HPV vaccine
We have had good results with this over the past year.
ACOG NEWS RELEASE
| For Release: | August 8, 2006 |
| Contact: | ACOG Office of Communications |
| (202) 484-3321 | |
| communications@acog.org |
Washington, DC — The American College of Obstetricians and Gynecologists (ACOG) today released clinical recommendations for females ages 9 to 26 for the human papillomavirus (HPV) vaccine in advance of their publication in the September 2006 issue of Obstetrics & Gynecology. A new committee opinion offers general information about the vaccine and addresses proper administration, precautions, and contraindications.
“The approval of this vaccine represents a significant development in women’s health and the fight against cancer. Obstetrician-gynecologists should be proactive in educating our patients about the vaccine so that as many women as possible are able to take advantage of this medical milestone,” said ACOG President Douglas W. Laube, MD, MEd. “We must be prepared both to administer the vaccine and to answer patient and parent questions that will arise,” Dr. Laube added.
“Ob-gyns will play a critical role in the vaccine’s widespread use in girls and women and we should discuss vaccination with our patients. Additionally, ob-gyns should stress the importance of continued cervical cytology screening regardless of vaccination status,” Dr. Laube added.
Despite the protection the vaccine offers, ACOG emphasizes that the recommendations for cervical cytology screening remain unchanged. Pap screening should begin within three years of sexual intercourse (or by age 21) and then annually until age 30. After age 30, most women can continue annual testing or can choose to be tested every two to three years after three consecutive negative Pap tests. While the vaccine protects against HPV types 6, 11, 16, and 18, there are additional HPV strains that can cause cervical cancer. Pap testing can detect abnormal cervical cells caused by other HPV strains not covered by the vaccine.
The HPV vaccine is most effective when administered to girls and women before the onset of sexual activity. While the US Food and Drug Administration has approved the vaccine for girls and women ages 9 to 26, the federal Advisory Committee on Immunization Practices recommends that girls routinely receive the vaccine between the ages of 11 and 12. Although most ob-gyns are not likely to see many girls in this age group, ACOG recommends that teens first visit an ob-gyn between the ages of 13 and 15. This initial reproductive health visit is an ideal time to discuss the benefits of the vaccine and to offer it to teens.
Vaccination is also recommended for women up to age 26, regardless of sexual activity. Ob-gyns are encouraged to talk about the vaccine any time they see a patient within the target population and offer it to those who have not yet received it. However, women who are already sexually active should be counseled that the vaccine may be less effective if there has been prior HPV exposure.
Women who previously have had abnormal cervical cytology, genital warts, or precancerous lesions can be vaccinated. Those with suppressed immune systems also can be vaccinated, although the protection may be less than that of patients with normal immune function. The HPV vaccine is not a treatment for current HPV infection or genital warts. Patients undergoing treatment for HPV-related symptoms (cervical cytology abnormalities, genital warts) should continue with their prescribed medication and therapy.
While the vaccine has not been shown to have a harmful effect on pregnancy, it is not recommended that pregnant women be vaccinated. If a woman discovers she is pregnant during the vaccine schedule, she should delay finishing the series until after she gives birth. Women who are breastfeeding can receive the vaccine.
The recently approved vaccine shows great promise for controlling the spread of the main types of HPV that cause cervical cancer and genital warts. Given in a series of three shots over six months, the vaccine protects against four strains of HPV responsible for 70% of cervical cancers and 90% of genital warts cases. With widespread use, HPV vaccination has the potential to lower the occurrence of cervical cancer in future generations. Worldwide, cervical cancer is the second leading cause of cancer death in women with nearly half a million new cases and 275,000 deaths annually. An increase in routine Pap testing has led to a decrease in new cases and death (9,710 and 3,700 respectively) from cervical cancer in the US, but there is still a significant population of women who are not regularly screened.
Committee Opinion #344, “Human Papillomavirus Vaccination,” to be published in the September 2006 issue of Obstetrics & Gynecology, also addresses research recommendations, educational outreach, consent, and advocacy concerns.
# # #
The American College of Obstetricians and Gynecologists is the national medical organization representing over 51,000 members who provide health care for women