What is HPV?
HPV is a virus that spreads from person to person; according to various studies, high-risk strains of HPV cause more than 85% of cervical cancer cases. Four out of five people contract HPV during their lifetime.
How is vaccination carried out?
In Estonia, girls aged 12–14 years are vaccinated against HPV, on the basis of the national immunisation schedule. The vaccination usually takes place at school as it is voluntary and in case of minors, a parent shall make the vaccination decision.
Safety of the vaccine
HPV vaccines have been in use since 2006. In clinical studies, the effects of HPV vaccines on hundreds of thousands of patients have been studied. The results of those studies confirm that the vaccine is effective and safe.
References to studies
Belgian oncology centre confirms efficiency of vaccine (2018)
Researchers at a Belgian oncology centre studied scientific literature published on the safety of HPV vaccine, which focused on the protection and potential complications of vaccine. The study, which includes experiences of tens of thousands of adolescent girls and women, confirms that HPV vaccine is safe and efficient.
A study of 240,000 Finnish girls confirms the safety of vaccine (2018)
HPV vaccinations have been administered in Finland since 2013. The data gathered since then has allowed for the analysis of data from 240,605 girls in order to evaluate the pros and cons of vaccination. The study confirmed that people who had received HPV vaccination did not experience other diseases at a higher rate than people who had not been vaccinated against HPV. The HPV vaccine protects against specific types of cancers and does not affect the incidence of other diseases.
Australia is on the way to defeating cervical cancer by way of vaccination
In 2007, Australia was one of the first countries to launch a free national HPV vaccination programme. Thanks to purposeful activities, there are only 7 cases of cervical cancer per 100,000 women discovered in Australia every year (23 in Estonia), and this number is to be lowered further. In Estonia, morbidity and mortality of cervical cancer are one of the highest in Europe.
The most common questions and answers
12 types of HPV are currently known to cause cancer of the cervix, anus, vulva, vagina, penis and throat. All those HPV types are very contagious. In most cases, contraction of those types of HPV has no symptoms, so that the infected person will have no idea of the infection. In most cases, the infection persists for 1–2 years and then disappears by itself.
However, one in ten cases of the infection lasts longer and can cause precancerous formations. If those are not discovered on time, those may develop into cancer.
Nearly all cases of cervical cancer begin with the HPV infection. Every year, an average of 180 new cases of cervical cancer are discovered in Estonia and about 65 women die as a result of this.
About 80% of men and women will contract HPV in their lifetime and the infection is particularly prevalent among sexually active people aged up to 25 years.
The source of infection is another person who has contracted HPV. Papillomaviruses spread from one person to another through direct contact with skin or mucous membranes (e.g. sexual intercourse or intimate touch). You can get the infection already during the first sexual intercourse. Condom use reduces the risk of infection, but does not guarantee complete protection.
About 80% of people contract HPV during their lifetime.
After contraction, the virus can live in the person’s body for a long time without displaying any symptoms. In most cases, the immune system of the person is able to destroy the virus within a few months or years. However, some people do not fully recover from the infection and it can lead to the development of a malignant tumour, i.e. cancer. This usually takes a long time, about 20 years or longer.
- Avoid promiscuous sexual intercourse.
- Use a condom.
- Don’t smoke.
- Go for regular health checkups.
- Get vaccinated.
Vaccination does not replace the regular Pap smear test used for cervical screening – women should visit their gynecologist regularly even after getting vaccinated. In order to ensure thorough protection, the current screening recommendations apply to women who have been vaccinated against HPV as well.
However, screening does not enable the detection of rapidly growing cervical cancer in teenagers and young women. Therefore, cervical cancer prevention programmes for teenagers should focus primarily on HPV vaccination , which is very effective when done prior to the person becoming sexually active.
As the disease spreads through intimate contact and sexual intercourse, the only definite method of prevention is to completely avoid sexual contact with others. Even if a person only has one partner, it is still possible to get the infection from them.
The use of condoms and other barrier methods for preventing pregnancy can reduce the risk of contracting HPV. Unfortunately, those methods do not provide complete protection because the items used do not cover all areas of the skin through which the virus can spread.
The best solution for women is vaccination – and, if possible, vaccination should be conducted before becoming sexually active – along with regular cervical cancer screening. Vaccination against HPV does not protect against all types of HPV, but depending on the vaccine, it provides protection against types that cause more than 85% of cervical cancer cases and up to 90% of genital warts.
It is recommended that girls are vaccinated when they are about 12 years old, prior to coming into contact with the virus.
During 2018–2019, all girls aged 12–14 years are vaccinated against HPV in Estonia, on the basis of the national immunisation schedule. The national immunisation schedule stipulates that as of January 2020, only 12-year-old girls born on 1 January 2008 or later are vaccinated.
The course of vaccinations for those under 15 years old consists of two vaccination dosages (administered at an interval of 6–13 months). The vaccine is administered to the deltoid muscle region of the upper arm.
The HPV vaccine Gardasil 9 contains nine proteins that are similar to those of the human papillomavirus. Those are not live virus cells, nor can they bring about an infection; however, when the vaccine is injected to the body, the organism reacts to the proteins just as it would react the real virus. The body will produce antibodies against those particles, thereby creating a defence system that can ward off the real HPV virus when the body comes into contact with that. This is what helps prevent diseases caused by dangerous strains of HPV, such as cancer of the cervix, vagina, vulva, anus, penis, oral cavity, as well as pre-cancerous conditions. The vaccine also protects from the occurrence of genital warts (condyloma acuminatum). The vaccine does not contain live virus and cannot therefore cause an infection and is not dangerous.
The HPV vaccine used in Estonia – Gardasil 9®provides protection against nine types of HPV (16, 18, 31, 33, 45, 52, 58), which cause more than 85% of cervical cancer cases and 90% of genital warts.
A healthy person is not required to go for a medical check-up prior to HPV vaccination. However, a healthcare worker should be consulted in the following cases:
- it is time to administer the second dose of HPV vaccine to the child, but the child experienced an allergic reaction after the first dose;
- it is known that the child has an allergy.
HPV vaccines have not been tested on pregnant women; therefore, pregnant women should postpone vaccination or complete their vaccination scheme after they have given birth.
It is not necessary to go for a separate health check-up after HPV vaccination (only in relation to the vaccination).
However, vaccinated women should still attend regular cervical cancer screening. This is because HPV vaccines protect from the majority, but not all HPV types that can cause cervical cancer. When vaccination has been conducted after the person became sexually active, the woman might have already contracted one or several types of HPV included in the vaccines and therefore not acquired the desired protection.
The vaccine Gardasil 9 is contraindicated to people who have hypersensitivity to the active substances or excipients of the vaccine. People who have experienced hypersensitivity after the first dose of vaccine, must not get another vaccination injection.
The safety and efficacy of all HPV vaccines have been thoroughly evaluated by way of clinical trials. By today, more than 270 million vaccine doses have been administered across the world and the vaccines are still considered safe. An independent evaluation organised by the European Medicines Agency reached the same conclusion.
The Global Advisory Committee on Vaccine Safety of the World Health Organization (GACVS) regularly analyses scientific data about HPV vaccines on the basis of studies carried out across the world. All serious health problems that have occurred after vaccination and that might have a connection to vaccination are studied; the committee analyses the incidence rate of relevant health problems before and after the introduction of the vaccine. So far, no evidence has been found of serious risks in connection to the use of vaccines.
- Video: “What is the working principle of the HPV vaccine?”
- The World Health Organization (WHO). The Global Advisory Committee on Vaccine Safety of the WHO, 2 and 3 December 2015. Weekly epidemiological record. 2016; 91 (3): 21–32
- WHO Position Paper on HPV immunization (WER, 2017)
- Study of the Belgian oncology centre
Japan made HPV vaccines available to girls aged 13–16 years on 2013, but stopped vaccinations funded by the state two months later, in order to conduct a closer investigation of the claims about side-effects mentioned in the media.
The Global Advisory Committee on Vaccine Safety of the World Health Organization has researched the efficacy and safety of HPV vaccines as of 2006, and carried out further studies in 2014 as well. As a result of those studies, no causal link has been found between the potential side effects described in the Japanese media and HPV vaccines. Despite the scientific evidence, however, the Japanese authorities have not reintroduced the national recommendation for HPV vaccination due to pressure from the anti-vaccination campaigners.
During 2006–2010, a cohort study of the vaccination registry was carried out in Denmark and Sweden in order to
determine whether or not vaccination against HPV is associated with any serious side effects (autoimmune, neurological and/or thromboembolic syndromes). The study involved 997,585 women aged 10–17 years, of whom 296,826 received a total of 696,520 doses of 4-valent HPV vaccine.
After the analysis period, the results and conclusions of the study were published in 2013: there is no causal relationship between HPV vaccination and the above-mentioned adverse side effects.
Not unlike other vaccines and medication, HPV vaccine can have mild side effects. Those include redness, swelling or pain at the injection site on the person’s arm. Some recently vaccinated people experience headaches, low-grade fever, join or muscle pain and nausea. These safe localized reactions or side effects are a natural response of the body to the vaccine and a normal part of the development of immunity, and usually disappear sooner than within a day.
However, it is important to keep in mind that if the symptoms persist for more than a few days, are disturbing or become more severe over time, you should turn to your doctor.
Reactions experiences on the arm of the vaccination injection:
- About eight people out of ten experience pain.
- About one person out of four experiences pain or swelling.
- About one person out of three experiences a headache.
- About one person out of ten will develop a slight fever (38 °C).
- About one person out of 65 will develop a moderately high fever (39 °C).
The aforementioned mild side effects usually pass within a few hours or days.
Sometimes, people can faint at the time of vaccination or when receiving any other injection. This is more common in situations where many young people are being vaccinated at once, e.g. in a doctor's office at school. In this case, the fainting is not caused by the vaccine itself, but rather by tension and anxiety.
About one among a million people who receive any vaccine will develop an allergic reaction (anaphylactic shock). Therefore, the patient should remain under the supervision of the nurse or physician for 15 minutes after the administration of the vaccine. Should you feel dizzy after the vaccination or if you experience hearing or visual impairment, please inform your healthcare provider.
The Agency of Medicines should also be notified of potential side effects.
Unfortunately, rumours about serious side effects and chronic health problems caused by HPV vaccines are spread on social media and among teenagers. Thorough studies and continuous pharmacovigilance (involving over 270 million doses of vaccine) have not proven the validity of such claims.
Watch a video about the side effects of HPV vaccine.
The occurrence of serious side effects is highly unlikely. However, the parent can help ensure that the vaccination goes smoothly.
- If the child has an allergy, inform the healthcare provider of this before vaccination. The healthcare provider can then give advice whether or not the child’s allergy is related to a specific vaccine.
- Make sure the child stays under the supervision of healthcare workers for 15 minutes after the vaccination.
- Following vaccination, the child may experience common side effects (redness or pain at the injection site), fever or pain in the body. Confirm to the child that these side effects are normal, not dangerous, and that the side effects will pass soon.
- If any unexpected symptoms arise, notify the doctor of this. Notifications of side effects are taken very seriously and analysed in order to find a possible connection with vaccination.
The Agency of Medicines should also be notified of any side effects.
In order to make the vaccine effect as effective as possible, it also contains small amounts of adjuvants (substances that help strengthen the body's immune response). These can be mineral salts, water and substances such as aluminium sulfate (aluminium compound), with which we come into contact constantly by way of air, food and cosmetic products, such as deodorants.
Contrary to various rumours, the vaccines currently available do not contain thiomersal or other mercury compounds.
The Gardasil 9 vaccine is highly effective. In a clinical study, 93–100% of girls who had not contracted HPV prior to vaccination acquired the necessary antibodies after vaccination (i.e. their bodies were ready to fight off HPV). Therefore, we can say that the effectiveness of HPV vaccine in preventing cervical cancer is based on preventing the contracting of HPV. The HPV vaccine Gardasil 9 prevents the development of cancers and precancerous conditions caused by HPV types 16, 18, 31, 33, 45, 52 and 58 with nearly 100% efficacy.
As a result of vaccination, a rapid decline (up to 90%) in the incidence of HPV infection and genital warts has been noted among teenage girls and young women in Australia, Belgium, Germany, Sweden, the United Kingdom, the United States and New Zealand. This limiting of the spread of the HPV infection has resulted in a sharp decrease in the number of women with precancerous changes (cervical cancer), as well as that of women and men with genital warts.
When the spread of HPV is limited, the decrease of cervical cancer cases and other forms of HPV-related cancers follows.
The protection acquired by way of vaccination is long-lasting. Studies on the duration of protection are ongoing.
The vaccine has no therapeutic effect. If a person is already infected with a HPV type included in the vaccine before vaccination, then the person shall not be protected against diseases caused by this type of HPV, but will be protected against other types of HPV in the vaccine (that the person has not previously contracted).
By the end of 2017, up to 10,000 people have been vaccinated against HPV in Estonia. HPV vaccine has been available in Estonia since 2006.
This is possible, but the effectiveness depends on previous exposure to the virus. Above all, the vaccine provides protection against HPV types with which the person to be vaccinated has not come into contact. Generally, people contract one or more types of HPV shortly after becoming sexually active; therefore, they should be vaccinated prior to that.
Vaccination against HPV with regular examinations is the best way to prevent cervical cancer.
Cervical cancer is the most common HPV-related illness that can, in a worst case scenario, be fatal. This is why the main goal of HPV vaccination is to protect women in particular.
The World Health Organization and the authorities in most countries recommend that girls aged 9–14 years are made a priority in terms of HPV vaccination. Protecting girls from HPV also provides indirect protection for their future partners and it has become clear that such “group immunity” prevents the spread of the virus effectively.
Each country decides independently, on the basis of the local burden of disease and the financial resources available, to whom HPV vaccine is administered. If the state is in a position to do this, it may be decided that girls over the age of 14 are vaccinated as well, and boys too.
Even though HPV mostly causes cervical cancer, boys can benefit from being vaccinated against HPV as well. This is because HPV can cause several types of cancer and genital warts in men as well.
Cervical cancer is not a hereditary disease. The majority of sexually active people (about 80%) contract one or several types of HPV at some point in their lifetime and only some of them develop cancer as a result of the HPV infection.
The World Health Organization recommends that all girls should be vaccinated against HPV and all women should go for regular check-ups so that any malignant cervical cell changes can be discovered on time.
Based on current scientific research, it can be said that HPV vaccination does not affect the ability of girls and women to get pregnant, neither does it have any effects on their pregnancies in the future. The vaccine does not affect the fertility of boys or men either.
Yes, it is possible in Estonia for parents to refuse HPV vaccination of their children.
However, parents ought to understand that if they refuse to have their child vaccinated, this means that their child may later suffer from a HPV-related disease.
Everyone who have not been vaccinated against HPV are at a high risk of contracting HPV and transmitting it to others as well. The HPV infection can cause several types of cancer and genital warts in men.
More than 80% of people who have not been vaccinated against HVP prior to becoming sexually active will contract at least one type of HPV in their lifetime. In time, most of those infections (about 90%) will go away on their own. However, if the infection does not disappear on its own, it can cause precancerous changes, which in turn can develop into cancer of the cervix, vagina or vulva. In men, the HPV infection can cause cancer of the penis, anus or throat. Some types of HPV can cause genital warts in men and women both.
It is important that both vaccinated and unvaccinated women attend regular cervical cancer examinations, so that any precancerous changes can be discovered as early as possible. This means that there will be sufficient time for treatment.