Questions from Readers: HPV Vaccine

Vicky asks:  
I am already seven months after 25, which means I can only get two shots of HPV vaccine before 26. Does the cut off age 26 means finishing all three doses before 26? Thank you!

The answer depends on your insurance company’s policies. Some, but not all, insurance companies will pay for the all three vaccinations if you start before you turn 27.  Check with your insurance company.

Kry asks:  
I’ve taken my Cervarix jab and recently found that it’s only protecting me against 2 types of infections. Do I need to take Gardasil to get protected from all 4 types? Please advise.

If you’ve had all 3 of the Cervarix shots then you are fully protected against the HPV types that cause cervical cancer.  There is no need, and in fact it isn’t recommended, to also get the other brand of immunization.

Johana asks:  
I’ve missed the 3rd shot cause of my pregnancy, it already passed a year or so….do I have to start it over from the beginning??

Congratulations on your new baby.  You can go ahead and get the third shot of your HPV vaccine now. No need to start from the beginning.  You should still get most of the effect of the vaccine even though you didn’t get the third shot on time.  And you will get better protection than if you never get the third shot.

Monz asks:  
Hello, I wanted to know if a 25 year old female has been diagnosed with mild dysplasia, can she still get the vaccine Cervarix? … and will it protect her against cervical/vaginal cancer before it happens?

Yes, a 25 year old who has been exposed to one type of HPV (the reason for the mild dysplasia) is still a candidate for cervical cancer vaccination.  There’s a good chance that you haven’t been exposed to both HPV types that Cervarix protects against and that you would get protection against that HPV type with vaccination. The vaccines will protect you against getting two types of HPV that cause 70% of cervical cancer. Talk to you doctor about getting the vaccine. The cut-off age in the US is 26, so you don’t have a lot of time left.

Mariah asks:  
I am 15 years old and I was wondering if I could still get the shots if I have had sex?.. I heard you are supposed to get it before u have sex but it’s too late for that so I just want to know, thanks

Ideally, females should get vaccinated before they become sexually active. This is because the vaccines are most effective in girls/women who have not yet been exposed to the types of HPV covered by the vaccines. Girls/women who have not been exposed or infected with these types get the full benefit of the vaccine. However, if you are already sexually active, you may also benefit from the vaccines. It is unlikely that you have been exposed to all the HPV types that the vaccines protect against. So you are likely to get some protection but you may not get as much protection as someone who had the shot before they were exposed to HPV.

CS asks:  
I had my first shot in August and I totally forgot to go back and get my second shot. Therefore, I’m overdue. Is the first shot still effective?

Not everyone gets their HPV shots according to the recommended schedule.   The first shot gives you some protection, but not as much as when you have all three shots. There does not appear to be a reduced effectiveness in those who get the 2nd and 3rd doses at a later time.  Call your doctor’s office to reschedule as soon as possible.

Lea asks:  
I had my 1st and 2nd injection of Gardasil. Is it ok if my 3rd injection is Cervarix? My doctor doesn’t have a stock of Gardasil.

The Federal Advisory Committee on Immunization Practices (ACIP) recommends continuing the 3-shot series with the vaccine with which you first started. However, it is permissible to finish with the other vaccine when the first one isn’t available or is unknown. You should get the same level of protection.

Julie asks:  
I’m due for my 2nd shot of HPV. However, I still have a cold and cough.  Is it okay to continue with my scheduled shot? Thanks

There is no contraindication to getting your HPV shot because you have a cold.  But we all know that colds and infections are tough on the immune system and our bodies.  Just to make it easier on yourself, you might consider delaying your second shot a few weeks so you can get the shot when your immune system is not fighting any infections. Bottom line: it’s slightly better to wait until the cold is over, but it is okay to get the shot even if you have a cold.

Steph asks:  
I have recently visited the doctor to get my first shot. This month I’m going to get the second dose. I have had unprotected sex, but he pulled out before anything. Am I still exposed…and will the shot still help me prevent HPV???

The vaccines give the best protection if they are given before you have any sexual  contact. Since you have had the first shot, you should already have some protection against certain types of HPV infection. However, you will have less protection than if you have had all three shots before you engaged in sexual activity.  You may or may not already be infected. HPV is spread very easily. It can be spread even without intercourse and it is often spread in the first several sexual encounters.  You should plan to get the second and third shots on schedule.  They will offer you still more prevention protection against HPV infection than you have with just the one shot. Good luck to you.

Selena asks:  
I am 44 years old. Would it be beneficial to take the vaccine? If so, which shall I take, Gardasil or Cervarix? Or, it offers no protection since I am of this age group?

In many countries, including the United States, the vaccine is not approved for use in all age groups.  Generally, the age cap is over 26 years of age. The studies to see if it works in women in the over 26 age groups are ongoing.  As more data becomes available, these recommendations might change.  You should discuss your individual risks and benefits for use of an HPV vaccine outside of recommendations with your healthcare provider. He or she can also advise you on which vaccine to get.

Lisa asks:  
I have had a wart on my foot for several years now. I didn’t know that plantar warts were caused by a strain of HPV until after I received the Gardasil treatment. Will the vaccine still work?

There are about 100 different types of HPV that cause different diseases.  Some cause plantar warts like you have. Some HPV types cause different types of warts that affect the genitals. These are called genital warts. Other types of HPV cause cervical cancer. The HPV or Cervical Cancer Vaccines, Gardasil© and Cervarix©, protect against certain types of HPV, not all types of HPV. The vaccine that you have had,  Gardasil©, protects against 4 types of HPV: 16 and 18 that cause 70% of cervical cancer and 6 and 11 that cause about 90% of genital warts. Gardasil© does not protect against plantar warts. So, your vaccination does not affect your plantar warts. However, if you haven’t been exposed previously to HPV types 16 or 18 or 11 or 6, the vaccine will provide you protection against these types.

Smiley asks:  
I was diagnosed with adenocarcinoma when I was pregnant. I had a hysterectomy after delivery. I am HPV neg. everyone always asked if they should get the shot & would it have helped me? Am I correct in saying that it would not have helped me, that it prevents HPV or did I understand wrong. It was a stressful time.

You are right in saying that the HPV or Cervical Cancer Vaccines are designed to prevent HPV infection, not to treat infections that have already occurred.  Therefore, getting the vaccine after you’d already been diagnosed with adenocarcinoma would not have helped you with that infection. However, if you are in the age group eligible for the vaccine (9-26 in the US) and you haven’t been exposed to all the types of HPV that the vaccines protect against, then you might have gotten protection against additional cervical infections. These are questions to ask your doctor about.  Good luck to you and remember to keep your regular appointments.

Sophia asks:  
I have had my 3rd cervical cancer jab but I was on my period. Is that a problem?

The vaccines are given over 3 visits: the first visit, then in about 2 months, and the last one at 6 months from the first.  You can still safely get the shot when you are having your period.

Maria asks:  
Hi, I had the LEEP done 1 month ago. Is it advisable to get the vaccination for HPV after the LEEP?

There are a number of factors that will help answer your question. First, your age. The vaccines are recommended in the US for women ages 9-26. Second, your sexual history.  The more sexual partners you’ve had and the earlier you initiated having sex, the more likely you are to have been exposed to the types of HPV that the vaccines protect against.  The vaccines prevent getting certain types of HPV. But if you already have the HPV, the vaccine does not clear the virus and getting the vaccine will not be very effective for you. Please talk to your healthcare provider about this question. Together you can decide whether getting vaccinated is right for you.

Ericson asks:  
If you missed the exact schedule for the third dose of HPV vaccine like a week after or a month will it still be effective? And how long it must be to reschedule?

You should try to do your best to get the shot on time. However, if you do not get it on time, there does not appear to be a reduced response in those who get the 2nd and 3rddoses at a later time.  Call your doctor’s office to reschedule as soon as possible.

Koel Sen asks:  
Am 23 years old. Recently I developed Genital Warts that I am treating. My query is-since I have already got Genital Warts should I be taking a vaccine (Gardasil)against both, cancer and warts or Cervarix that prevents only cancer? Will a vaccine against some strains of warts prevent them from recurring?

There are two vaccines to prevent getting certain types of HPV.  Cervarix protects against two HPV types that prevent infection by 2 HPV strains that cause 70% of cervical cancer cases. Gardasil protects against 4 types of HPV including 2 strains that cause genital warts plus the same 2 strains that cause most of the cases of cervical cancer. But if you already have the HPV, the vaccine does not clear the virus and getting the vaccine will not be very effective for you. Please talk to your healthcare provider about this question. Together you can decide whether getting vaccinated is right for you and if so, which vaccine you should have.

Bhavana asks:  
Hi! I have taken one shot of the vaccination but wish to discontinue for some personal reasons. Can I do that or does it have any repercussions or side effects if you leave the course in between. Thanks.

The vaccines are designed to be given in 3 doses to get the most protection against future HPV infections. If you miss the recommended time for the second or third dose, get the next dose as soon as convenient. You will likely still get all or most of the same protection that you would have gotten had you followed the recommended schedule. But if you do not get the second or third dose ever, then you will not get the full protection against HPV. You will have some protection but less than is recommended.

Linda asks:  
I’ve had complete Cervarix shots while I was sexually active. Can I still get vaccinated with Gardasil to be protected against other types of HPV?

It is not recommended you get both vaccinations.

Meena asks:  
Hi there, My daughter had her first HPV vaccine on 19th Nov 2009 and then the second vaccine on the 22nd Dec 2009. She will be getting the third vaccine on the 25th June. Will this still be effective? I would really appreciate your response. Regards, Meena.

As you’ve noted, the recommended schedule for the HPV or cervical cancer vaccines is at month 1 for the first dose, dose 2 about 2 months later and then dose 3 at 6 months after the first dose.  If there is some variation in this schedule, your daughter is still likely to get the full or nearly full protection afforded by the vaccine.  You are to be congratulated for making sure that she gets all 3 doses. Getting all 3 doses provides greater protection than merely getting one or two doses.  A small variation in the schedule happens frequently to all of us busy people.

Roberta asks: 
How precisely do you have to comply with the timing of the 2nd and 3rdshots?  Does it matter if I get the second shot a week or two before the recommended time?  Would it hurt to wait two or three months to get a follow up shot if I can’t get to the doctor at the exact time?

You should try to do your best to get the shot on time. However, if you do not get it on time, there does not appear to be a reduced response (non-inferiority) in those who get the 2nd and 3rd doses delayed.

Rachel asks:  
I had my first shot last June 6, 2009. My OBGYN injected it on my right butt. I just read in your publication that it should be administered either in the arm or thigh. Is that a problem?

No- but it probably hurt :-)

Sabah asks:  
Will the vaccinations have any side effects in the future. Also after a set number of years will l have to redo any vaccinations?

Studies show that the vaccine is extremely safe. There is no live virus in the vaccine. The most common side effects that occur right after receiving the injection are redness and soreness where the shot was given. Headaches (like when you have a cold or fever) can also happen. Rarely, fever can also occur. Over-the-counter pain and fever medications will help if you have symptoms. As with any new vaccine, the Centers for Disease Control and Prevention and the FDA will continue to monitor HPV vaccination for long term effects.  One of the questions that they will be looking to answer is the same one you’ve asked, that is, how long will this vaccination last and will a booster be needed in future years.  After seven years of research, the efficacy of the vaccine appears to be lasting.                                                             

Cristina asks:  
Is it safe to have the cervical cancer vaccine if I’ve had a vaccine like the pneumococcal vaccine recently?  Do I have to wait to get it?

From what we know from studies conducted on the cervical cancer vaccine so far, it appears to be safe to get the cervical cancer vaccine along with other vaccines (co-administration).  Long term studies will continue.

Jane asks:  
Are there any side effects to the HPV vaccine?

Studies show that the vaccine is extremely safe. There is no live virus in the vaccine. The most common side effects are redness and soreness where the shot was given. Headaches (like when you have a cold or fever) can also happen. Rarely, fever can also occur. Over-the-counter pain and fever medications will help if you have symptoms. As with any new medication, safety issues will continue to be monitored by the Centers for Disease Control and Prevention and the FDA.  While there are rare reports of girls or young women having complications after getting the vaccine, to date, this has not affected recommendations or approval for use of the vaccine.

Tanya asks:  
Is there any vaccination for those who have already been infected by HPV?

You ask whether the HPV vaccine can be given to someone who has already been diagnosed with HPV. The answer is yes, maybe.  The only vaccine currently available is Gardasil. It protects against 4 different strains of HPV; two that cause cervical cancer and two that cause genital warts. So if someone has had one of the HPV strains, but not the others, the vaccine may still offer protection against the ones that that person hasn’t already had. The vaccine does not cure existing HPV infections, it is not designed or meant to be a ‘therapeutic’ vaccine.  Such vaccines are currently in clinical trials.  It is also important to remember that there are age restrictions currently for the vaccine. It has been approved for women ages 9-26. So if you are older than that your insurance generally will not pay for the vaccine. There is a three dose series costing approximately $360 for the drug plus an administration fee for each dose. Most insurance plans are currently covering it.  Your best bet is to discuss your situation with your healthcare provider before you decide to get the vaccine.

Maureen asks:  
Do you know why older women cannot get the HPV vaccine, even if they have taken the HPV test and results show they do not have any of the cancer causing HPV virus types?

Gardasil, the only vaccine currently in the US market, was approved in June 2006 in the US by the Food and Drug Administration for girls and women between the ages of 9 and 26 and has been recommended by many organizations for routine use in 11 and 12 year old girls.  The vaccine is not approved for women over age 26 in the US.  As more data is generated on clinical trials, this may change.

Beverly asks:  
Is it true that some women diagnosed with HPV can also get the vaccine to prevent them from getting other strains?

Yes, it is true that women who have been exposed to HPV may still get some benefit from the cervical cancer vaccine.  The maximum benefit is achieved when the vaccine is administered prior to any HPV exposure.  The vaccine is approved for women between the ages of 9 and 26.

Rachel asks:  
I would like to start the 3-series vaccination for my 15 year-old daughter. My insurance does not cover the cost; and my primary physician quoted me $150 per shot – $450 total. This sounds extremely high to me. Are there places that offer this service cheaper? What is a reasonable amount to pay?

Your 15 year-old daughter may be eligible for the vaccine under the federally funded Vaccines for Children Program depending on your family income. Most local health departments utilize this program to pay for children’s vaccines. I would suggest that you contact your local health department and ask them if they offer the vaccine on a sliding fee scale.  I applaud you on taking the preventive step of getting your daughter vaccinated.

Monica asks:  
My daughter has been recommended for the vaccine against cervical cancer. Will the injection make her get her periods sooner? Would it in any way cause her menstrual problems?  She hasn’t started menses yet?

You asked about the cervical cancer vaccine. The vaccine is recommended for young girls to prevent HPV infection. It works best when given before a girl or woman has had any exposure to the HPV virus, which is transmitted through sexual contact. The vaccine has no effect on menses or her menstrual periods. It should neither hasten nor delay menses. What is does is to establish protection so that any HPV your daughter may be exposed to at some point in her future will not have an opportunity to invade the cells of her cervix and start to cause the cervical changes that can lead to cancer. It has been approved by the US Food and Drug Administration. It is recommended in many countries and by many physician organizations and by the Centers for Disease Control and Prevention (CDC).


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