Guidance

HPV universal vaccination information for health professionals from September 2023

Updated 20 June 2023

Applies to England

About the HPV vaccination

The HPV vaccine has been used in the UK since 2008 and more than 10 million doses have been given. It’s used in over 80 countries including the USA, Australia, Canada, and most of Western Europe, and more than 80 million people have been vaccinated worldwide.

In 2022 the HPV vaccine changed from Gardasil to Gardasil® 9 and this HPV vaccine is also given in several other countries.

The vast majority of parents choose to accept the HPV vaccine for their children. Most women aged 15 to 27 years in England have now been given the vaccine.

Vaccination age

The best time to be vaccinated is between 12 and 14 years of age. Vaccination at a younger age is more effective at preventing HPV infection, there are no benefits to delaying vaccination. Ideally the vaccination should be given before becoming sexually active as HPV can spread by skin to skin contact. Condoms do not completely prevent the risk of infection.

Evidence of HPV vaccine efficacy

In England, we have already seen a significant decrease in infections with the 2 main HPV types that can cause cancer (types 16 and 18).We have also shown declines – probably due to cross-protection – in 3 other HPV types linked to cancer (types 31, 33 and 45).

We expect to see even greater declines in these types (and types 52 and 58) following the implementation of Gardasil® 9.

The number of precancerous lesions in the cervix has already fallen by over 70% since the programme began in Scotland. We have also seen large declines in the number of genital warts in young people.

A study published in The Lancet in 2021 found that cervical cancer rates in England were 87% lower in young women who had been eligible for HPV vaccination when they were aged 12 to 13 years, compared to similar young women born a few years earlier who had not been offered vaccination, clearly showing the programme is preventing cervical cancers.

Side effects from the HPV vaccine

To date, the number of reports to the Medicines and Healthcare Products Regulatory Agency (MHRA) of suspected side effects for HPV vaccines is not unusual. The overwhelming majority relate to mild conditions commonly seen when you vaccinate teenagers (for example injection site reactions such as redness, pain, swelling; headache, nausea, fatigue; immediate faints due to needle phobia).

The UK programme has already contributed to preventing deaths from cervical cancer. We expect prevent hundreds of deaths every year.

HPV vaccination and premature ovarian failure

Premature ovarian failure is rare but occurs naturally in adolescent girls. The number of cases reported does not exceed what might be expected in the absence of vaccination.

The vaccine and chronic or long term illness

There is no evidence that the HPV vaccine can cause any long term or chronic conditions to develop. When large numbers of people are vaccinated, it’s not surprising that some people go on to develop illnesses some time after vaccination – that does not mean that the vaccine caused the illness.

It’s easy to understand why the family might blame the vaccine, particularly if the onset of illness is poorly defined. In 2016, Danish researchers showed that girls who reported

illnesses from the HPV vaccine were more likely to have seen the doctor in the period before vaccination. This suggests that some of these conditions may have already been developing before vaccination.

A number of authorities, including the Centers for Disease Control and Prevention (CDC) in the USA, the World Health Organization (WHO), and the European Medicines Agency (EMA) have looked carefully at all the cases that have been reported and concluded that there is no credible evidence of a link between HPV vaccine and a range of chronic illnesses.

In 2013, the MHRA conducted a large study in the UK which showed no link between HPV vaccine and illnesses such as chronic fatigue syndrome and fibromyalgia.

Over the past few years several studies based in different countries have found no evidence of a link between the HPV vaccine and a range of serious and chronic illnesses (see below).

Extensive reviews of vaccine safety have concluded that evidence does not support a link between HPV vaccine and the development of a range of chronic illnesses.

Illnesses reported in the HPV vaccine product insert.

Although the US package insert lists a range of reported illnesses, these are included regardless of any established link with the vaccine. Similarly, in the spirit of openness, the EU product insert also mentions conditions reported after vaccination across the world – even in isolated cases – but this does not mean that the vaccine was responsible.

Any suspected side effects from the vaccine, can be reported on the Yellow Card website or by calling 0800 731 6789 (9am to 5pm Monday to Friday) or by downloading the Yellow Card app.

Further information

HPV Collection

NHS website

The HPV vaccine: beating cervical cancer

Jo’s Trust

References

1. Vichnin M and others. An Overview of Quadrivalent Human Papillomavirus Vaccine Safety: 2006 to 2015. Pediatric Infectious Disease Journal. 2015 Sep;34(9):983-91.

2. Grimaldi-Bensouda L and others. Autoimmune disorders and quadrivalent human papillomavirus vaccination of young female subjects. Journal of Internal Medicine. 2014 Apr;275(4):398-408.

3. Pellegrino P and others. On the relationship between human papilloma virus vaccine and autoimmune diseases. Autoimmunity Reviews. 2014 Jul;13(7):736-741

4. Klein NP and others. Safety of quadrivalent human papillomavirus vaccine administered routinely to females. Archives of Pediatrics and Adolescent Medicine. 2012 Dec;166(12):1140-8.

5. Donegan K and others. Bivalent human papillomavirus vaccine and the risk of fatigue syndromes in girls in the UK. Vaccine. 2013 Oct 9;31(43):4961-7.

6. Gee J and others. Monitoring the safety of quadrivalent human papillomavirus vaccine: findings from the Vaccine Safety Datalink. Vaccine. 2011 Oct 26;29(46):8279-84.

7. Cameron RL and others. Adverse event monitoring of the human papillomavirus vaccines in Scotland. Journal of Internal Medicine. 2016 Apr;46(4):452-7.

8. Arnheim-Dahlström L and others. Autoimmune, neurological, and venous thromboembolic adverse events after immunisation of adolescent girls with quadrivalent human papillomavirus vaccine in Denmark and Sweden: cohort study. BMJ. 2013 Oct 9;347:f5906.