HPV Human Papillomavirus & Vaccinations (BT)This is a featured page

This page lists research, reports and resources that describe the HPV virus and HPV vaccinations as an intervention to prevent cervical cancer and a wide spread sexually transmitted infection. This rough draft was posted on November 7, 2010 and is open for comments (use the "thread" tool found at the bottom of this page) and editing (use the EasyEdit tool found at the top of the page).

The references and resources shown here were originally collected as part of a project funded by the Public Health Agency of Canada through the Society of Obstetricians and Gaeynecologists of Canada. The materials from that project have been supplemented by items found in through the clipping/information service (The School Health Insider) that is provided by the International School Health Network for its members.

Editor:
Writer: Doug McCall, International School Health Network
Contributors
Related Documents in this Encyclopedia

A. Defining, describing and Understanding the Intervention

A-1 Overview

ResearchReports/Resources (Educational, Planning etc)


The FACTS on the Safety and Effectiveness of HPV Vaccine (Public Health Agency of Canada)
The Gardasil vaccine was approved in Canada in July 2006. The vaccine is effective in preventing the strains of human papillomavirus that are responsible for 70 per cent of cervical cancer. HPV is one of the most common sexually transmitted infections in Canada, and the majority of cervical cancers are caused by this infection. Despite the effectiveness of HPV vaccination, vaccinated females must continue to have regular cervical cancer screening. In February, 2007, based on sound scientific consideration, the National Advisory Committee on Immunization (NACI) issued recommendations for the use of Gardasil� for females aged 9 to 26. The Chief Public Health Officer of the Public Health Agency of Canada (PHAC) reviewed these recommendations and strongly supports this vaccine.

National Advisory Committee on Immunization statement on Gardasil In January 2007 the National Advisory Committee on Immunization (NACI) released its recommendations on the Health Canada approved human papillomavirus vaccine, which protects against HPV types 6, 11, 16 and 18. HPV 6 and 11 are linked to 90% of genital warts. HPV 16 and 18 are linked to approximately 70% of cervical cancers. The recommendations state that the following groups of people be vaccinated with the approved vaccine:
  • females between the age of 9 and 13 years who have not yet become sexually active
  • females between the ages of 14 and 26 years, even if they have become sexually active, as they would benefit from the vaccine
  • females between the age of 14 and 26 years who have had previous Pap abnormalities, including cervical cancer, or have had genital warts or known HPV infection, as they could still benefit from the vaccine (they may not have been infected with the HPV types covered by the vaccine) Ob/gyns to Provinces: Do not delay HPV Vaccine Roll-Out (SOGC)
The Society of Obstetricians and Gynaecologists of Canada (SOGC) is urging the provinces and territories to move quickly to immunize females aged 9 to 26 against the Human Papillomavirus (HPV), the virus that can cause cervical cancer. The recommendations are part of the clinical guidelines released today in Ottawa on the diagnosis, treatment and prevention of HPV. The call for provincial publicly funded immunization programs comes as the SOGC releases the national clinical guideline on HPV. Produced by the SOGC in collaboration with six national health organizations, the comprehensive guideline is the culmination of an exhaustive review of scientific evidence regarding the management, treatment, and prevention of HPV. The SOGC Guidelines on HPV Immunization were produced by SOGC, in collaboration with:
  • Association of Medical Microbiology and Infectious Disease Canada (AMMI Canada)
  • Canadian Dermatology Association (CDA)
  • Canadian Paediatric and Adolescent Gynaecology/Obstetrics Committee (CANPAGO)
  • Canadian Paediatric Society
  • College of Family Physicians of Canada (CFPC)
  • Health Canada
  • Society of Canadian Colposcopists (SCC)
  • Society of Gynecologic Oncologists of Canada (GOC)
HPV, Vaccines, and Gender: Policy Considerations (Canadian Womens' Health Network, 2007)
A careful review of the literature, including that which was submitted by the manufacturer with its application for approval of Gardasil, reveals a sufficient number of unanswered questions to lead us to conclude that a universal immunization program aimed at girls and women in Canada is, at this time, premature and could possibly have unintended negative consequences for individuals and for society as a whole. We suggest that rather than giving widespread administration of this vaccine a "green light," a more appropriate policy at this time would be a "yellow light" of caution. We recommend that the funding announced by the federal government be used to support the research needed to answer the many questions outlined below; to fund a public education campaign to quell the unfounded anxiety that has been instilled by marketers of the vaccine that HPV represents a "new" or "imminent" threat; and to ensure equal access to Pap testing, including timely follow-up and application of improvements in testing. Only when there is a solid evidence base and an appropriately-provisioned cervical screening program accessible to all can we determine the most appropriate holistic strategy - and the place of vaccination in it - to address cervical cancer and the transmission of HPV between and among Canadian girls, boys, women, and men. We have been given an exciting opportunity to establish effective guidelines and to create a model of how to approach future vaccines. We must take full advantage of it. In this paper, we summarize some of the major questions and concerns that need to be addressed before there is a full-scale roll-out of an HPV vaccination program. These closely reflect issues raised in the analytical framework created by Erickson et al.[i] in the context of the development of the National Immunization Strategy (NIS), and support efforts to ensure a comprehensive and systematic evaluation of all relevant factors before decisions regarding the importance of a new immunization program are made. As well, they echo some of the research questions identified as important in the Final Report from the Canadian Human Papillomavirus Vaccine Research Priorities Workshop held in Quebec City in 2005.[ii]We hope raising these questions now will contribute to the deliberations necessary to ensure a responsible and transparent evidence-based decision-making process. See also:

The HPV vaccine, one year later (Canadian Womens' Health Network 2008) In PEI, Nova Scotia and Newfoundland, uptake of the vaccination programs which began last September has been high (around 80%), but in Ontario only 50% of girls eligible for the vaccine have actually received it so far. School-based vaccination programs usually have very high uptake rates, and the low rate in Ontario, where most of the investigative media reports were published, may be because parents have decided to wait until further evidence is known. The governments of Quebec, British Columbia and Manitoba all recently announced they will be unrolling vaccination programs in the fall of 2008. Without the usual National Immunization Strategy to guide provinces in the implementation of a vaccination program (the Strategy was not used in this case), the authorities in Quebec have decided to provide only two doses of the vaccine to Grade 4 girls, then a third shot when the girls reach Grade 9. The vaccine is approved for use in three doses within six months, so Quebec’s plan would be an “off-label” (unapproved) use of the vaccine. A clinical trial is currently underway to evaluate this method, which may or may not prove to be effective in the long term, but it has not yet concluded.

Canadian Cancer Society perspective on HPV vaccines
Because of their potential impact in reducing the number of cervical cancers diagnosed in Canada, the Canadian Cancer Society believes that HPV vaccines should be available and affordable to the public. However, vaccines should be used as a complement, not a replacement, for cervical cancer screening. Gardasil � the quadrivalent vaccine The quadrivalent vaccine is manufactured by Merck Frosst Canada Ltd. and marketed under the name Gardasil. Gardasil protects against infection with HPV type 6, 11, 16 and 18 in women not previously infected by these HPV types. The vaccine prevents nearly 100% of the precancerous changes that happen to cells in the cervix from persistent infection with HPV type 16 and 18. Based on current research, Gardasil provides protection for at least 5 years.

HPV vaccine (Human papillomavirus) (Canadian Pediatric Society)
Human papillomavirus (HPV) is the most common sexually transmitted infection in Canada. There are many different types of HPV. Many of them can affect the genital area of men and women including the skin of the penis, vulva (area outside the vagina) or anus, and the linings of the vagina, cervix, or rectum. Most people with HPV infection do not know they have it because it usually causes no symptoms. But, HPV is the major cause of cervical cancer in women. The virus must be present for many years before it develops into cancer. It can also cause genital warts in both men and women. A vaccine can help protect girls from several types of HPV that cause cancer and warts. In Canada, girls 9 to 13 years old should get the vaccine, which is given in 3 doses.

Human Papillomavirus (HPV) Vaccine Position Statement (Canadian Federation for Sexual Health)
The Canadian Federation for Sexual Health believes that the human papillomavirus vaccination, like any vaccination, if proven to be safe and effective, should be equally available to all in Canada, and should be medically supervised, safe and fully funded.

A-2 Linkage to other Interventions or to models/frameworks of comprehensive approaches, coordinated programs or health-promoting school strategies

ResearchReports/Resources (Educational, Planning etc)




A-3 Elements or aspects of the intervention

ResearchReports/Resources (Educational, Planning etc)


Videoforteensabout HPV (4 minutes)

Video for parents about HPV (20 minutes)

Hear Carmen's touching and emotional storyabout her experience in dealing withthe consequences ofliving with HPV (4 minutes)

Listen to an interview on CBC radio with Dr. Harald zur Hausen on his thoughts about the HPV vaccine. Dr. zur Hausen recently won a Nobel Prize for his discovery of HPV as the cause of cervical cancer

Fact Sheet/Web Page The HPV Infection (BC Ministry of Health, Canada)

Fact Sheet/Web Page. Human Papillomavirus (HPV) Vaccine (BC Ministry of Health, Canada)

Fact Sheet Ten HPV Myths (BC Ministry of health, Canada)

Should my daughter get the HPV vaccine? (BC Health Guide)
This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.


A-4 General discussion of Strategies for implementation/Barriers to Overcome

ResearchReports/Resources (Educational, Planning etc)
Article Parent Perspectives: The Vaccines They Are Willing to Receive Using School Immunization, (J of Ado Health Sep-10) http://is.gd/gCg9G

Article Human Papillomavirus Vaccine Uptake, With and Without a School Mandate (J of Ado Health Sep-10) http://is.gd/gCfXb

Article Voluntary School-Based Human Papillomavirus Vaccination: An Efficient Acceptable Model (J of Ado Health Sep-10) http://is.gd/gCfJV

Brotherton JM, Gold MS, Kemp AS, McIntyre PB, Burgess MA, Campbell-Lloyd S; New South Wales Health HPV Adverse Events Panel.(2008)Anaphylaxis following quadrivalent human papillomavirus vaccination. CMAJ 2008 Sep 9;179(6):525-33. Epub 2008 Sep 1.
Vamos CA, Robert J. McDermott, Ellen M. Daley (2008)
The HPV Vaccine: Framing the Arguments FOR and AGAINST Mandatory Vaccination of All Middle School Girls

Journal of School Health Volume 78, Issue 6, pages 302–309, June 2008


HPV and Other Vaccines for Teens (Wall Street Journal)
The Centers for Disease Control and Prevention said about 25% of teenage girls received at least one dose of Merck & Co.'s Gardasil vaccine in 2007, providing the first national estimate of vaccine use. The data, released Thursday, were included in a survey designed to track vaccination rates among 13-to-17 year olds.Since 2005, three new vaccines have been added to the list of recommended vaccines for adolescents along with an additional dose of varicella, which is designed to protect against chicken pox.

Several Alberta Catholic School Boards Refuse HPV Vaccine (Canadian Press)
 Alberta is scrambling to come up with a backup plan to vaccinate girls against a virus that causes cervical cancer as more Catholic school boards opt out over a program they say condones premarital sex. So far at least six of Alberta's 20 Catholic boards have voted against allowing girls in Grades 5 and 9 to be inoculated against HPV in schools. More boards are expected to say no after Calgary Bishop Fred Henry spoke out against the program during a meeting with school trustees. Ted Paszek, president of the Alberta Catholic School Trustees' Association, said the bishop's message at a meeting last month resonated with many of the boards. About 8,000 girls in the Catholic system are eligible to receive the vaccine this fall. "The bishop said it would be unacceptable for Catholic schools to be offering this vaccine, that it would tacitly condone premarital sexual activity," said Paszek, who is also president of the Elk Island Catholic School Division, which is to vote on the HPV vaccine this Thursday.

Another school board rejects HPV vaccine (Winnipeg Sun)
In a meeting Tuesday night, the board voted unanimously not to allow the HPV vaccine to be offered in local Catholic schools. A number of Alberta Catholic ...

Alberta health minister critical of Catholic school boards' ban on ... (The Canadian Press)
Alberta announced in June that the HPV vaccine would be offered to Grade 5 girls beginning in September and to Grade 9 girls starting next year - but only...

B.C.'s health officer insists HPV vaccine Gardasil is safe (www.straight.com)
BC's health officer is standing by Gardasil, the HPV (human papillomavirus) vaccine used to protect against cervical cancer, amid mounting public concern over its safety.


A-5 Evaluated Examples of the Intervention


ResearchReports/Resources (Educational, Planning etc)
Researchers Question Wide Use of HPV Vaccines (New York Times)
Two vaccines against cervical cancer are being widely used without sufficient evidence about whether they are worth their high cost or even whether they will effectively stop women from getting the disease, two articles in this week�s New England Journal of Medicine conclude.

Public Health Fact sheet: Patient information about HPV and the HPV vaccine
Tav van Zyl*, Eric Wooltorton, MD MSc and Noni MacDonald, MD MSc
CMAJ August 28, 2007; 177 (5). doi:10.1503/cmaj.071061.
The vaccine is primarily effective in females who have not yet been exposed to HPV; thus, it is recommended that females be vaccinated before they become sexually active. The vaccine offers protection for at least 5.5 years, and studies are being performed to determine whether a booster dose will be required. Even with the vaccine, regular Pap smears are essential because the vaccine does not protect against all types of HPV that can cause cervical cancer. The most common side effect is soreness around the injection site in the arm. Few other minor side effects were reported in the studies


A-6 Behaviour Theories that Explain or Relate to the Intervention


ResearchReports/Resources (Educational, Planning etc)




B) Evidence of Effectiveness of the Intervention/Examples of


ResearchReports/Resources (Educational, Planning etc)




B-1 On Health & Social Development Overall

ResearchReports/Resources (Educational, Planning etc)




B-2 On the Specific Health and Social Problem/Behaviours or Protective Factors/Behaviours

ResearchReports/Resources (Educational, Planning etc)




B-3 On Learning and School Effectiveness

ResearchReports/Resources (Educational, Planning etc)




C) Evidence on how to Implement, Sustain the Intervention

ResearchReports/Resources (Educational, Planning etc)




C-1 Use of Diffusion and Education Change Knowledge/Theory

ResearchReports/Resources (Educational, Planning etc)




C-2 Use of Capacity-Building Knowledge/Theory and Sustainability

ResearchReports/Resources (Educational, Planning etc)




C-3 Consideration of Ecology and System Characteristics

ResearchReports/Resources (Educational, Planning etc)




C-4 Consideration of Community or Cultural Contexts

ResearchReports/Resources (Educational, Planning etc)




D Questions related to Future and Current Research


ResearchReports/Resources (Educational, Planning etc)




D-1 Major knowledge/practice/policy questions and draft or existing research agendas

ResearchReports/Resources (Educational, Planning etc)




D-2 Use of new research methods (beyond RCT’s)

ResearchReports/Resources (Educational, Planning etc)




D-3 Methodological Issues and Questions


ResearchReports/Resources (Educational, Planning etc)




Research Showing the Connection between this Intervention and Educational Outcomes or School Effectiveness

ResearchReports/Resources



Research Showing Cost-Effectiveness or Cost-Benefits of this Intervention

ResearchReports/Resources





A


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