HPV vaccination available in New Zealand
On 26th July a vaccine against HPV infection was registered in New Zealand. This page summarises what we know about HPV and the potential role of the new vaccine.

About HPV infection:

• Human Papilloma Virus (HPV) is the most common sexually transmitted infection affecting men and women. Approximately 50-70% of people will catch HPV at some time in their lives. Most people who catch HPV are not aware that they have done so.
• 98% of HPV infections resolve without problems, however 1 in 50 women have infection that persists for more than 5 years and this can increase the chance of developing cervical pre-cancer.
• If cervical pre-cancer is not treated, over time some will progress to become cancer.
• HPV infections can be with either 'low risk' or 'high risk' HPV types. Low risk types can cause genital warts and verrucae. High risk HPV is the cause of smear test abnormalities and cervical cancer in women who have persistent infection.
• More than 100 different types of HPV have been identified. The most common cause of genital warts is HPV 6 and 11, which are responsible for approximately 90% of the disease. 70% of cervical cancer is caused by HPV 16 and 18.
• Over the past 10 years in New Zealand, the cervical screening (smear test) programme has resulted in a 40% fall in the number of cervical cancers and a 60% fall in deaths from the disease.

About the HPV vaccine that is now available:

• The vaccine is called Gardasil and is produced by the pharmaceutical company Merck Sharpe and Dohme.
• The vaccine contains non-infectious, virus-like particles which immunise against the four HPV types: 6, 11, 16 and 18.
• Effectiveness of the vaccine is high - almost 100% of pre-cancers and genital warts caused by HPV 6, 11, 16 and 18 are prevented.
• The vaccine is given in 3 doses over a six-month period.
• In order to be effective, the vaccine must be given before exposure to the HPV types has occurred. Since HPV is so common among sexually active young people, this means it is best given before the first sexual encounter.
• Gardasil is not publicly funded and costs approximately $450 for the full course.

Some common questions about HPV vaccination

Who should get the vaccine?
The vaccine is recommended for 11-12 year old girls, but may be given to girls as young as 9. It may also be beneficial for 13-26 year old girls and women.

Why give it to girls who are so young?
The vaccine will prevent HPV infection only if exposure to the HPV has not already occurred - i.e. before they are sexually active.

Is it worth getting the vaccine if I am sexually active?
There may be some benefit if you have not already been exposed to one or more of the four HPV types that it protects against.

How can I find out if I have been exposed to HPV - and in particular, which types?
There are no tests currently available to tell if you have had any or all of these HPV types.

But my friend had HPV on a smear test - can't this tell if I've been exposed?
HPV changes can be seen on smear tests sometimes, but even if it is found, it is not possible to tell if the HPV type is one of those in the vaccine. Similarly, the absence of HPV changes in a smear does not mean you haven't been exposed.

Is the vaccine safe?
The vaccine has been tested in over 11,000 females aged between 9 and 26 throughout the world and has been licensed by drug administration bodies in the US, UK and New Zealand as safe and effective. The research to date has shown no serious side effects. The most common problem is soreness at the injection site (86%) or headache (40%). Monitoring for side effects is ongoing. The vaccine is made from non-infectious proteins that form part of the HPV virus.

Will a booster be needed?
We don't know the answer to this yet. Studies have confirmed protection for 5 years so far, and the research is still ongoing.

I have had some smear test problems in the past - is it worth getting the vaccination to stop these coming back?
The vaccine cannot treat or prevent smear abnormalities that have already developed. Once you have been exposed to a particular HPV type, vaccination will not affect the progress of HPV-related change as a result of that infection. The vaccination can prevent you getting a different HPV type if you have not yet been exposed to it. As mentioned above, it is not possible to test which HPV's you have been exposed to. Therapeutic vaccines are in development but these are still at a research stage.

If I have the vaccine, does it mean that I won't need to have smears?
No. The vaccine prevents the 2 high risk HPV's that are responsible for approximately 70% of pre-cancer changes and cervical cancers. Other high risk HPV's exist, so it is still necessary to take part in the smear testing programme. Also the vaccine will not prevent HPV's that you have already been exposed to through sexual activity.

If I have HPV, can I get treatment?
It is not possible to treat HPV itself, but there are treatments for the problems that it can cause, such as genital warts, cervical pre-cancer changes and cancer of the cervix.

How can I prevent HPV infection?
The only sure-fire way to prevent infection is to abstain from all sexual activity. You are less likely to get it if you and your partner are faithful, but even women with only one partner can catch HPV if their partner has had previous sexual partners.

Condoms may help prevent HPV transmission, but it is not completely clear how effective these are. Areas not covered by the condom may be exposed to the virus, leading to transmission. Condoms can prevent other sexually transmitted infections such as HIV and chlamydia.

Dr Danny Tucker