Human Papillomavirus (Cervical Cancer) Vaccine Update

Abstract

•There has been a paradigm shift in cervical cancer prevention strategies since the availability of the first cervical cancer vaccine, Gardasil.•It is imperative that nurse practitioners continually incorporate evidence-based information related to the human papillomavirus (cervical cancer) vaccines into their practice, thereby protecting females against a preventable cancer. Cervical cancer is preventable because of immunization with human papillomavirus (HPV) vaccine and the Papanicolaou test that facilitates early identification and treatment of precancer.1American Cancer Society. Cancer facts and figures. 2016. http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf. Accessed November 4, 2016.Google Scholar Despite these strategies, approximately 12,900 females in the United States will be diagnosed with cervical cancer in 2016 while approximately 4,120 will die from the disease.1American Cancer Society. Cancer facts and figures. 2016. http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf. Accessed November 4, 2016.Google Scholar To date, 3 HPV vaccines have been approved by the Food and Drug Administration to prevent HPV-related diseases. One such disease is cervical cancer; most cervical cancer cases are secondary to persistent HPV infection.1American Cancer Society. Cancer facts and figures. 2016. http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf. Accessed November 4, 2016.Google Scholar Many adolescents and adults are not aware of the connection between HPV and cervical cancer.2Wilson A.R. Hashibe M. Bodson J. et al.Factors related to HPV vaccine uptake and 3-dose completion among women in a low vaccination region of the USA: an observational study.BMC Womens Health. 2016; 16: 1-9Crossref PubMed Scopus (45) Google Scholar HPV vaccine uptake among eligible females in the United States is low.3Centers for Disease Control and Prevention (CDC)Noninfluenza Vaccination Coverage Among Adults—United States, 2012.MMWR Morb Mortal Wkly Rep. 2014; 63: 95-102PubMed Google Scholar The strongest predictor of HPV vaccine uptake is a provider recommendation.2Wilson A.R. Hashibe M. Bodson J. et al.Factors related to HPV vaccine uptake and 3-dose completion among women in a low vaccination region of the USA: an observational study.BMC Womens Health. 2016; 16: 1-9Crossref PubMed Scopus (45) Google Scholar Therefore, nurse practitioners in all practice settings need to provide evidence-based education regarding the link between cervical cancer and HPV and recommend HPV vaccination in order to reduce cervical cancer incidence and mortality. This column highlights the most recent HPV vaccination, Gardasil 9 (Merck & Co., Inc., Whitehouse Station, NJ), which is preceded by a brief introduction to the first 2 HPV vaccines. Gardasil, the first HPV vaccine, has been available for use among females since 2006 and males since 2011, whereas Cervarix (GlaxoSmithkline Biologicals, Rixensant, Belgium) has been available in the US since 2010 for use among females between 10 and 26 years of age. Both Gardasil and Cervarix have indication to prevent precancer and cancer that are secondary to HPV 16 and 18. Gardasil is also indicated for the prevention of HPV types 6 and 11 causing genital warts in males and females. Gardasil 9, the third HPV vaccine, was approved for use in the US in 2014.4US Food and Drug Administration. FDA approves Gardasil 9 for prevention of certain cancers caused by five additional types of HPV. 2014. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm426485.htm. Accessed November 4, 2016.Google Scholar It is a 9-valent vaccine that is indicated for the prevention of cervical, vaginal, vulvar, and anal cancers; precancerous cervical, vaginal, vulvar, and anal lesions; and genital warts.4US Food and Drug Administration. FDA approves Gardasil 9 for prevention of certain cancers caused by five additional types of HPV. 2014. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm426485.htm. Accessed November 4, 2016.Google Scholar, 5Gardasil [package insert]. Whitehouse Station. NJ: Merck & Co, Inc; 2016.Google Scholar The 9 types of human papillomavirus that Gardasil 9 protects against are types 6, 11, 16, 18, 31, 33, 45, 52, and 58.4US Food and Drug Administration. FDA approves Gardasil 9 for prevention of certain cancers caused by five additional types of HPV. 2014. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm426485.htm. Accessed November 4, 2016.Google Scholar, 5Gardasil [package insert]. Whitehouse Station. NJ: Merck & Co, Inc; 2016.Google Scholar HPV types 6 and 11 prevent genital warts in males and females between the ages of 9 and 26 years old. HPV 16, 18, 31, 33, 45, 52, and 58 prevent cervical, vaginal, vulvar, and anal cancers, as well as precancerous cervical, vaginal, vulvar, and anal lesions cancers in females who are 9 to 26 years old.4US Food and Drug Administration. FDA approves Gardasil 9 for prevention of certain cancers caused by five additional types of HPV. 2014. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm426485.htm. Accessed November 4, 2016.Google Scholar, 5Gardasil [package insert]. Whitehouse Station. NJ: Merck & Co, Inc; 2016.Google Scholar On the other hand, HPV 16, 18, 31, 33, 45, 52, and 58 prevent anal cancer, as well as precancerous anal lesions in males who are 9 to 26 years old.4US Food and Drug Administration. FDA approves Gardasil 9 for prevention of certain cancers caused by five additional types of HPV. 2014. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm426485.htm. Accessed November 4, 2016.Google Scholar, 5Gardasil [package insert]. Whitehouse Station. NJ: Merck & Co, Inc; 2016.Google Scholar Initially, the dosing for Gardasil 9 was 0.5 mL intramuscularly in the upper aspect of either the deltoid or anterolateral thigh at 0-, 2-, and 6-month intervals. However, in 2016, the Food and Drug Administration approved the 2-dose regimen for use among 9 to 14 year olds (Table).5Gardasil [package insert]. Whitehouse Station. NJ: Merck & Co, Inc; 2016.Google ScholarTableNew Gardasil 9 Administration RegimenVariable, Dose, and ScheduleRegimen2 dose3 doseAge9-149-26Schedule0 and between 6 and 12 months0, 2, and 6 months Open table in a new tab The most common adverse reactions to Gardasil 9 are injection site erythema, edema, and pain; the first 2 adverse effects are more severe among recipients of Gardasil 9 compared with Gardasil. Syncope can occur as with the other vaccines, but it may be accompanied by seizurelike activity and clonic-tonic movement, which may be of short duration. Serious adverse effects include headache, asthmatic crisis, allergy to the vaccine, and pyrexia. This vaccine is contraindicated in individuals with allergy to the vaccine or yeast because the latter is a component of the vaccine. Females who are pregnant or breastfeeding should not receive the vaccine. If a pregnant woman receives the vaccine, the incident should be reported to Merck’s Pregnancy Register at 1-800-986-8999 because the effects of the vaccine on the fetus are being monitored. Because the vaccine does not protect against infections that are already present and does not protect against all types of cervical cancer causing HPV types, females should be screened for cervical cancer. Cervical cancer screening with the Papanicolaou test should begin at 21 years of age and ends at 65 years of age in women who are not at high risk.1American Cancer Society. Cancer facts and figures. 2016. http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf. Accessed November 4, 2016.Google Scholar There has been a paradigm shift in cervical cancer prevention strategies since the availability of the first cervical cancer vaccine, Gardasil. The availability of the third vaccine, Gardasil 9, makes it possible to protect females against 7 cervical cancer–causing strains of HPV. Additionally, the recent approval of the 2-dose regimen of the vaccine is likely to increase vaccine series completion. It is imperative that nurse practitioners continually incorporate evidence-based information related to the HPV (cervical cancer) vaccines into their practice, thereby protecting females against a preventable cancer.