HPV Vaccine (Human Papillomavirus Vaccine)

Key facts about the HPV Vaccine

The HPV vaccine is provided free by the NHS for boys and girls aged 12- 13 in the UK. Men, 45 years or under, who have sex with men (MSM) and are considered at high risk of HPV infection are also eligible for the HPV vaccine.

A one-dose schedule was introduced in September 2023, where a single dose of the HPV vaccine is offered in school year 8 (12 -13 years old).

Two doses are available for MSM aged 25-45. A three-dose schedule is offered and will continue to be offered to individuals who are immunosuppressed at the time of immunisation and those known to be HIV-positive, including those on antiretroviral therapy. (See the 'more information about the vaccine' section below).

This vaccine gives protection against the most high-risk strains of the Human Papillomavirus (HPV), including ones which cause cervical, mouth and genital cancers. Cervical cancer is the most common cancer in women under the age of 35. About 3,200 women are diagnosed with cervical cancer in the UK annually, and around 900 women die from it. Since the introduction of the vaccine, cervical cancer rates have reduced by almost 90% in women in their 20s who were offered it at ages 12 to 13. See ‘more information about the vaccine’ below.

In the UK, Gardasil 9 is available and offered for free as part of the NHS programme – this protects against nine strains of HPV.

EDUCATE: All about HPV

https://www.youtube.com/embed/rHUMDOI3s2U?wmode=opaque&controls=&rel=0

Who should get this vaccine

Since September 2019, both girls and boys have been offered the HPV vaccine between the ages of 11 and 14 years old. It is offered in year 8 at school (12 -13 years old). See this video from the NHS about the year 8 HPV vaccine.

Any girls or boys who have missed the vaccine in school are still eligible to receive it for free through their GP until their 25^th birthday. All doses are covered by the NHS for boys and girls who are in the eligible cohorts:

girls who started year 8 in 2008 or later, up to their 25^th birthday
boys who started year 8 in 2019 or later, up to their 25^th birthday

Since April 2018 the HPV vaccine has also been offered to all men who have sex with men that are aged 45 or younger. This follows a successful pilot programme that has run since 2016. A two-dose vaccine schedule is offered at routine check-ups at sexual health (GUM) clinics and HIV clinics. See the Public Health England news item.

Other individuals, such as those attending specialist sexual health services (SSHS) or HIV clinics who are deemed at risk, are often offered the HPV vaccine where considerable benefits are deemed. These may include:

transgender individuals
sex workers
people living with HIV - a three-dose schedule should be offered to individuals who are immunosuppressed at the time of immunisation and those known to be HIV-positive, including those on antiretroviral therapy

Safety and side effects

Between 2009 and 2018 more than 10 million doses of HPV vaccine were given in the UK, which means over 80% of women aged 15-24 have received the vaccination. There have been no examples of the vaccine causing serious side effects during this period. The side effects associated with the vaccine are listed below:

Very common - may affect more than 1 in 10 people include:

pain, swelling, or redness at the injection site.
headache

Common - may affect up to 1 in 10 people include:

bruising or itching at the injection site
fever
tiredness
dizziness
nausea

Uncommon - may affect up to 1 in 100 people include:

swollen glands (neck, armpit, or groin)
hives (urticaria)
fainting, sometimes accompanied by shaking or stiffening
vomiting
joint pain
aching muscles
unusual tiredness or weakness
chills
generally feeling unwell

Rare - may affect up to 1 in 1,000 people include:

allergic reactions

If you are concerned about any reactions that occur after vaccination, please consult your doctor.

It is quite common for teenagers to have panic attacks before vaccination, or to faint during vaccination. These should not be confused with reactions to the vaccination itself.

After careful analysis, there is also no evidence that the HPV vaccine is linked to serious side effects such as chronic fatigue syndrome, POTS (postural orthostatic tachycardia syndrome) or CRPS (Complex Regional Pain Syndrome). More information about this is available here: results of a study by the MHRA in 2013

As with any vaccine, medicine or food, there is a very small chance of a severe allergic reaction (anaphylaxis). Anaphylaxis is different from less severe allergic reactions because it causes life-threatening breathing and/or circulation problems. It is always extremely serious but can be treated with adrenaline. Healthcare workers who give vaccines know how to do this.

In the UK between 1997 and 2003 there were a total of 130 reports of anaphylaxis following ALL immunisations. During this six-year period, around 117 million doses of vaccines were given in the UK. This means that the overall rate of anaphylaxis is around 1 in 900,000.

If you are concerned about any reactions that occur after vaccination, consult your doctor. In the UK you can report suspected vaccine side effects to the Medicines and Healthcare products Regulatory Agency (MHRA) through the Yellow Card Scheme. You can also contact the MHRA to ask for data on Yellow Card reports for individual vaccines. See more information on the Yellow Card scheme and monitoring of vaccine safety.

Ingredients

The HPV vaccine used in the UK is called Gardasil 9. This vaccine contains individual proteins from nine types of HPV virus, which produce an immune response. Apart from the active ingredients (the antigens), it contains very small amounts of these ingredients:

aluminium strengthens the immune response to the vaccine
polysorbate 80 is used as an emulsifier (to hold other ingredients together)
an amino acid called histidine is used as an acidity regulator
sodium chloride (salt)

The vaccine may also contain traces of this product used during the manufacturing process:

a few millionths of a gram of sodium borate (borax) is used as an acidity regulator

Other brands of HPV vaccines used in other countries may contain different ingredients. If you are not in the UK, ask for the patient information leaflet for the vaccine you are offered.

Videos and images about the vaccine

Click here for an accessible text version of this infographic

HPV lesson plan

Co-produced by young people and researchers from the University of Bristol and London School of Hygiene and Tropical Medicine, ‘EDUCATE’ will help you teach students about the human papillomavirus (HPV) vaccine and provide reassurance about receiving the vaccine — which is usually offered to teenagers at school as part of the national vaccination programme.

https://pshe-association.org.uk/resource/educate-hpv-vaccine

Cervical cancer short film

In this short film Carron Hulme talks about her experience of surviving cervical cancer, and her daughters Charlotte and Mollie talk about the HPV vaccine. Charlotte talks about receiving three doses of the HPV vaccine, but in 2014 the schedule changed. Girls and boys now receive two doses, as long as they get the first dose when they are under 15. Thanks to Jo’s Cervical Cancer Trust for their help in making this film.

Carron's story: cervical cancer and the HPV vaccine

https://www.youtube.com/embed/B-YEut6zKZ0?wmode=opaque&controls=&rel=0

More information about the vaccine

JCVI advises changing from a two-dose schedule to a one-dose schedule.

The JCVI has been examining the evidence of changing to a one-dose schedule for the HPV vaccine since 2018 – the first major review took place in 2020. Following studies in various countries, the evidence has shown that a single dose has comparable efficacy (how well the vaccine works) to three doses.

The JCVI has now recommended this change to the UK government for the routine adolescent programme and MSM programme before the 25th birthday. This change began in September 2023. MSM ages 25-45 still receive two-doses, and individuals who are immunosuppressed or HIV-positive will remain on a three-dose schedule. See the UKHSA report here.

Types of HPV vaccine

There are three HPV vaccines available;

Cervarix, protects against two types of HPV - 16 and 18.
Gardasil, protects against four types of HPV – 6, 11, 16, and 18
Gardasil 9, protects against nine types of HPV - 6, 11, 16, 18, 31, 33, 45, 52 and 58

In the UK, Gardasil 9 is available and offered for free as part of the NHS programme.

All of the vaccines protect against the two most common high-risk types of the virus: 16 and 18. These two strains are linked to over 70% of cervical cancers and 63% of penile cancers as well as most mouth, anus and throat cancers.

In addition to types 16 and 18, Gardasil protects against types 6 and 11, responsible for around 90% of genital warts.

Gardasil 9 protects against a further four types of HPV: 31, 33, 45, and 52 which cause an additional 15% of cervical cancers.

The Cervarix vaccine was previously used in the UK until 2012 and is also used in other countries.

Changing from a three-dose schedule to a two-dose schedule

In May 2020, the JCVI (Joint Committee on Vaccination and Immunisation) HPV sub-committee agreed that the schedule for those aged over 15 years should change from three doses to two doses given at least six months apart. Based on this, the JCVI main committee advised the move to a two-dose schedule at least six months apart, for both those aged 15 years and over, and MSM.

The JCVI also advised (in June 2021) that the three-dose schedule should continue to be offered to individuals who are known to be HIV-infected, including those on antiretroviral therapy, or are known to be immunocompromised at the time of immunisation.

The impact of the HPV vaccine

In clinical trials, the HPV vaccine was over 99% effective at preventing pre-cancer caused by HPV types 16 or 18 in young women, which are linked to 70% of cervical cancers. It is estimated that by 2058, after 50 years of this vaccination programme, 64,000 cervical cancers and 50,000 other cancers will have been prevented.

A 2021 study published in The Lancet has shown that the HPV vaccine has dramatically reduced cervical cancer rates by almost 90% in women in their 20s who were offered it at ages 12 to 13. Their findings show that the vaccines have almost eliminated cervical cancer in women born since September 1, 1995.

The World Health Organization has declared a global strategy to eliminate cervical cancer completely through vaccination and screening. It is important that women who have been vaccinated continue to take up the offer of cervical smear testing later in life so that other kinds of cervical cancer can be picked up.

HPV vaccine programmes around the world are currently being evaluated. Evidence from a recent study of 66 million young men and women showed an 83% reduction in high-risk HPV in teenage girls and 66% reduction in women aged 20-24. The study also showed precancerous cervical lesions declined by 51% in teenage girls and 31% in women up to age 24 (Analysis of HPV Vaccine Effectiveness).

In the graph below, the prevalence of high-risk HPV types 16 and 18 has reduced with the increasing number of women who have received the vaccine in England. Studies have shown that protection against HPV lasts at least 10 years, and this is expected to be long-term.

Click here for an accessible text version of this graph

Source: https://www.sciencedirect.com/science/article/pii/S0140673619302983

As the HPV vaccine is still new, we won’t know the effect on rates of cervical cancer until those women who have received the vaccine are older. However, studies looking at the percentage of women diagnosed with cervical abnormalities have shown a marked reduction since the introduction of the vaccination programme.

The graph below shows the percentage of 20 year old women diagnosed with cervical abnormalities by their birth year. This shows that as vaccine uptake has increased with each birth year, cervical abnormalities have fallen.