UPDATED RECOMMENDATIONS FOR THE USE OF A TWO DOSE SCHEDULE FOR HUMAN PAPILLOMA VIRUS VACCINATION
Stanley A Gall , MD
A
vaccine against human papilloma virus ( HPV ) was approved by the Food and Drug Administration ( FDA ) in 2006 and recommended by the Advisory Committee on Immunizations Practice ( ACIP ) for the prevention of cervical cancers and genital warts in 2006 . Routine vaccinations at ages 11-12 were recommended initially for females in 2006 and for males since 2011 ( 1 , 2 ). The recommended 3-dose schedule was for administration of vaccine at 0 , 1 and 6 months . The updated recommendation is for use of a 2-dose schedule for girls and boys who initiate the vaccination series at ages 9-14 years and is administered at 0 and 6-12 months ’ schedule . The 3-dose vaccine schedule remains in effect for persons who initiate the vaccination series at age 15 through 26 years and for immunocompromised persons .
HPV infection causes cervical , vaginal and vulvar cancers in women , penile cancers in men , and oropharyngeal and anal cancers and genital warts in both men and women . It has been found in other cancers as well , with ongoing research . Three HPV vaccines are currently licensed in the US . HPV-4 and HPV-9 ( Gardasil 4 , Gardasil 9 ) are licensed for females and males ages 9 through 26 years . HPV vaccine ( HPV-2 ) Cervarix is licensed for use in females ages 9 through 26 years . As of late 2016 , only Gardasil -9 ( 9v HPV ) is being distributed in the U . S . 9 v HPV vaccine contains the oncogenic HPV types 16 , 18 , 31 , 33 , 45 , 52 , 58 and the non-oncogenic types 6 and 11 . ( 1 ) ( 2 )
A recent study was reported to determine whether a 2-dose schedule ( 0 , -6-12 months ) was equivalent to the 3-dose schedule ( 0,1,6-12 months ) using two doses of 9 v HPV , 4 v HPV or 2 v HPV in persons 9 through 14 years and compared to clinical endpoints demonstrated in clinical trials using the 3-dose regimen . ( 3 ) Immunogenicity outcomes studied were sero-conversion , geometric mean titers ( GMT ) or antibody avidity .
There were 1,377 participants in the study and the seroconversion to all nine HPV types was 97.9 percent by four weeks after the last dose of vaccine . For persons who received two doses ( 0 , 6-12 months ) compared to those receiving the three doses ( 0 , 1 , 6-12 months ) the results were similar for sero-conversions and
GMT . Interestingly , GMTs were significantly greater for the 9-14 years and subjects receiving the 2-dose schedules compared to the persons 16-26 receiving the 3-dose regimen .
The ACIP recommends routine HPV vaccinations at ages 11-12 , but this vaccine can be initiated at age 9 , for females through age 26 , and for males through age 21 . The ACIP recommends HPV vaccination in males who have sex with men through age 26 . ( 4 )
For persons who are vaccinated prior to their 15 th birthday , they should receive an additional two doses of vaccine ( 0 , 6-12 months ). After the 15 th birthday , the three dose schedule should be followed ( 0 , 1 , and 6-12 months ).
For persons who initiated vaccinations before their 15 th birthday , they should receive two doses of any HPV vaccine at 0 , 1 , 6-12 month schedule . 9 v HPV may be used to continue or complete a vaccination series started with 4 v HPV or 2 v HPV .
If a vaccine schedule has been interrupted , the series does not need to be restarted . ACIP recommends the 3-dose series of HPV vaccine for males and females ages 9-26 with primary or secondary immuno compromised conditions .
Contraindications and precautions including those related to pregnancy are unchanged from previous recommendations ( 1 ) ( 2 ).
Dr . Gall practices obstetrics , gynecology and women ’ s health as part of the University of Louisville Physicians Group .
BIBLIOGRAPHY
1 . Markovitz LE , Dunne EE , Saraiya . M etal Human papilloma virus vaccination : recommendations of the Advisory Committee on Immunization Practices ( ACIP ) MMWR Recomm Rep 2014 ; 63 : ( RR-05 )
2 . Petrosky E , Bocchini ; JA Jr , Hatiri S , etal : Use of 9-Valent human papillomaviruses ( HPV ) Vaccine : Updated HPV vaccination recommendations of the Advisory Committee on Immunization Practices . MMWR Morb Mort Wkly Rep 2015 ; 64 : 300-304 .
3 . Iverson O , Mirande MI , Llied A . etal : Immunogenicity of 9 Valent HPV Vaccine using 2 dose regimens in girls and boys vs a 3 dose regimen in women JAMA 2016 ; 316 : 2411-2421
4 . Use of a 2 dose Schedule for Human Papilloma Vaccinations – updated recommendations of the Advisory Committee on Immunization Practices MMWR 2016 ; 65 : 1405-1408
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