The American College of Obstetricians and Gynecologists has endorsed federal recommendations to routinely vaccinate girls 11-12 years old against the human papillomavirus using either the quadrivalent or bivalent vaccines.
Echoing the advice of the Advisory Committee on Immunization Practices, ACOG officials said the vaccine can be given to girls as young as 9 years old and that catch-up vaccination should be offered through age 26 years. ACOG outlined its position in the September issue of Obstetrics & Gynecology (2010;116:800-3).
Although ob.gyns. are unlikely to care for girls in the initial vaccination group, ACOG said that ob.gyns. should offer the vaccine to girls in the catch-up group and routinely document human papillomavirus (HPV) vaccine status in the patient’s record.
Two HPV vaccines are currently licensed by the Food and Drug Administration for sale in the United States. Merck’s Gardasil, which is offered as a three-dose course, is a quadrivalent vaccine that provides protection against cervical cancer, cervical dysplasias, vulvar and vaginal dysplasias, and genital warts associated with HPV genotypes 6, 11, 16, and 18.
Last year, the FDA approved the bivalent HPV vaccine Cervarix. This new vaccine, marketed by GlaxoSmithKline, is also offered as a three-dose course and is thought to provide protection similar to that of Gardasil for infections caused by the HPV genotypes 16 and 18. About 70% of all cervical cancer cases are associated with HPV genotypes 16 and 18, and about 90% of genital warts are associated with the HPV genotypes 6 and 11, according to the Centers for Disease Control and Prevention.
In the policy statement issued by ACOG’s Committee on Adolescent Health Care, the organization urged girls to get vaccinated before they are sexually active. “The ideal time for girls to receive the HPV vaccination is before they become sexually active and become exposed to HPV,” Dr. Diane F. Merritt, chair of the committee, said in a statement. “For those already sexually active, we also recommend the HPV vaccination for adolescents and young women up to age 26.”
Dr. Merritt said physicians should counsel patients that the HPV vaccine may be less effective if they have already been exposed to the virus.
ACOG does not recommend that girls and women be tested for HPV before they are vaccinated. Serologic assays to test for HPV DNA are unreliable and aren’t currently commercially available, according to the organization. “More importantly, it’s unlikely that someone would have been exposed to all of the HPV strains that the vaccines protect against, so testing is somewhat pointless,” Dr. Merritt said.
But women should have routine cervical cytology screening, according to ACOG. The organization said cervical cancer screening is needed in all women aged 21 years and older, even if they received the HPV vaccine before becoming sexually active.
HPV vaccination is not recommended during pregnancy, but physicians do not need to routinely perform pregnancy testing before giving the vaccine, according to ACOG. Instead, ACOG officials advised physicians to remind their patients to use contraception while they are receiving the vaccine series. If a woman becomes pregnant while receiving the vaccine, the series should be delayed until the end of the pregnancy. The vaccine is safe for breast-feeding women, ACOG said, because the virus it contains is inactive.