Vaccination is the only truly effective method of preventing human papilloma virus (HPV) infection, which can lead to cervical cancer and other rarer forms of cancer.
Now: as the official document The 100 Questions About HPV explains, typically HPV infection - which is transmitted with sexual intercourse and it is very common, especially among young people - it does not cause any alteration and resolves on its own in a short time. In a minority of cases it causes lesions (ie cellular changes) in the cervix, but the vast majority of these lesions heal spontaneously. Only some, if left untreated, slowly progress to cancer. HPV is also involved in the onset of other forms of cancer, particularly rare, such as cancer of the mouth, anus and, in the male, the penis.
Read also: Papilloma virus, what science says
So let's see how exactly HPV vaccination works, who should do it and when, and what vaccines are available. We also do this with the help * of the 100 questions on HPV, a document formulated by the Del Paeseno Group for cervicocarcinoma screening (Gisci) and updated in May 2022.
1. What is the HPV vaccine used for?
To interrupt the chain of events that leads from infection to cancer in the bud.
2. Who should get the vaccine?
The effectiveness of the vaccine is maximum in those who have not yet had the infection, and therefore in women who have not yet had sexual intercourse.
According to the national vaccination calendar 2022-2022, vaccination is recommended and free for all girls and all boys over 11 years old. The vaccine is also very effective for girls up to 25/26 years who have not had sexual intercourse.
For girls and women who have already had sexual intercourse and in any case up to 40-45 years, the benefit could be only partial: they have probably already come in contact with one or more types of HPV, and in this case the vaccine would not be useful. At the same time, however, this could protect them from infections against types they haven't yet come into contact with, contained in the vaccine itself. According to Gisci, in these conditions Whether or not to have the vaccine should be discussed with your doctor.
3. Do males also have to be vaccinated?
The new National Vaccine Plan 2022-2022 has included vaccination of 11-year-olds among the recommended interventions. This is to protect boys from the fearful consequences, although very rare in men, of HPV infection (cancer of the penis, anus and oropharynx), and for reduce the circulation of the virus. In this way, in fact, infections are reduced even in unvaccinated women, who continue to have the greatest burden of disease.
The Gisci also recommends vaccination in sexually active homosexual males: a population in which HPV-related cancers are more frequent than in the rest of the general male population.
4. What vaccines are these?
There are currently 3 HPV vaccines available:
- Gardasil directed against four types of HPV virus (quadrivalent vaccine): two of these viruses are responsible for cervical cancer (16 and 18); the other two (6 and 11) are responsible for genital warts (condylomas). Alone, Types 16 and 18 are responsible for over 70% of cervical cancer cases;
- Cervarix, effective against the two types of HPV (16 and 18) which are responsible for cervical cancer (bivalent vaccine);
- Gardasil 9 (most recent), a 9-valent vaccine that in addition to types 16, 18, 6 and 11, also protects against infection of high-risk types 31, 33, 45, 52, 58. It is estimated that, alone, these seven high-risk types account for nearly 90% of cervical cancers.
5. Are the available vaccines effective?
Studies have shown that the various vaccines available are very effective (almost 100%) against the types of papilloma virus against which they are directed. Furthermore, the results of some studies suggest that these vaccines may also provide some degree of protection against infection caused by some types of HPV not contained in vaccines.
6. How long does the vaccine last?
For now we know the protection given by the vaccine lasts at least 9 years, that is for the entire observation period made so far for the first vaccines widespread in the country and aimed at types 16 and 18. For the 9-valent vaccine the observation period was shorter (5-6 years).
7. How is the vaccine made?
The timing of vaccinations - experts speak of a "schedule" - varies according to the type of vaccine and age. Generally, these are two doses up to 13/14 years, and three doses within a few months of each other after 14/15 years.
Typically the injection is given in the upper arm.
8. After the first three doses of the vaccine, do I need to have boosters?
For now we know that the protection given by the vaccine lasts at least 8-9 years. In the next few years we will know if, and if so when, it will be necessary to make recalls.
9. What reactions can you have after getting the vaccine?
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The HPV vaccine quite often causes some symptoms like fever, pain, swelling and redness in the area where the injection was given, or headache or muscle aches. These symptoms go away on their own in a few days.
10. Are these vaccines safe?
To begin with, it should be noted that these vaccines are produced from the empty envelope of the virus alone. That is, they do not contain genetic material, which is essential to allow the virus to reproduce and cause an infection. In this way there is no chance that the vaccine will cause the infection.
As for any adverse effects, it is recalled that since 2006, HPV vaccines have been authorized in more than 110 countries and have been distributed more than 270 million doses. Studies conducted after the introduction of the vaccine confirmed a high level of vaccine safety, i.e., rarely observed serious events have been shown not to occur more frequently among vaccinated than in unvaccinated.
Even a very recent review by the Cochrane Collaboration pointed out that these vaccines do not increase the risk of serious side effects, nor do they increase the risk of abortion if by chance they are carried out during pregnancy. In this regard, however, there are still scarce data on the effect of this vaccination possibly carried out in pregnancy on the risk of fetal malformations.Read also: Vaccines for childbearing age and pregnancy: the recommendations of the Ministry of Health
Among the undesirable effects attributed to HPV vaccination there would be one autoimmune / anti-inflammatory syndrome called ASIA and described by an Israeli researcher, Yehuda Shoenfeld. However, it must be said that this is an extremely generic syndrome, which could depend on many conditions if its existence, which is still doubtful at the moment, is confirmed (only Shoenfeld and his colleagues have observed it).
Furthermore, studies conducted on large numbers have definitively denied the hypothesis that vaccination can cause effects such as permanent pain in the limbs or alterations in the heart rhythm when standing upright (POTS syndrome).
11. Is the vaccine mandatory? It's free?
The vaccine it is not compulsory, but it is recommended and free for young girls and boys who are in the 12th year of life (i.e. they have turned 11 years old). In some regions, the vaccine is also free for other age groups under 25. Women wishing to get the vaccine outside these age groups will have to pay for it.
12. Do I have to go to the doctor to have the vaccine ordered?
For girls and boys who have turned 11 it is not necessary, because they receive the invitation to get the vaccine directly from their ASL.
For other age groups, a doctor's request will be required to buy the vaccine. Some indications, however, may vary from Region to Region, so for precise information it is better to call the vaccination centers of your ASL.
13. Do you still need to screen after the vaccine?
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Absolutely yes: vaccinated women will also have to continue screening, with the PAP test every three years from the age of 25 and a HPV test every 5 years from 30-35 years.
* Some answers have been partially edited
- hpv vaccine
- papilloma virus
- 6-14 children years