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An Advisory Committee Statement (ACS)
National Advisory Committee on Immunization (NACI)
February 2015

Update on the recommended Human Papillomavirus (HPV) vaccine immunization schedule

Summary Table of Information Contained in this NACI Statement

The following table highlights key information for immunization providers from the full National Advisory Committee on Immunization (NACI) Statement: Update on the recommended Human Papillomavirus (HPV) vaccine immunization schedule.

For readers interested in the full PDF version of the Update on the recommended Human Papillomavirus (HPV) vaccine immunization schedule, the document is available for downloading or viewing on the Government of Canada PublicationsExternal site Web site.

1. What

Human papillomavirus (HPV) infections are the most common sexually transmitted infections. There are over 100 types of HPV, and they are broadly classified into high and low risk types.

High-risk HPV types 16 and 18 and others can lead to cervical and anogenital cancers, as well as certain cancers of the head and neck. HPV types 16 and 18 cause approximately 70% of cervical cancers.

Low-risk HPV types can cause anogenital warts (AGW). Most cases (>90%) of AGW are attributable to HPV types 6 and 11.

Gardasil® (HPV4 vaccine) has been authorized for use in Canada since 2006 for the prevention of infection caused by HPV types 6, 11, 16 and 18 -related cancers and genital warts. Cervarix® (HPV2 vaccine) has been authorized for use in Canada since 2010 for the prevention of cervical cancer caused by HPV types 16 and 18.

2. Who

Gardasil® or Cervarix® are recommended for the prevention of cervical cancer and adenocarcinoma in situ (AIS) in:

  • females 9 through 26 years of age
    • females 15 through 26 years of age who have had previous Pap test abnormalities, including cervical cancer and external genital warts

Gardasil® is recommended for the prevention of vulvar, vaginal, anal cancers and their precursors, and AGW in:

  • females 9 through 26 years of age

Gardasil® is recommended for the prevention of anal intraepithelial neoplasia (AIN), anal cancer, and AGW in:

  • males between 9 and 26 years of age, including males who have sex with males
  • Cervarix®  is not recommended for males at this time

Gardasil® or Cervarix®  may be administered to:

  • females over 26 years of age

Gardasil® may be administered to:

  • males over 26 years of age

HPV vaccines are not recommended for:

  • females or males < 9 years of age as no immunogenicity or efficacy data are available in these groups

3. How

HPV vaccines have been licensed to be given as three separate 0.5 mL doses: HPV2 vaccine at months 0, 1, and 6 and HPV4 vaccine at months 0, 2, and 6. As of July 3, 2014, HPV2 vaccine has also been authorized for use in girls from age 9 to 14 years of age at the time of first injection as a 2-dose schedule (0, 6 months).

New evidence on a 2- vs 3-dose HPV immunization schedule has recently been summarized and reviewed by other immunization technical advisory groups, including the World Health Organization's Strategic Advisory Group of Experts (WHO's SAGE). Consistent with recommendations by these groups, NACI now recommends that HPV2 and HPV4 vaccines may be administered to immunocompetent individuals 9-14 years of age as two separate 0.5 mL doses at months 0 and 6-12. Immunocompromised and immunocompetent HIV infected individuals, and individuals who have not received any dose of HPV vaccine by 15 years of age should continue to receive three doses of HPV vaccine.

Because fainting post-vaccination is more common in younger people, it is particularly important to observe each vaccinee for 15 minutes after vaccine administration to avoid serious injury in the event of syncope.

4. Why

In the absence of vaccination, it is estimated that 75 per cent of sexually active Canadians will have a sexually transmitted HPV infection at some point in their lives. Even if a person is already infected with one or more vaccine HPV type(s), the vaccine will provide protection against the other HPV type(s) contained in the vaccine.

Women must consult with their health care professional for regular cervical cancer screening (i.e. Pap tests) regardless of HPV vaccination status.

A 2-dose HPV immunization schedule among immunocompetent 9-14 year olds is expected to provide similar protective efficacy compared to a 3-dose schedule in immunocompetent individuals aged 9-26 years, and may be considered to allow for potential cost savings and other individual and programmatic advantages.