The Standing Committee on Vaccination (STIKO) at the Robert Koch Institute in Berlin recommends vaccination against human papillomavirus (HPV) as the standard vaccination for girls and young women aged 9 to 14. Every year, more than 4,700 women across Germany are diagnosed with cervical cancer and about 1,500 women die from this disease. HPV vaccination reduces the risk of cervical cancer in women. Vaccination has also recently been recommended for boys.
Things to know about cervical cancer vaccination.
The vaccine is approved for the prevention of cervical cancer (cancer of the uterine cervix) and its precursors, as well as vulvar cancer and external genital warts (genital warts). The double vaccination should ideally be given to girls aged 9 to 14 years, 5 months apart, and should be completed before the first sexual intercourse. There is complete protection only after both doses have been administered. The vaccination does not work against pre-existing HPV infections or existing genital warts. This does not mean, however, that girls are excluded from the vaccination or that reimbursement by health insurance companies could become invalid if sexual intercourse has already taken place. It is also not to be assumed that even the first sexual intercourse will result in an infection with the four crucial virus types. Missed vaccinations should be made up by the time the child reaches the age of 18, which is the day before the child’s 18th birthday. A third dose of vaccine is required for catch-up vaccinations at ages older than 14 years or when there is less than a 5-month interval between the first and second doses. Gynecologists, family physicians, or even pediatricians may administer the vaccine.
HPV vaccination also recommended for boys
For boys, the STIKO also recommends HPV vaccination at the age of 9 to 14 years – follow-up vaccinations are also advisable here until the age of 17 years. The reason for the recommendation is not only that the virus is also spread by men. The vaccination also serves to protect the men themselves, because they can fall ill as a result of the same HPV types, for example, mouth–throat cancer, penile or anal cancer.
No age limit for vaccination
The STIKO specifically points out that women outside the age range of 9 to 14 years also benefit from vaccination. It is the responsibility of the gynecologist to point this out to patients and to offer vaccination according to the approval of the vaccine currently on the market. The STIKO leaves no doubt that cervical cancer vaccination does not replace the recommended screening examinations. Vaccination and screening examinations together form the mainstays of effective cervical cancer prevention.
Cervical cancer vaccination: what to consider?
Since August 2017, only the Cervarix and Gardasil 9 vaccines have been licensed in Germany:
- Cervarix is effective only against HPV 16 and 18, which are responsible for about 60 to 70 percent of all cervical cancers. The active ingredient does not provide protection against genital warts.
- Gardasil 9, on the other hand, protects against 9 HP viruses, which are the cause of about 75 to 90 percent of all cervical cancers. Gardasil 9 also protects against genital warts.
According to current findings, it is not yet clear whether the vaccine protection lasts permanently or whether a booster vaccination is needed. Although previous studies indicate that the vaccination has a lasting effect. However, cervical cancer usually develops over many years, so further testing is needed. Because vaccination against HPV viruses does not cover all oncogenic HP types, the STIKO explicitly points out that cervical cancer screening measures must be used without change.
Cervical cancer vaccination during pregnancy?
However, because of insufficient data, vaccination during pregnancy should be avoided. Breastfeeding is not a contraindication, as it is with all other vaccinations. If a woman becomes pregnant during the vaccination program, the missing second or third vaccination can be made up after delivery. Individual cases in which the vaccination was inadvertently administered during pregnancy proved not to be harmful to the baby.
HPV-related diseases
Cervical cancer is caused exclusively by human papillomaviruses, and the main route of transmission is sexual intercourse. The link between HP virus infection and cervical cancer is even stronger than that between smoking and lung cancer, experts said. Human papillomaviruses are widespread. An estimated 80% of sexually active girls and women come into contact with the viruses at some point in their lives (often as teenagers or young adults). It is believed that in Europe, for HPV-related diseases as a whole.
- 75% of all cases of cervical cancer.
- 95% of vulvar and vaginal cancers
- 70% of pre-cancerous and 50% of potentially pre-cancerous cervical lesions.
- 80% of precancerous vulvar and vaginal lesions
- 90% of genital warts
Are caused by virus types 6, 11, 16 and 18. Vaccinated individuals should be informed by the doctor that the vaccination protects only against the types contained in the vaccine HPV 6,11, 16 and 18, where 16 and 18 are responsible for the prevention of cervical cancer, while 6 and 11 are primarily to prevent the formation of genital warts. The latter are not considered malignant, but they are extremely distressing both physically and psychologically.
Incidence of genital warts on the rise
The median age of onset for cervical cancer is 53 years. While the death rate from cervical cancer has decreased significantly as a result of screening, the incidence of genital warts increased tremendously, from about 10 per 100,000 women in 1970 to 200 per 100,000 today. For this reason, physicians advocate a generous approach to cervical cancer vaccination, even if women outside the recommended age range will likely have to pay for the vaccination themselves in the future. Patients with recurrent genital warts may also benefit from vaccination, and condom use reduces the risk of permanent infections. The fact that the mortality rate from cervical cancer has nearly halved in recent decades is due to cytologic screening, which is performed as part of the preventive examination by a gynecologist.
More education about HPV
A survey showed a sobering result: only 3.2% of German women are aware of the virus and directly associate its potential danger with cervical cancer. Consequently, awareness of the need for cervical cancer vaccination as an effective preventive measure must be raised and sustained. There is a great willingness on the part of physicians to provide this vaccination, especially among gynecologists, who have always seen themselves as preventive physicians for women. The task of the media is to build confidence in vaccination through comprehensive information and education in broad sections of the population and especially among young people.
Update vaccination protection regularly
STIKO and the Professional Association of Gynecologists point out that vaccination against HPV should also be used as an opportunity to complete other vaccinations recommended – especially for adolescents. Only 25% of adolescents have complete vaccination protection. Complete vaccine protection includes vaccinations against:
- Measles, mumps, rubella (if not already two MMR vaccinations, the gaps should be closed at the latest in adolescence).
- Hepatitis B (basic immunization recommended if not already vaccinated in infancy).
- Chickenpox (those who have not had varicella or not vaccinated, receive one or two vaccinations – depending on age).
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Diphtheria, tetanus, poliomyelitis and pertussis: a booster vaccination is recommended for all young people.
