Position Statement on the use of the HPV Vaccine in children
May 2011
CDA Pharmacy & Therapeutics committee Statement in support of the use of HPV Vaccine in children
It is estimated that 75% of sexually active adults in Canada can expect to have at least one Human Papillomavirus (HPV) infection in their lifetime[1]. Approximately 400,000 Canadian women have low-grade cervical changes found by Pap-smear that require further testing & treatment[2]. Cervical Cancer is diagnosed in 1,400 Canadian women annually and results in approximately 420 deaths every year[3]. The development of effective and safe HPV vaccines has offered significant hope that a reduction in these dire numbers might be realized.
While there are over 100 strains of HPV, a small number account for the majority of cases of anogenital warts (e.g. types 6 & 11) and for over 70% of cases of Cervical Cancer (types 16 & 18). Each of these subtypes produces a unique outer protein and these proteins have served as targets in the development of HPV vaccines. Two vaccines are currently approved for use in Canada. Gardisil®, a quadrivalent vaccine directed against HPV types 6, 11, 16 & 18 is approved for use in 9-26 year old males and females and Cevarix® which provides protection against HPV types 16 & 18 and is approved for use in females only. The vaccines have been shown to be quite effective in limiting about 90% or more of infections with the included HPV strains and no serious adverse events have been linked to their use. It is important to understand that there is no active or live virus in the vaccines. They contain no antibiotics or preservatives including mercury/thimerosal.
The use of these vaccines is intended as prevention for infection, not as treatment for anogenital warts or cervical cancer. While there may be a benefit to sexually active individuals vaccinated, the vaccine is ideally administered to presexual individuals as it seems the antibody levels achieved are higher[4]. Current studies suggest that vaccine responses are durable but it is unclear if booster doses might be necessary later in life. Because these vaccines are primarily effective against only the most common causes of cervical cancer, vaccination with either agent does not preclude the need for routine cervical cancer screening.
Because of their documented safety and their role in the significant reduction in the incidence of anogenital warts in men & women and of cervical intraepithelial neoplasia and cervical cancer in women, the Canadian Dermatology Association supports and encourages the administration of HPV vaccines to male and female Canadian children.
Prepared by the CDA Pharmacy & Therapeutics Committee April 11, 2011
Ratified by the CDA Board of Directors May 2011
[1] Health Canada Publications: It’s your health: Human Papilloma Virus (accessed at http http://www.hc-sc.gc.ca/hl-vs/alt_formats/pdf/iyh-vsv/diseases-maladies/hpv-vph-eng.pdf)
[2] Society of Gynecologic Oncologists of Canada Position Statement Regarding Prophylactic HPV Vaccines
[3] Health Canada Publications: It’s your health: screening for cervical cancer (accessed at http://www.hc-sc.gc.ca/hl-vs/alt_formats/pacrb-dgapcr/pdf/iyh-vsv/diseases-maladies/cervical-eng.pdf)
[4] Saslow D, Castle PE, Cox JT, et al. American Cancer Society Guideline for human papillomavirus (HPV) vaccine use to prevent cervical cancer and its precursors. CA Cancer J Clin. 2007 Jan-Feb;57(1):7-28.
