‘Should I take the HPV vaccine?’

Given the controversy that followed after Indian model Poonam Pandey faked her death to raise awareness against cervical cancer, conversations around whether or not to take the HPV vaccine sprouted among many. However, contemplation has kept us from actually getting our shot.

On National Vaccination Day 2024 - a day observed annually on March 16 to raise awareness of the importance of vaccines for protection against deadly diseases - Mid-day.com spoke to gynaecologists who answered common questions we all have had.

Dr Madhuri Burande Laha, consultant obstetrician and gynaecologist, Motherhood Hospital, Kharadi, says, "The HPV vaccine, also known as the human papillomavirus vaccine, is a crucial tool in preventing HPV infection and its associated health risks.

Human papillomavirus (HPV) is a common sexually transmitted infection that can lead to cervical cancer.

Dr Nandita Palshetkar (@drnanditapalshetkar_bloomivf), obstetrician, gynaecologist, director of Bloom IVF India and president of IVF Society of India (ISAR) states, "The HPV vaccine works by triggering the immune system to generate antibodies targeting specific HPV strains. This proactive approach aids in averting infection and lowering the likelihood of HPV-associated conditions like cervical cancer, genital warts, and certain other cancers."

Additionally, Dr Sampada Dessai, consultant, gynaecological cancer and robotic surgeon, P. D. Hinduja Hospital and MRC, Mahim says, "All women should be made aware of the HPV vaccine, their advantages and importance in preventing cervical cancer when taken timely."

The HPV vaccine made its debut in the early 2000s. The inaugural vaccine, Gardasil, was pioneered by Merck & Co. and gained FDA approval in 2006. Subsequently, another vaccine named Cervarix, developed by GlaxoSmithKline, also received regulatory approval. Together, these vaccines have played a crucial role in curtailing the prevalence of HPV-related diseases on a global scale.

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The HPV vaccine was first developed and introduced in India in 2008, marking a significant milestone in the country's efforts to combat cervical cancer. Cervavac, developed in India, is a breakthrough HPV vaccine designed to prevent HPV infection and cervical or HPV cancer. The Serum Institute of India develops it. Another company producing HPV vaccines in India is Bharat Biotech which has also been instrumental in preventing HPV infections

Laha, Palshetkar and Dessai answer some crucial questions related to HPV vaccines.

Are there various types of HPV vaccines?
Laha: In India, there are two types of HPV vaccines available that are Cervarix and Gardasil. Both vaccines target the HPV virus. Cervarix offers protection against two high-risk strains of HPV (16 and 18) which are responsible for cervical cancer cases. Gardasil protects against not only HPV 16 and 18 but also against two additional low-risk strains (6 and 11) which cause genital warts. By preventing persistent infection with high-risk HPV types, these vaccines effectively reduce the risk of developing cervical cancer.

Palshetkar: There are several types of HPV vaccines available, with the two main categories being:

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1. Bivalent HPV vaccine: This targets two high-risk strains of HPV, specifically HPV types 16 and 18. These strains are responsible for the majority of cervical cancers, as well as some other HPV-related cancers.

2. Quadrivalent HPV vaccine: This vaccine targets four HPV types - 6, 11, 16, and 18. Along with protecting against HPV types 16 and 18, associated with cervical cancer, it also provides protection against HPV types 6 and 11, which cause genital warts.

3. Additionally, there is a non valent vaccine that offers extra protection against HPV types 31, 33, 45, 52, and 58.

All these vaccines function similarly by introducing small amounts of harmless HPV proteins (antigens) to the immune system, which triggers the production of antibodies. These antibodies can recognise and remember the specific HPV strains, enabling the immune system to swiftly neutralise the virus upon subsequent exposure, thereby preventing infection or cancer development.

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How much does a single dose of HPV vaccine cost?
Laha: The cost of a single dose of the HPV vaccine in India can range from Rs. 2000 to Rs. 4000, making it unaffordable for many women. This poses a significant barrier to accessing this crucial preventive measure against cervical cancer. To make the HPV vaccine more accessible and affordable to all Indian women, there is a critical need for increased awareness campaigns highlighting the importance of vaccination in preventing cervical cancer.

Palshetkar: The cost of a single dose of the HPV vaccine in India can vary, influenced by factors like the vaccine type, manufacturer, and administration location (government vs. private healthcare facilities). Typically, prices range from a few hundred to a few thousand Indian rupees. However, accessibility and affordability of the HPV vaccine remain significant challenges for many Indian women.

Dessai: The single dose cost of the HPV vaccine varies as per the type. Gardasil-4 costs around Rs 4000, Gardasil-9 around 10,000 whereas Cervavac costs around Rs 2000 per dose. It is easily available at doctor's clinics, community health clinics, school-based health centres and public and private hospitals.

In specific districts of certain states like Punjab, Sikkim, Karnataka, Tamil Nadu, Chhattisgarh and Maharashtra, the government has announced free HPV vaccination for school girls. Currently, India lacks a national immunisation program for carcinoma cervix eradication.

Who should take the HPV vaccine?
Laha: The HPV vaccine is recommended for men and women between the ages of nine and 26. This includes individuals who have not been previously vaccinated or completed the full series. People with weakened immune systems due to certain medical conditions or treatments should also consider getting vaccinated.

It is essential to note that, for men, getting vaccinated against HPV is essential not only for their health but also to prevent transmission to their partners.

Palshetkar: The HPV vaccine is recommended for both men and women, usually starting around the ages of 11 or 12, although it can be administered as early as age 9. Its efficacy is highest when given before individuals become sexually active and may encounter the virus. Moreover, catch-up vaccinations are advised for those who missed receiving the vaccine at the recommended age. Importantly, it can be administered up to the age of 45.

Dessai: As per the CDC guidelines, the preferred and ideal target age group for HPV vaccines is nine-14 years for both males and females with two doses. Catch-up vaccination is recommended for women aged 15-26 years. Older age group from 27-45 years requires three doses. However, women aged 26 and above who have been sexually active should be counselled regarding reduced efficacy in older age groups and the importance of screening.

HPV vaccination prevents new HPV infections but does not treat existing HPV infections or diseases. The most favourable time to take the vaccine is before the sexual debut.

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Who must not take the vaccine?
Palshetkar: While the HPV vaccine is generally safe and effective, certain individuals should exercise caution or consult with a healthcare provider before receiving it. These may include:
1. Individuals who have experienced a severe allergic reaction to a previous dose of the HPV vaccine.
2. Pregnant individuals, as a precautionary measure.
3. Individuals currently suffering from a moderate or severe illness should consult with a healthcare provider before vaccination.
4. Those with compromised immune systems, such as individuals undergoing cancer treatment or living with HIV/AIDS, should discuss the potential risks and benefits of vaccination with their healthcare provider.

Individuals must disclose their medical history and any concerns to their healthcare provider before receiving the HPV vaccine to ensure its safety and appropriateness for their situation.

Does the vaccine guarantee complete protection from human papillomavirus (HPV) infection?
Laha: The efficacy rate of the HPV vaccine varies depending on the specific type of vaccine and the number of doses received. Studies have shown that the vaccine can be effective in preventing infection with certain high-risk strains of HPV that are known to cause cervical cancer.

Palshetkar: The HPV vaccine significantly reduces the risk of HPV infection, but it does not guarantee complete protection. The efficacy rate varies depending on the specific vaccine and the number of doses received.

For example, the Gardasil-9 vaccine, which protects against nine HPV strains, is highly effective in preventing infections with those strains as well as related diseases like cervical cancer and genital warts. Clinical trials have demonstrated efficacy rates of over 90% for preventing HPV infections and associated diseases. However, the vaccine does not protect against all HPV strains or against infections that may have occurred before vaccination. Overall, while the vaccine provides strong protection, it's not 100% effective.

Dessai: If vaccination is done before being exposed to the virus, the HPV vaccine is 97 per cent effective in preventing precancerous lesions of the cervix - the cell changes that could lead to cancer. It is highly effective in preventing external genital warts.

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Does an HPV vaccine need a booster shot?
Laha: The HPV vaccine has shown that booster shots may not be necessary for long-lasting protection. Studies have demonstrated that a full series of vaccines provides lasting protection for at least 10 years and likely longer, reducing the need for additional booster shots.

Palshetkar: Yes, HPV vaccines may require booster shots to maintain long-term protection. The number of booster shots needed depends on the specific vaccine and individual factors. For example, the Gardasil 9 vaccine typically requires a series of two doses for individuals who receive their first dose before the age of 15. For those who start the series at age 15 or older, three doses are recommended. Booster recommendations may evolve as more research becomes available.

Dessai: No, there is no recommendation for booster doses for HPV vaccines, if the recommended doses are completed on time.

Against which diseases does the HPV vaccine provide protection?
Laha: The HPV vaccine protects against several types of cancers and diseases. These include cervical cancer, throat cancer, anal cancer, penile cancer, and genital warts.

Palshetkar: The HPV vaccine protects against several diseases caused by human papillomavirus (HPV) infection, including cervical cancer, anal cancer, vulvar cancer, vaginal cancer, penile cancer, oropharyngeal cancers (cancers of the back of the throat, including the base of the tongue and tonsils), genital warts.

Are there any side effects of the vaccine?
Laha: While the HPV vaccine is generally considered safe and effective, like any medical intervention, it may have some potential side effects. Common side effects include soreness at the injection site, mild fever, and nausea. These symptoms typically resolve after a few days.

Palshetkar: Like any vaccine, the HPV vaccine may cause side effects, but they are usually mild and temporary. Serious side effects are rare. It's important to alert your doctor if any symptoms or problems persist.

Dessai: The most common side effects are similar to those of other vaccines like fainting, pain and swelling at the injection site (arm), headache, nausea and fever. The vaccine should be taken in a lying down or sitting position to avoid injuries if one faints. It is also advisable to take rest for 15 minutes after vaccination. The most common adverse reactions based on several studies are local reactions like pain at the local site (mild to moderate) in 83 per cent, swelling with erythema in 25 per cent and systemic adverse effects such as fever in 4 per cent of the individuals.

Common misconceptions about the vaccine
As mentioned by all the three experts, here are some common misconceptions:

Myth: The HPV vaccine is only for girls.
Fact: The HPV vaccine is recommended for both boys and girls to protect against HPV-related cancers and diseases.

Myth: The HPV vaccine encourages promiscuity (Having multiple sexual partners).
Fact: Research has shown no link between HPV vaccination and increased sexual activity. The vaccine is recommended to be given before potential exposure to HPV, ideally before becoming sexually active.

Myth: The HPV vaccine can cause infertility.
Fact: There is no evidence to suggest that the HPV vaccine causes infertility. It is safe for both males and females.

Myth: The HPV vaccine is unnecessary if you're in a monogamous relationship.
Fact: Even in monogamous relationships, individuals may not be aware of their partner's HPV status. The vaccine protects against multiple strains of HPV, providing broader protection.

Myth: The HPV vaccine is only for young people.
Fact: The HPV vaccine is recommended for individuals up to age 45, although it is most effective when given before potential exposure to the virus.

Disclaimer: This information does not replace professional medical advice. Consult a qualified specialist or your physician for personalised guidance.