Following recommendations from the National Immunisation Advisory Committee (NIAC), the HPV vaccine was introduced into the national immunisation programme in 2011 as part of the national strategy to protect women from cervical cancer.
Since September 2011 all girls in First year in second level schools and age equivalent girls in special schools or home schooled have been offered the HPV vaccine during the academic year.
There was also a HPV catch-up vaccination programme for girls in Sixth year in second level schools in September 2011 and also for age equivalent girls born attending special schools, home schooled, Youthreach and Community Training Centres. This was repeated for girls in Sixth year in September 2012 and 2013. The catch up programme is now complete.
From September 2014 the programme targets all girls in First year of second level schools as all other girls will have already been offered the vaccine. The vaccine will not be offered again and older girls may visit their GP to obtain the vaccine privately.
Human papilloma virus (HPV)
The human papilloma virus (HPV) is the name given to a family of viruses that affect the skin and the moist membranes (mucosa) that line the body. Mucosa are found in the:
- cervix (the neck of the womb)
There are over 100 different types of HPV, with around 40 types affecting the genital area. These are classed as high-risk and low-risk depending on the type of conditions that they can cause.
Some types of HPV are transmitted through sexual contact, which can cause genital warts and cervical cancer.
Combined with cervical screening the HPV vaccination is an important step towards preventing cervical cancer.
Cervical screening is a method of identifying abnormal cells in the cervix (neck of the womb). Early detection and treatment can prevent three-quarters of cancers developing.
Regular cervical screening is the best way to identify abnormal cell changes in the cervix. Following the introduction of the national HPV vaccination programme the cervical screening programme will continue to play an important part in checking women between the ages of 25 and 60 for early-stage cell changes.
Different types of HPV
Infection with some high-risk types of HPV can cause abnormal tissue growth as well as other cell changes that can lead to cervical cancer (cancer of the cervix).
Infection with other types of HPV may cause:
- genital warts: small growths or skin changes on or around the genital or anal area. These are the most common viral sexually transmitted infection (STI) in Ireland.
- skin warts and verrucas
- vaginal cancer or vulval cancer (although these types of cancer are rare)
- anal cancer or cancer of the penis
- some cancers of the head and neck
- laryngeal papillomas (warts on the voice box or vocal cords)
Why was HPV vaccine introduced into the National Immunisation Programme?
The HPV Vaccination Programme was introduced to protect girls from their future risk of cervical cancer.
What HPV vaccines are available to protect against cervical cancer?
There are two vaccines available to protect against cervical cancer.
Gardasil is the name of the HPV vaccine used in Ireland for the school based HPV vaccination programme. Gardasil vaccine protects against two high-risk HPV types (types 16 and 18) that cause 7 out of 10 cervical cancers and two low-risk HPV types (types 6 and 11) that cause 9 out of 10 genital warts.
There is also another HPV vaccine called Cervarix. It protects against the same two types of HPV that cause 7 out of 10 cervical cancers.
How effective is the HPV vaccine?
Gardasil vaccine provides almost 100% protection from HPV types 6, 11, 16 and 18 if a course of vaccine is received at the correct intervals and if it is given before a girl has an infection with these types.
This is why the routine programme is targeting girls in first year of second level school before they are likely to be exposed to HPV infection.
HPV infections are transmitted through skin-to-skin contact. Genital HPV infections are common and are transmitted through sexual contact. The viruses that cause genital HPV infections may be present on your genitals and the surrounding area, including around your anus.
Up to 8 out of 10 people are infected with HPV at some time during their lives. In most cases, the virus does not cause any harm because the immune system (the body's natural defence against infection) usually gets rid of the infection. It is also possible for you to be infected with more than one type of HPV.
Having sex just once could expose you to a genital HPV infection. Therefore, if you are infected with HPV, it does not necessarily mean that you have had a large number of sexual partners. However, a large number of sexual partners will increase your risk of becoming infected, as will having sex at a young age.
Using a condom during sexual intercourse is the most effective method of protecting against sexually transmitted infection (STI), and it can also help to prevent a genital HPV infection. However, as condoms do not cover the entire genital area and are often put on after sexual contact has begun, a HPV infection can still be transmitted even when a condom is used.
High-risk types of HPV
The most common high-risk types of HPV (HPV-16 and HPV-18) are responsible for about 70% of cervical cancer cases.
If your immune system does not deal with a high-risk HPV infection, it can lead to cell changes (dyskaryosis) and abnormal growth of pre-cancerous cells in your cervix. This is also known as cervical intraepithelial neoplasia (CIN).
CIN is not cancer but, if left untreated, it can develop into cancer in some women. This can take up to 10 years.
Low-risk types of HPV
Low risk types of HPV include HPV-6 and HPV-11, which cause most cases of genital warts. The low-risk types of HPV are unlikely to lead to cervical cancer because genital warts themselves do not cause cervical cancer.
Following recommendations from the National Immunisation Advisory Committee (NIAC), the HPV vaccine was introduced into the national immunisation programme in 2011 as part of the national strategy to protect females from cervical cancer.
Since September 2011 all girls in first year in second level schools and age equivalent girls in special schools or home schooled have been offered the HPV vaccine during the academic year.
From September 2014 the programme targets all girls in first year of second level schools as all other girls will have already been offered the vaccine. The vaccine will not be offered again and older girls may visit their GP to obtain the vaccine privately.
Following recommendations from the National Immunisation Advisory Committee (NIAC), the Minister for Health and Children announced the introduction of the HPV vaccine into the national immunisation programme in 2010 as part of the national strategy to protect females from cervical cancer.
HPV vaccine was offered to all girls in First and Second year of second level schools in 2010 and age equivalent in special schools. Girls outside of the traditional school system (home-schooled) were also vaccinated.
There was also a HPV catch-up vaccination programme for girls in Sixth year in second level schools in September 2011 and also for age equivalent girls born attending special schools, home schooled, Youthreach and Community Training Centres. This was repeated for girls in Sixth year in 2012 and 2013.
Since September 2014 the programme has been provided for all girls in First year of second level schools. All other girls had already been offered the vaccine.
Who should not receive HPV vaccine?
Girls should not receive the vaccine if they:
• have had a previous allergic reaction (anaphylaxis) to a previous Gardasil vaccine
• are pregnant
Girls should tell the vaccination team if they have an illness or condition that increases their risk of bleeding.
If a girl has a high fever, the vaccination will be postponed. This is because symptoms of the illness may be confused with side effects from the vaccine, and this could result in the wrong diagnosis being made.
If a girl is in first year of second level school, parents/guardians receive information about the vaccine and a consent form before the HPV vaccine is given. If a girl is aged 16 years and over, she can consent to the vaccination herself.
The vaccination schedule
The HPV vaccine is given as an injection into the muscle of the upper arm. Up until 2014 a three dose vaccine schedule was required and given over six months. Since then, two doses six months apart have been recommended for girls up to14 years of age. Girls aged 15 years and older need three doses of the vaccine to be protected, as to date there is no evidence to support a two-dose schedule.
The course must be completed to ensure the best protection against the HPV virus types.
There may be some mild side effects, including:
• pain, redness or swelling in the arm where the vaccine was given and/or
• a mild fever or headache
These can be treated with paracetamol or ibuprofen.
Rarer side effects include an itchy rash or hives. Like most vaccines, severe allergic reactions are extremely rare.
Fainting has been reported after vaccination with Gardasil. This can happen after any vaccination. Girls are advised to sit down for 15 minutes after vaccination which can help to prevent fainting.
The HPV school vaccination programme uses the quadrivalent vaccine Gardasil, manufactured by Sanofi Pasteur MSD. This HPV vaccine is licensed for use from the age of 9 years for the prevention of premalignant genital lesions (cervical, vulvar and vaginal), cervical cancer and genital warts causally related to HPV types 6, 11, 16 and 18.
Is Gardasil a live vaccine?
Gardasil is not a live vaccine. It is made from proteins like those that coat the HPV virus known as virus like particles (VLPs). These VLPs cannot cause HPV infection or cancer.
How does Gardasil work?
When the vaccine is given in the upper arm, the body makes antibodies that will help the immune system fight HPV infection. These antibodies stay in the girl’s body and protect her from the types of HPV that cause 7 out of 10 cervical cancers and 9 out of 10 genital warts. The vaccine cannot cause HPV infection or cancer.
How long has Gardasil been in use?
Gardasil has been licensed for use since 2006. Over 187 million doses of Gardasil have been distributed globally either as part of national immunisation programmes or by private doctors. Gardasil is currently used in several European countries, the United States, Canada, Australia and New Zealand.