Brook position statement - HPV vaccination

Brook supports HPV vaccination of young people at school before they become sexually active but believes that young men should also be offered the vaccine.    There is no evidence that vaccination encourages young people to become sexually active earlier.

Brook’s Position on the Human Papillomavirus Vaccination

Brook supports the Human Papillomavirus (HPV) vaccination programme and encourages all young women to take up the vaccination.

Ideally young people should be given the vaccination before they become sexually active and are exposed to HPV.   It is estimated that at least 10% of young women already have HPV by the age of 16(1).   For this reason Brook supports vaccinating young people at school.    There is no reason to believe that this will encourage them to become sexually active earlier.   

Brook welcomes the decision by the Department of Health to use Gardasil in the national HPV vaccination programme from September 2012(2).    Gardasil protects against cervical cancer and genital warts which are the second most frequently diagnosed sexually transmitted infection amongst people under 25 in the UK(3).    Cervarix, the current vaccine used in the programme, only protects against cervical cancer.

Brook believes that young men should be included in the HPV vaccination programme and should be offered a vaccination that prevents the types of HPV that cause genital warts. 

Brook believes that there is a benefit to vaccinating women over 18 if they wish, even if they have been sexually active.    Brook believes that there is a place for its centres to provide vaccinations to provide greater choice for young people.

Brook believes that parents should not be able to prevent a child from being given the HPV vaccination if the child wants it.  Currently consent from a parent or guardian is needed for girls under 16.   However, young women, including those under 16 are legally able to consent for themselves if they understand the implications of the decision they are making.

Brook believes that all young people have the right to choose their own medical treatment in accord with the UN Convention on the Rights of the Child.

Brook believes young people should be given information and education about HPV before they are vaccinated so that they can make informed choices and take care of their bodies.

Women who have been vaccinated are not protected against all types of HPV. Brook believes that cervical smear tests are still extremely important and women should not regard the HPV vaccination as an alternative.

Brook believes that health professionals should be reminded how to recognise symptoms in the very small number of young women who develop lesions and should be able to offer a cervical smear test to women under 25 if there are clinical reasons for doing so.

Brook encourages young women to take good care of their sexual health, to understand their bodies and to ask for help from health professionals if they are worried. 

Human Papillomavirus (HPV) Vaccine Background Information

The national HPV vaccination programme was introduced in September 2008. All 12-13 year-old girls (school year 8) are being vaccinated. A three-year catch up programme also offered the HPV vaccine to 13-18 year old girls.

The Joint Committee for Vaccination and Immunisation discussed the vaccination of boys as well as girls, but decided that it would not be cost effective in preventing cervical cancer.

For women to be protected three vaccinations are needed over a six month period. High levels of protection have been shown for at least six years in follow-up studies. Longer lasting protection is expected as antibody levels in vaccinated women have remained very high.

Cervarix, the HPV vaccine manufactured by GlaxoSmithKline, was originally selected for the NHS HPV vaccination programme. It protects against HPV types 16 and 18 which are responsible for 70% of cervical cancers.    

From September 2012 Gardasil, developed by Merck, will be the vaccine that is offered.  Gardasil protects against HPV types 16 and 18 and also HPV types 6 and 11 that cause 90% of genital warts.   

In clinical trials, both vaccines were found to be over 99% effective at preventing pre-cancerous lesions associated with HPV types 16 or 18 in young women(4). 

Gardasil is in particular demand among gay men, who are at significantly increased risk for genital warts, penile cancer, and anal cancer(5).

Information about HPV

There are over 100 types of Human Papillomavirus (HPV). Only 13 of them are known to cause cancer. The others are classed as low risk and cause genital warts, other warts and verrucas or have no symptoms.

HPV infection is very common and causes no symptoms in three quarters of infected people. In most individuals the immune system will clear an HPV infection within two years.

Around 40 types of HPV affect the genital area. They are transmitted through sexual contact (including skin-to-skin genital contact) with someone else who has the virus. Because condoms do not cover the entire genital area they can only provide partial protection against HPV.

Some types of high risk HPV (mainly 16 and 18) can infect the cells of the surface of the cervix where it can stay for many years without a woman being aware of it. The HPV virus can damage these cells leading to changes in their appearance. Over time, these changes can develop into cervical cancer which is the twelfth most common cancer affecting women in the UK.

References

1 ‘10% of women infected with human papillomavirus by age 16’, Health Protection Agency Press Release, 19 September 2007
2 Department of Health press release: HPV vaccine to change in September 2012, November 24, 2011 
3 Selected STI diagnoses made at GUM clinics in England: 2006-2010, Health Protection Agency, 2011
4 Harper et al., 2006; Ault et al., 2007 cited in  The ‘Green Book’ chapter on Human papillomavirus (HPV), Department of Health, 2008
5 ‘Gay men seeking HPV vaccine’, Cancer Research UK, 23 February  2007 (http://info.cancerresearch.org)

Publication date: November 2011