Download Human Papilloma Virus 2017

Kenneth McCall, BSPharm, PharmD, BCGP
Associate Professor | UNE
Immunization Update:
Maine Pharmacy Association
April 2017
October 13-15, 2017
Portland, Maine
HPV Overview
 Nonenveloped, double-stranded DNA virus1; necessary cause
of cervical cancer.2
 More than 100 types of HPV viruses identified; 30 to 40 infect the
anogenital tract.3,4
– HPV 16 and 18 account for ~70% of cervical cancers worldwide.5
– HPV 16 and 18 are also associated with precancerous lesions.6
1. Howley PM. In: Fields BN et al, eds. Fundamental Virology. Lippincott-Raven;1996:2045–2076. 2. Walboomers JM et al. J Pathol. 1999;189:12–19.
3. Schiffman M et al. Arch Pathol Lab Med. 2003;127:930–934. 4. Wiley DJ et al. Clin Infect Dis. 2002;35(Suppl 2):S210–S224. 5. Dunne EF et al. JAMA.
2007;297:813–819. 6. Clifford GM et al. Br J Cancer. 2003;89:101–105.
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What percentage of people in the US will be
infected with HPV in their lifetime?
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1. 80%
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2. 60%
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3. 40%
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4. 20%
Natural History of High-Risk HPV
Infection and Potential Progression
to Cervical Cancer1
~1 Year
Transient
Infection
HPV Infection
2–5 Years
Persistent
Infection
Low-Grade
Dysplasia
CIN 1
4–5
Years
High-Grade
Dysplasia
CIN 2/3
9–15
Years
>2 Years
Invasive
Cancer
CIN = cervical intraepithelial neoplasia.
1. Reprinted from Pagliusi SR, Aguado MT. Vaccine. 2004;23:569–578. Copyright© 2004, with permission from Elsevier.
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Healthy People 2020 goal is 80%
What is the Healthy People 2020 HPV
vaccination goal for female adolescents?
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1. 40%
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2. 60%
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3. 80%
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4. 100%
Recent HPV Vaccine News
 FDA approved
Gardasil 9 in December, 2014.
 Cervarix withdrawn from US Market in
October, 2016, due to low sales.
 CDC recommends HPV vaccine 2-dose
schedule for certain patients, December,
2016.
Meites E, Kempe A, Markowitz LE. Use of a 2-Dose Schedule for Human Papillomavirus Vaccination —
Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2016;65:1405–1408.
HPV Vaccine Recommendations
POPULATION
# OF HPV
DOSES
INTERVAL
Persons initiating HPV vaccine at
ages 9 through 14 years, except
immune-compromised persons
2
0, 6-12
months*
Persons initiating HPV vaccine at
ages 15 through 26 years and
immuno-compromised persons
initiating HPV vaccine at ages 9
through 26 years
3
0, 1-2, 6
months**
*In a 2-dose schedule of HPV vaccine, the minimum interval between the first and
second doses is 5 months.
** In a 3-dose schedule of HPV vaccine, the minimum intervals are 4 weeks between
the first and second doses, 12 weeks between the second and third doses, and 5 months
between the first and third doses.
Human Papillomavirus (HPV) vaccination
 HPV vaccines are not live vaccines and can be
administered to persons who are immunocompromised as a result of infection (including HIV
infection), disease, or medications.
 HPV vaccine can be administered to persons with a
history of genital warts, abnormal Papanicolaou test,
or positive HPV DNA test.
What is the routine schedule for the
HPV vaccine for an 18-year old?
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1. 0, 1-2, 6 months
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2. 0, 2-4, 12 months
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3. 0 and 6 months
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4. 0 and 2 months
A patient misses the 3nd dose of the HPV vaccine
series by a month. What is the best option?
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1. The HPV vaccine is no longer indicated.
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2. Give 3rd dose now to complete series.
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3. Repeat the second dose.
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4. Restart the series with the first dose.
A patient who has begun the HPV vaccine series
becomes pregnant. What should be done?
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1. The HPV vaccine is no longer indicated.
2. The next dose should be delayed until the
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3rd trimester.
3. The next dose should be delayed until aft
pregnancy.
4. The patient should complete the series on
an accelerated schedule.
Administration
 Gardasil®
 IM - deltoid
 1 inch, 25 gauge needle
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Storage
 Refrigeration at 36 to 46 F
 Do not Freeze
 Administer as soon as possible – total time out of
fridge should not exceed 72 hours
The mother of a 12-year-old boy requests the HPV
vaccination. Select the correct vaccine and series.
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 Gardasil®: 3 dose series
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 Cervarix®: 3 dose series
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 Gardasil®: 2 dose series
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 Cervarix®: 2 dose series
The mother of a 12-year-old boy who has a history of cancer
and B lymphocyte antibody deficiency requests the HPV
vaccination. Select the correct vaccine and series.
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 Gardasil®: 3 dose series
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 Cervarix®: 3 dose series
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 Gardasil®: 2 dose series
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 Cervarix®: 2 dose series
An 18-year-old man requests the HPV vaccine. He has no
contraindications. Select the correct vaccine and series.
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 Gardasil®: 3 dose series
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 Cervarix®: 3 dose series
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 Gardasil®: 2 dose series
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 Cervarix®: 2 dose series
A 12-year-old girl needs to start the HPV vaccine series and she
also needs a Tdap booster. Which of the following statements
about the administration of HPV and Tdap vaccines is true?
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1. Same day, opposite arm, separate syringe
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2. Same day, same arm, mixed in 1 syringe
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3. Must be separated by at least 7 days
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4. Must be separated by at least 4 weeks