HPV vaccine for children and adolescents

Question 1

How is HPV transmitted?

Answer 1

• transmitted sexually by direct epithelial to epiethlial contact
  
  • rarely transmitted vertically to infant exposed in maternal genital tract —> can lead to “juvenile-onset recurrent respiratory papillomatosis “

Question 2

What are the clinical manifestations of HPV?

Answer 2

• asymptomatic (most common)
• warts
• low risk HPV types are associated with development of nonmalignant cervical dysplasia and anal/genital warts
• HPV 6 and 11 cause 90% of genital warts
• malignancies (vulva, vagina, penis, anus, mouth, oropharynx)
• presence of HPV necessary for development of cervical cancer but infection must persist for yrs before lesions become malignant
• HPV 16 and 18 associated with malignancy

Question 3

What is the lifetime cumulative incidence of HPV?

Answer 3

> 70%

highest prevalence in 20-24 yrs

Question 4

What are risk factors for HPV infection?

Answer 4

• higher lifetime number of sexual partners
• partner’s number of lifetime sexual partners
• early age of first sexual intercourse
• previous other STIs
• hx of sexual abuse
• tobacco or marijuana use
• immune suppression
• HIV

Question 5

What is the coverage of the HPV9 vaccine?

Answer 5

90% of genital warts
85-90% of anogenital cancers

if vaccine is administered before exposure to targeted HPV types, efficacy is close to 100% against type-specific cervical disease

Question 6

What is HPV vaccine not associated with? (as listed in statement)

Answer 6

Guillain barre syndrome
autoimmune disease
ADEM
MS
stroke
venous thromboembolism
other serious health condition

Question 7

When should HPV-9 be administered routinely?

Answer 7

9-13 years

give as early as provincial/territorial programs allow to increase likelihood that it is given before onset of sexual activity

Question 8

How many doses of HPV?

Answer 8

• 2 doses for children 9-14 yrs, and given at least 6 months apart

Immunocompromised: 3 doses

Question 9

How many doses of HPV-9?

What if they already had HPV2 or HPV4?

Answer 9

Regardless of HPV 2 or HPV 4 administration:

• 9-14 years of age: 2 doses at least 6 months apart
• > = 15 years: 3 doses