Human Papilloma Virus Vaccine

1. Indications
   1. General indications
      1. Prevention of Cervical Dysplasia
      2. Prevention of anal cancer (receptive anal intercourse)
   2. Girls and women: Part of Primary Series
      1. Females routinely at age 12 and catch-up age <26 years
   3. Boys and men
      1. Not part of primary seeries for males
      2. FDA approved for for males aged 9 to 26
2. Mechanism
   1. Mixture of primary capsid proteins of 4 HPV types (Quadrivalent)
   2. Two low risk HPV types (but cause 90% of Genital Warts)
      1. HPV 6
      2. HPV 11
   3. Two high risk HPV types (cause 70% of Cervical Cancers)
      1. HPV 16
      2. HPV 18
3. Contraindications
   1. Pregnancy
   2. Anaphylaxis to yeast
4. Adverse Effects
   1. Local pain at injection site: 80%
   2. Local redness or swelling: 25%
   3. Fever
      1. Low grade in 10%
      2. Over 102 degrees in 1.4%
5. Efficacy
   1. Highest efficacy when administered prior to onset of sexual activity
6. Dosings
   1. Intramuscular Injection
   2. Schedule: 0, 2, and 6 months
7. Cost
   1. Three doses: $440 (covered by most U.S. insurance plans)
8. References
   1. Goeser (2007) Am Fam Physician 76:573-4
   2. Villa (2005) Lancet Oncol 6:271-8