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HPV Vaccine in Schools

As announced last month by the Hon. Minister of Health Mark Scotland, a cancer prevention vaccination, the Human Papillomavirus (HPV) vaccine, is being integrated into Cayman's childhood immunization programme starting in November of this year.

The programme will be offered initially at the two government high schools, John Gray and Clifton Hunter, beginning the week of November 5 from 10 a.m. to noon and is free of cost.

The target populations for the vaccine are girls aged 11-12 years in year 7. This vaccination involves three injections given by School Nurses over six months -- at the time of the appointment; two months after the first dose; and six months after the first dose.

Whilst the HPV vaccine is not mandatory, School Health Coordinator Nurse Joanna Rose Wright urges parents and guardians to have their young girls "take advantage of this cervical cancer prevention vaccination." She added, "No child will be vaccinated without parental consent, and parents will have the opportunity to be present at the time of vaccination if they choose."

A letter will be sent home to all parents on October 30 advising of the process and requesting confirmation of consent for the child to be given the vaccination. The letters are to be returned to the child's school teacher no later than November 1, 2012. Parents are urged to be on the lookout for letters in the school bags of year 7 girls, 11-12 years old.

While initially, the vaccine is offered to girls in the government high schools, children between the ages of 11 - 17 from both government and private schools, accompanied by their parents, can get their HPV vaccination at the following Health Services Authority facilities: the Public Health Clinic at the Cayman Islands Hospital, West Bay and Bodden Town health centres, and Faith Hospital in Cayman Brac. Appointments can be made by contacting the health centres.

Further information may be had by calling the Public Health Clinic on 244-2648. West Bay Health Centre on 949-3439; Bodden Town Health Centre on 947-2299; Faith Hospital on 948-2243 and Little Cayman Clinic on 948-0072.

Side bar: Questions & Answers for HPV Vaccine

What is HPV?

HPV stands for Human Papillomavirus.

Why get vaccinated?

The HPV vaccine (Gardasil) that will be used protects against four major types of HPV. These include two types that cause about 70% of cervical cancer and two types that cause about 90% of genital warts. Hence, HPV vaccine can prevent most genital warts and most cases of cervical cancer.

The FDA (Food and Drug Administration of the USA) has approved the vaccine for use among females aged 9 to 26 years.

Is Human Papillomavirus harmful?

HPV is the most common sexually transmitted infection. More than 50% of sexually active people will get HPV at some time in their lives, though most will never even know it. It is most common in people in their late teens and early 20s.

There are about 40 types of HPV that can infect the genital areas of men and women. Most HPV types cause no symptoms and go away on their own. But some types can cause pre-cancerous and cancerous lesions of the cervix, vagina and vulva, as well as genital warts. Cervical cancer is the second leading cause of cancer deaths among women around the world.

There is no treatment for HPV infection, although the conditions it causes can be treated.

Who should get the HPV vaccine?

HPV vaccine is routinely recommended for girls 11-12 years of age because of their robust immune systems. It can be given to girls as young as 9 years.

It is important for girls to get HPV vaccine before their first sexual contact. For these girls, the vaccine can prevent almost 100% of disease caused by the four types of HPV targeted by the vaccine.

If a girl or woman is already infected with a type of HPV, the vaccine will not prevent disease from that type.

Who should not get the HPV vaccine?

- Anyone who has had a severe allergic reaction to yeast or any component of the vaccine or to a previous dose of HPV vaccine should not get the shot.

- Pregnant women should not get the vaccine since the effects of the vaccine during pregnancy are still being studied.

- People with moderate or severe acute illnesses should also defer their vaccine until after the illness improves.

Will sexually active females benefit from the vaccine?

Ideally, females should get the vaccine before they become sexually active. Sexually active females who have not been infected with any of these four types of HPV that the vaccine prevents would receive the full protection. Females who already have been infected with one or more HPV types would still get protection from the vaccine for the types they have not acquired. Few young women are infected with all four HPV types in the vaccine.

Should girls/women be screened for cervical cancer before getting vaccinated?

No. Girls/women do not need to get a HPV test or pap test to find out if they should get the vaccine as it is very rare that any one is infected with all four HPV types covered by the vaccine.

Will the girls/women who have been vaccinated still need a regular pap test, also known as cervical cancer screening?

Yes. Regular Pap tests are recommended as the vaccine will not provide protection against all types of HPV that cause cervical cancer.

Why is the vaccine only recommended for girls/women 9 through 26 years old?

The vaccine has been widely tested in 9 through 26 year old females. The FDA may consider licensing the vaccine for older women when there is research to show it is safe and effective for them.

What about vaccinating boys?

The FDA has approved the vaccine for boys as well, but for now the Cayman Islands programme is limited to girls only.

Is the vaccine mandatory?

No. Girls under 18 will only be vaccinated with parental consent.

Are there other ways, besides the vaccine, to prevent HPV?

The surest way to prevent genital HPV is to avoid sexual contact.

For persons who are sexually active, condoms may lower their chances of getting HPV, if used all the time and the right way. But HPV can infect areas that are not covered by a condom-so condoms may not fully protect against HPV.

Chances of getting HPV can also be lowered by mutually faithful relationships and limiting partners.

How is the HPV vaccine given?

The vaccine is given in three shots over a six month period:

- 1st dose - selected date

- 2nd dose - 2 months after first dose

- 3rd dose - 6 months after first dose

Will girls/women be protected even if they got only one or two doses?

It is not yet known how much protection girls/women would get from receiving only one or two doses of the vaccine. For this reason, it is very important to get all three doses of the vaccine.

How long does the vaccine protection last? Will a booster shot be needed?

Protection from HPV vaccine is expected to be long lasting. More research is being done to find out if women will need a booster vaccine.

How safe is the HPV vaccine?

This vaccine has been licensed by the United States Food and Drug Administration (FDA) and approved by the Center for Disease Control (CDC) as safe and effective.

Studies have found no serious side effects. The most common side effect is soreness in the arm (where the shot is given).

There have recently been some reports of fainting in teens after they got the vaccine. For this reason, it is recommended that they wait in the clinic for 15 minutes after getting the vaccine.

Where will the HPV vaccine be available?

The HPV vaccine will be offered to 11 to 12 year old girls in year 7 at the John Gray and Clifton Hunter High Schools. Communications will be sent to parents. No child will be vaccinated without parental consent.

Parents may choose to be present at the time of the vaccination.

HPV vaccine will also be available to all children ages 11-17 years by appointment at:

Public Health Department, West Bay Health Centre, Bodden Town Health Centre and Faith Hospital, Cayman Brac.

The school based programme is available at no cost. The vaccine is also available at private clinics at a cost.

Are there any side effects to look for after vaccination?

The most common side effect is soreness in the arm (where the shot is given).

The common side effects at the injection site are:

- Pain (the most common side effect)

- Swelling

- Redness

- Itching

Other side effects Include:

- Fever mild to moderate (100 - 102 F)

- Nausea

- Dizziness

- Vomiting

- Fainting

When these side effects do occur, in most cases they are minor, meaning they require no treatment or are easily treated by you or your healthcare provider. Paracetamol (Panadol) can be given in 4 to 6 divided doses for up to 24 hours for fever and or injection site pain.

Rare serious side effects to watch for are:

- Signs of severe allergic reaction, including swelling of the face and or throat, difficulty breathing,

- hoarseness or wheezing, an itching, hives, fast heart beat or dizziness.

- Weakness, tingling, or paralysis

- Any unusual condition, such as a high fever (103 F or more) or behavior changes.

If you notice any of these rare serious side effects please consult a doctor immediately.

How do I learn more about HPV vaccine?

If you need more information you can contact the Public Health Department by calling 244-2734 or 244-2648 or the Cayman Islands Cancer Society at 949-7618.

For further information contact: Yvette Cacho