Human papillomavirus (HPV) is an infection that is transmitted through sexual and household contact (through simple physical contact with a carrier). 80% of people are at risk of infection during their lifetime.
Today, the number of HPV types reaches 100. Most of them cause skin formations - warts, and do not pose a threat to human life. However, some types (16 and 18) can cause dysplasia and cervical cancer, and cause cancer of the pelvic organs.
The human immune system usually copes with infections, but in some cases the virus persists in the body and threatens the development of cancer. HPV vaccination provides protection against this danger.
What HPV vaccines are there?
Currently, two vaccines against HPV have been synthesized: Cervarix, a bivalent HPV-16/18 vaccine [GlaxoSmithKline], and Gardasil, a quadrivalent HPV-16/18/6/11 vaccine [MSD]. In large multicenter studies involving tens of thousands of women aged 16 to 26 years, both vaccines were found to be nearly 100% effective in preventing disease caused by human papillomavirus types 16 and 18 (Cervarix) and types 6,11,16 and 18 (“Gardasil”). There is evidence of a possible additional protective role of these vaccines against other HPV types not included in the vaccines (so-called cross-immunity). Studies have shown immunity against primary infection with HPV types 45, 31, 33 and 52.
Saves from cancer or causes infertility. Everything about HPV vaccines from a scientific point of view
Is the HPV vaccine only needed for those who have not yet become sexually active, or is that not true? What are the HPV vaccines and do they cause infertility? How can you get vaccinated if you live in Russia?
How many HPV vaccines are there and how do they work?
According to WHO, there are three types of preventive vaccines, the first - Cervarix - protects against two highly oncogenic types of HPV 18 and 16.
The second, Gardasil, protects against four types of HPV: 18, 16, 11 and 6. The last two can cause the formation of genital warts - small skin-colored growths that appear on the genitals, near the anus, or sometimes in the mouth.
The third, Gardasil-9, protects against nine types of HPV: 58, 52, 45, 33, 31, 18, 16, 11, 6. It is noted that all three vaccines become ineffective if a person has already become infected with the virus.
Who is eligible for the HPV vaccine?
The WHO said that as a preventative measure, it is recommended that girls aged 9–14 years old receive the vaccine before sexual activity. Vaccination of the secondary target population: girls over 15 years of age and boys is recommended if feasible, cost-effective and does not divert resources from vaccinating the primary target population.
Cervarix is a vaccine that consists of a mixture of virus-like particles of recombinant surface proteins of HPV types 16 and 18, the effect of which is enhanced using the AS04 adjuvant system. The latter is used to enhance the immune response when administered simultaneously with an immunogen. Indications for use: prevention of cervical cancer in women 10–25 years old. The primary course of vaccination consists of three doses.
Gardasil is a tetravalent recombinant vaccine, it consists of virus-like particles that are unable to reproduce in the human body. Vaccination is recommended for girls and women aged 9–26 years, as well as boys 9–17 years old. For the full course you need to administer three doses of the vaccine. The safety of Gardasil has been confirmed in a large scientific study. According to its results, it turned out that all side effects remain at a slightly low level and do not threaten the lives of patients.
Gardasil 9 is a nine-valent recombinant vaccine that is indicated for active immunization in patients aged 9 to 27 years. It acts like Gardasil, but has an extended spectrum of protection against HPV. At the time of publication of the article, Gardasil 9 was not registered in the Russian Federation.
Is HPV really so dangerous that it’s worth getting vaccinated against?
Scientists have proven that oncogenic types of HPV lead to cervical cancer. There are more than 100 types of HPV, of which approximately 14 can cause cancer.
HPV is almost impossible to detect on your own, since the virus does not affect the functioning of the body in any way and goes away without additional therapy after a few months.
In the previous paragraph, we mentioned that the most dangerous oncogenic types of HPV are 18 and 16. They are responsible for 70% of cases of cervical cancer - this type of oncology is in second place in the world in terms of frequency among women. The first is breast cancer. Cervical cancer also shortens life the most, by an average of 24 years. More than 300 thousand people in the world die from it every year.
There are 2,869 million women around the world aged 15 years and older who are at risk of developing cervical cancer. Current estimates indicate that every year 569,000 women develop cervical cancer and 311,000 die from the disease.
In Russia, cervical cancer is diagnosed annually in 15 thousand people. Our country ranks 13th in terms of cervical cancer incidence among European countries.
How effective are vaccines?
The highest effectiveness in the fight against HPV was found in those who have not yet encountered the virus - 97–100%.
If we consider those who have already begun sexual activity and have encountered HPV, then the effectiveness of vaccination in preventing HPV diseases is significantly lower - 44–61%. The percentage depends on the vaccine.
I heard that the vaccine can cause infertility, is this true?
No, but the myth about infertility still exists. It came after the publication of a study showing a reduced likelihood of getting pregnant in American girls aged 25 to 29 years.
After about six months, the article was retracted because serious errors were found in it.
What is the situation with the HPV vaccine and vaccination in Russia?
Cervarix and Gardasil are registered in Russia, but Gardasil 9 is not. But the HPV vaccine is not included in the National Preventive Vaccination Schedule (NCPP). This means that the pace of vaccination will be several times lower, and oncogenic markers will also be common.
In the spring of 2021, it became known that Russian pharmaceuticals and RPC Combiotech began joint development of a domestic vaccine against HPV. It is expected to be a quadrivalent vaccine against the four types of HPV that cause cervical cancer.
In July of this year, Russia announced the start of vaccine testing.
All three HPV vaccines have passed the necessary stages of testing and review, and information about their safety has been published in international scientific journals, for example, the Journal of the American Medical Association and the New England Journal of Medicine.
In Russia, vaccination against human papillomavirus is not included in the National Vaccination Calendar, but for children it may be available according to regional calendars, as well as territorial and regional programs. It will be free. But for adults the vaccine is paid.
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Who is recommended for vaccination against HPV infection?
In recent years, HPV vaccines have been included in the national vaccination calendars of many countries around the world. HPV vaccination is recommended for all adolescent girls aged 12-14 years. It is early vaccination (before the onset of sexual activity) that is most effective. However, even at a later age, the vaccine has undoubted benefits. Currently, studies of the Gardasil vaccine have been completed in women under the age of 45 and in young men. Based on the results of these studies, HPV vaccines are recommended for use both in women without HPV infection and in infected patients.
Principles and purposes of vaccination
Cervical cancer, which is caused by the human papillomavirus, is the fourth most common cancer in women worldwide and accounts for 7.5% of all cancer deaths in women. Currently, there are no effective and proven treatments for HPV infection, so the only way to prevent it is vaccination.
Currently, HPV vaccines are actively used in many countries around the world. In a number of foreign countries, vaccination against HPV is included in the National Immunization Programs. In the USA, vaccination is carried out among all girls aged 11-12 years, in France - at 11 years, in Germany - at 12-17 years, in Austria - at the age of 9-17 years. World experience in the use of these vaccines for several years has shown their safety and high preventive effectiveness.
The vaccination is done three times. The interval between the first and second is two months, between the second and third is four months. But you can also do it according to a more dense scheme: the second - a month later and the third - two months after the second.
If pregnancy occurs, the third dose of the vaccine is postponed until the postpartum period. If all three vaccinations have been completed within 12 months, the vaccination is successful and complete.
What to do if the next vaccination date is missed?
The minimum acceptable interval between the first and second doses of the vaccine is 4 weeks, the minimum interval between the second and third doses is 12 weeks. Therefore, an accelerated vaccination schedule is sometimes allowed. If the vaccine schedule is interrupted, there is no need to start the entire series over. If vaccination is interrupted after the first dose, the second dose should be given as soon as possible and separated from the third dose by at least 12 weeks. If only the third dose is delayed, it should be given as quickly as possible. If the interval between vaccinations is violated, the vaccination course is considered completed if three doses are administered within 1 year.
Contraindications
Infection with one of the types of HPV included in vaccines is not a contraindication to vaccination; but you should consult your doctor and gynecologist about the need for such vaccination. HPV vaccines are contraindicated in the following cases: allergies to any component of the vaccine, severe allergic reactions to previous administration of this drug, pregnancy. As with any vaccination, temporary contraindications to vaccination are acute diseases and exacerbations of chronic diseases. In such cases, the HPV vaccine is postponed until recovery.
Vaccine effectiveness
Observations by dermatologists and oncologists prove the high effectiveness of HPV vaccinations, provided that they are given at the appropriate age and in strict accordance with the schedule.
Doctors' opinions: pros and cons
A clear position regarding this vaccination has not been formed in the medical community. Its optionality indicates that sufficient empirical material has not yet been accumulated and generalized to clearly indicate that vaccination can reduce the risk of developing cancer in women. As in most areas of the pharmaceutical industry, in the promotion of vaccines, in their advertising manufacturing companies are interested. For doctors, this is a good help in conducting business, given the cost of one dose of the vaccine.
Prevention and treatment of diseases associated with HPV
Human papillomavirus is a dermatological disease. Therefore, if rough formations similar to warts appear on the body or mucous membranes of the genital organs, it is necessary to consult a dermatologist, and not a therapist or surgeon. The main method of preventing human papillomavirus infections is to observe personal hygiene measures when communicating with sexual partners. It is people who are the main reservoir and source of infection. Papillomas that appear on the body are treated with ointments and antiviral drugs taken orally or administered intramuscularly.
What is HPV?
Human papillomavirus (HPV - Human Papillomavirus) is the common name for a group of viruses that includes more than 100 species.
There are low and high risk HPV.
In the first case, warts appear on the skin, papillomas on the hands, feet, neck, damage to the skin and mucous membranes in the genital area, but the body’s immune system usually copes with the infection.
High-risk viruses cause precancerous and cancerous changes in the cervix and external genitalia. Currently, 10–15 high-risk viruses are known. Most cases of cervical cancer (80%) are associated with viruses types 16 and 18.
How does HPV infection occur?
The source of the virus is a person who is infected with HPV. This virus is transmitted through contact of skin or mucous membranes. Some of the HPV viruses are sexually transmitted and affect the genitals of men and women.
The peak incidence occurs at a young age, when people most often have sex; there is a high chance that a person over 25 years of age already has the HPV virus or once had it.
How to determine whether a person is a carrier of the virus?
Only after laboratory analysis. Most HPV infections do not cause symptoms or outward signs.
How to understand that an infection has occurred?
Typically, HPV infection is asymptomatic, so a person may not even realize that he has it. In addition, the infection can go away on its own, but often becomes chronic.
HPV infection can be diagnosed using a Pap test - the primary screening for cervical cancer and precancerous changes. A gynecologist can also detect HPV when he sees morphological changes in the cervix.
HPV tests are not available for men.
Are only women carriers of HPV?
No. HPV is one of the most common infections in both women and men.
What happens after infection with HPV?
The peculiarity of the virus is that it penetrates the cell nucleus of the basal layer of the cervical epithelium. That is, there is no circulation of the virus in the blood, and therefore there are no symptoms of fever, weakness, or intoxication. Clinical signs of HPV (warts, condylomas) may or may not appear over time.
Did you get sick once and that’s it?
Even if the body defeats the human papillomavirus, it can become infected again. Our body does not acquire immunity to it.
How to cure HPV?
The bad news is that there is no cure for HPV. The good thing is that you can detect the presence of a disease that can be caused by a virus in time and begin treatment.
How are HPV and cervical cancer related?
Unfortunately, the connection is direct and strong. High-risk types of HPV are the main cause of the appearance and development of not only cervical cancer, but also cancer of the genital organs of women and men, as well as children. Children become infected during the passage of an HPV-infected mother through the birth canal.
How to protect yourself from HPV?
Since the disease is transmitted through intimate or sexual contact, the only option is complete abstinence from sexual activity. Let's be honest, this option is not suitable for anyone. HPV can be contracted even during a monogamous relationship if the partner has been sexually active in the past.
Using a condom reduces the risk of infection, but does not guarantee 100% protection. The virus can enter the human body from any infected area of the skin.
The best solution to avoid viral infection is vaccination. If possible, it should be done before the start of sexual activity. Vaccination does not protect against all types of HPV, but it does fight against those that cause cervical cancer.
How is immunization done?
Vaccination with Gardasil and Cervarix involves a three-act intramuscular injection of the vaccine. Immunization takes six months. The first injection is given at a time convenient for the patient, the second - after a month, the third - after 6 months.
Before vaccination, pregnancy is excluded; a test is done for this. If a person has a fever on the day of vaccination, immunization is postponed until complete recovery.
The vaccine should only be received after consultation with a doctor. It is important to mention in the conversation about bleeding gums and the tendency to form hematomas, if any. You should also tell us if you have recently received vaccinations or are taking any medications.
Side effects of vaccination
Gardasil and Cervarix underwent clinical testing before they were approved for mass use. Their safety and effectiveness have been proven. However, the use of vaccines may cause side effects:
- pain at the injection site;
- slight redness and swelling of the skin;
- slight increase in temperature and muscle soreness;
- enlarged lymph nodes;
- cold-like symptoms.
There is no need to worry about such side effects, since they disappear on their own within 2-3 hours.
In rare cases, a serious allergic reaction may occur after receiving the HPV vaccine. In such a situation, you must immediately consult a doctor or call an ambulance. Signs of such a reaction are:
- skin rash and red spots on the skin;
- itching of the skin;
- swelling of certain parts of the body;
- labored breathing;
- weakness, dizziness.
Such side effects are rare and the vaccine is generally well tolerated. However, before immunizing children or receiving vaccinations for adults, consulting a doctor is required. If this cannot be done at your local clinic, you can contact specialized vaccination centers.
What diseases are caused by the human papillomavirus?
An external visual manifestation of the penetration of the virus into the human body is the formation of pointed papillomas. Their favorite localization is the genital area. That is why genital papillomas are regarded as a sexually transmitted disease. It is HPV that is considered the most common infection of this type. Contact and household transmission of the virus is also possible - due to violation of hygiene rules:
- using other people's bath accessories;
- putting on someone else's underwear;
- sleeping in the same bed with a person infected with HPV or who is a carrier of it.
Having appeared in the human body, the virus can provoke the development of cancer of the cervix, vulva, vagina, and anus in women, and cause cancer of the head of the penis or carcinoma of the anus in men. The most common HPV-associated complication is cervical cancer, which can be considered a serious social problem. After all, sick young women face a significant deterioration in health, disability, and decreased fertility.
Will the vaccine help if the virus is already in the body?
According to the latest research from the National Cancer Institute in the United States, if a person is already infected with HPV, the vaccine will protect him from all other types of the virus. And if self-healing occurs, it will prevent re-infection. That is, the vaccine, unfortunately, will not be able to cure you of an existing infection, but will reduce the risk of cancer.
This is why experts do not even recommend getting tested for HPV before vaccination, since the test result does not affect the advisability of vaccination.
Expert opinion
We decided to introduce you to the reviews of the center’s doctors about HPV vaccination.
Kruglova Irina Ivanovna: “I recommend that my patients get vaccinated. After all, the risks are minimal, the drugs are absolutely safe. But what is the result - you protect yourself from cancer! Cervical cancer, which accounts for 7.5% of all deaths among women from cancer. And it’s great that the effect exists regardless of age and even the presence of the virus in the blood. But we must remember that vaccination does not cancel regular screening for cervical cancer: once a year it is still necessary to undergo smear cytology or PCR.”
Akhmedova Larisa Maratovna: “When my patients ask me whether to get vaccinated against HPV, I always ask - what do you have to lose? Yes, the vaccine is not free. But its cost is incomparable to what women have to go through when faced with oncology and even genital warts. If you are already 30 years old, technically you could not be vaccinated at 10 years old, as recommended by WHO. But the vaccine is also effective after the onset of sexual activity, when you could theoretically encounter papillomavirus. There are 190 species of them, but only 2 are deadly, and we can completely protect ourselves from them today.”
Where does cancer come from?
There are several theories about the causes of cancer: exposure to carcinogenic substances, the influence of certain viruses, and hereditary predisposition.
The outstanding Russian scientist L.A. Zilber, who already in 1935 formulated the principles of virology and immunology of cancer, is deservedly considered one of the discoverers of the role of viruses in the development of cancer. In subsequent years, foreign and domestic scientists confirmed the important role of viruses in the process of carcinogenesis.
A more detailed study of the role of viruses in the development of cancer at the end of the 20th century. marked the beginning of the development of vaccines against cancer. The invention and mass use of a vaccine for the prevention of hepatitis B is generally recognized as the first success in this area. In addition to preventing the infectious disease itself, vaccination prevents cirrhosis and primary liver cancer. Over 30 years of vaccination, including the mass use of this vaccine since 1997, hundreds of thousands of human lives have been saved and extended in Russia.
The second significant success of scientists was the discovery of the connection between the human papillomavirus (HPV) and the development of cervical cancer (CC). For the discovery of this connection, Harold zur Hausen received the Nobel Prize in 2008. Later, the role of HPV in the development of cancer of a number of other organs was revealed.
How to reduce the risk of HPV infection?
The risk of HPV infection is reduced only by sexual abstinence or mutually monogamous relationships with an uninfected sexual partner. However, if the partner has been sexually active in the past, monogamy also cannot protect against infection. A condom does not protect against HPV infection, since infection occurs through contact with the skin and genitals of a partner. However, it has been observed that using a condom reduces the risk of cervical cancer caused by HPV.
But only vaccination completely protects against the risk of HPV and cervical cancer.
Who is recommended for Gardasil vaccination?
Children and teenagers from 9 to 17 years old, young women from 18 to 26 years old. Ideally, you should be vaccinated against HPV before your first sexual contact, since the vaccine is most effective for those girls and women who have not yet been infected with any of the HPV types included in it. Sexually active women can also be vaccinated, but in this case the vaccine will only protect them against types of HPV that they have not yet been infected with.
Will vaccination be effective if I am over 27 years old?
Until recently, vaccination was not prescribed after 27 years of age, but not because it could negatively affect the body. The thing is that its effectiveness at this age has not been proven. That is, it was believed that by the age of 28 a person had already become familiar with the virus in one way or another, and there was no point in vaccination.
However, in 2021, the Food and Drug Administration (USA) approved vaccination against the papilloma virus for men and women over 27 years of age. The experience of Australia is also impressive, where they vaccinate all minors under 19 for free and recommend that all adults do it themselves at their own expense. Scientists believe that thanks to such universal vaccination, the number of cervical cancers will drop to 400 cases per year within 10 years, and after 50 years, the problem will be almost completely overcome.
So if you are over 27 years old and sexually active, the HPV vaccine is still an effective cancer prevention method.
Vaccinations during pregnancy and breastfeeding
Although animal experiments have shown the safety of the HPV vaccine (its use did not lead to developmental defects or pathologies in the offspring), given the lack of such data among humans, its use in pregnant and lactating women is not recommended. In addition, for any vaccines the rule applies: immunization must be completed no later than 2 months before the planned conception of the child.
If a woman becomes pregnant during the vaccination period, her doctor must be informed. This may require more careful monitoring of the pregnancy. A woman receives her next HPV vaccine after giving birth.
Immunization during breastfeeding is also not recommended because it is unknown whether the active components of the vaccine pass through breast milk. Children whose mothers received Gardasil during lactation were more susceptible to infectious diseases affecting the respiratory system.
What drugs are used to prevent HPV?
The following vaccines are used for preventive purposes:
- Cervarix, manufactured in Belgium;
- Gardasil, made in Holland.
Once in the body, they activate the immune system, which begins to synthesize specific antibodies that provide guaranteed lifelong protection of the body against the human papillomavirus. The preparations also contain aluminum hydroxide (an immune system stimulant), substances with antibacterial effects, preservatives and yeast particles.
Vaccinations are given intramuscularly in the shoulder or thigh. In order to develop stable immunity against papillomavirus, it is necessary to administer the vaccine three times. The second injection is given after one or two months after the first, and the third - after six months (permissible after 3-4 months).
