Committee Makes Official HPV Vaccine Recommendations

ATLANTA, March 16 -- The CDC's Advisory Committee on Immunization Practices has put its official stamp of approval on the wide use of the vaccine against four major strains of human papillomavirus that cause cervical cancer.

The vaccine was licensed by the FDA last June. At that time, the committee voted unanimously to recommend:

• That the vaccine be part of routine care for girls 11 and 12.
• The girls as young as nine could be vaccinated, if parents and health-care providers agree.
• That women and girls from the ages of 13 through 26 should have access to the vaccine as a "catch-up."
• The vaccine should be part of the federal Vaccines for Children program, which provides free vaccines for children who are uninsured, Medicaid recipients, Native Americans, or Alaska Natives.

This week, the committee formally made those recommendations official policy, in a statement in the Morbidity and Mortality Weekly Report.

The availability of the vaccine "offers an opportunity to decrease the burden of (human papillomavirus) infection and its sequelae, including cervical cancer precursors, cervical cancer, other anogenital cancers, and genital warts," the committee said.

The vaccine, manufactured by Merck, under the brand name Gardasil, targets four strains of HPV, including two that are thought to be responsible for 70% of all cervical cancer.

Another vaccine, which targets a wider variety of papillomavirus strains, is under development by GlaxoSmithKline, but it is not yet licensed.

The rationale for vaccinating girls aged 11 and 12 is based on epidemiological data suggesting that girls that age are, for the most part, not yet sexually active, but will acquire a papillomavirus soon after they become active.

"Ideally, (human papillomavirus) vaccine should be administered before sexual debut," the committee said.

On the other hand, young women ages 13 through 26 can also benefit from the vaccine, since even if they are sexually active, they are unlikely to be infected with all four of the papillomavirus strains in the vaccine.

The vaccine should be given in three injections of 0.5 mL, administered intramuscularly, preferably in the deltoid muscle, the committee said. The second and third vaccinations should come two and six months after the first.

The minimum interval between the first and second dose is four weeks, while the minimum interval between the subsequent doses should be at least 12 weeks.

The vaccine is not a live vaccine and can be given with other age-appropriate vaccines, such as meningococcal conjugate vaccines.

The committee noted that cervical cancer screening recommendations have not changed because -- although the vaccine targets are thought to be responsible for 70% of all cervical cancers -- other carcinogenic strains circulate and could cause disease.

The vaccine should not be used in girls under the age of nine, the committee said, nor in women older than 26.

The committee noted that the vaccine is contraindicated for anybody with a hypersensitivity to yeast or to any other vaccine component.

Physicians should also be alert to the possibility of syncope within a few minutes of vaccination and consider observing patients for about 15 minutes after vaccination.