pain, redness and swelling at the injection site
• low-grade temperature (fever)
• mild headache
• mild nausea.

Managing fever after HPV immunisation

If you experience fever after immunisation, treatment options that can reduce its effectsinclude:

• drinking extra fluids 
• not overdressing
• although routine use of paracetamol after vaccination is not recommended, if fever is present,paracetamol can be given. Check the label for the correct dose or speak with your pharmacist (especiallywhen giving paracetamol to children).

Managing injection site discomfort after HPV immunisation

Many vaccine injections may result in:

• soreness
• redness
• itching
• swelling 
• a burning sensation 

at the injection site for one to two days. Paracetamol might be required to ease the discomfort.

Concerns about side effects of immunisation

If a side effect following immunisation is unexpected, persistent or severe, or if you are worried aboutsomeone’s condition after a vaccination, see your doctor or immunisation nurse as soon as possibleor go directly to a hospital.

You can report immunisation side effects to SAEFVIC, the Victorian vaccine safety and central reportingservice. In other states or territories, you can discuss with your immunisation provider how to reportadverse events. 

It is important to seek medical advice for anyone who is unwell after vaccination, as this may be due toother illness rather than because of the vaccination.

Rare side effects of immunisation

There is a very small risk of a serious allergic reaction (anaphylaxis) to any vaccine. This is why youare advised to stay at the clinic or medical surgery for at least 15 minutes following immunisation, incase further treatment is required. 

Immunisation and HALO

The immunisations you may need are decided by your health, age, lifestyle and occupation. Together,these factors are referred to as HALO.

Talk to your doctor or immunisation provider if you think you, or someone in your care, have health,age, lifestyle or occupation factors that could mean immunisation is necessary. You can check yourimmunisation HALO using the Immunisation for Life infographic (pdf) downloadable poster. 

Where can I get more information about HPV immunisation?

Find out more about immunisation by speaking with your health professional. The best place to start iswith your GP. You can also ask your:

• maternal and child health nurse
• paediatrician
• local community health centre 
• local council immunisation service.

There is a lot of information online. When looking for immunisation information, stick to reliableinformation providers, such as:

• Better Health Channel
• Australian Government Department of Health.

You can also call:

• NURSE-ON-CALL Tel. 1300 60 60 24 -- for expert healthinformation and advice (24 hours, 7 days) 
• ImmunisationSection, Department of Health and Human Services, Victorian Government Tel. 1300 882 008
• Immunisation Unit, Department of Health, Victorian Government Email: immunisation@health.vic.gov.au
• Melbourne Sexual Health Centre Tel. (03) 9341 6200 or 1800 032 017 (toll free fromoutside Melbourne metropolitan area only)
• Cancer Council Helpline Tel. 13 11 20
• Victorian vaccine safety service ( SAEFVIC) Tel. 1300 882 924 (option 1) - the line isattended between 9 am and 4 pm and you can leave a message at all other times