Contents

9 Human papillomavirus (HPV)

9.5 Recommended immunisation schedule

9.5.1 Recommended and funded

From 1 January 2017 males and females aged 26 years and under become eligible for HPV vaccine. Including males in a routine vaccination programme is expected to increase the benefit to the population in terms of reduction for both HPV-related cancer outcomes and genital warts.

See Table 9.2 for HPV vaccine recommendations and schedules. Children aged 14 years and under receive two doses of HPV vaccine, at 0 and 6–12 months. However, three doses are required for this age group if they have confirmed HIV infection or are transplant or chemotherapy patients, or if the minimum dosing interval is not met (see below). Older individuals receive three doses of HPV vaccine, at 0, 2 and 6 months.

Initially, HPV9 (Gardasil 9) will be used in school-based programmes only. HPV4 (Gardasil) will continue to be used in primary and secondary care until existing stocks are used up, and then HPV9 will be used.

Table 9.2: HPV vaccine recommendations and schedules

Note: HPV vaccine may be offered from age 9 years, but the usual Schedule will be at age 11/12 years (school years 7/8). Funded recommendations are in the shaded rows. See the Pharmaceutical Schedule (www.pharmac.govt.nz) for any changes to the funding decisions.

Recommended and funded Doses HPV Schedulea
Children aged 14 years and under 2b,c 0 and 6–12d months
Individuals aged 15–26 yearse,f 3 0, 2 and 6 monthsg
Individuals aged 9–26 years:    
  • with confirmed HIV infectionh
3 0, 2 and 6 months
  • transplant (including stem cell) patientsi
   
  • post-chemotherapy patientsi
An additional dose At least 1 month after the last dose
Recommended but not funded Doses HPV Schedule
Individuals aged 27 years and older:e,f,j
  • who have had little previous exposure to HPV and are now likely to be exposed
  • who are men who have sex with men
  • with HIV.
3 0, 2 and 6 monthsg
aIndividuals who started with HPV4 may complete their remaining doses with HPV4 or with HPV9 when available. Those who were fully vaccinated with HPV4 are not eligible for HPV9.
bIn New Zealand, HPV9 is registered as a 2- or-3-dose schedule for children aged 14 years and under, and HPV4 is registered as a 3-dose schedule for all age groups. However, there are not expected to be any safety or efficacy concerns when administering a 2-dose HPV4 schedule to children aged 14 years and under, providing there are at least 6 months between doses. A 2-dose HPV4 schedule is recommended by the WHO (see ‘International recommendations’ in section 9.4.2 above).
cRegardless of the age at the 1st dose, if the 2nd HPV dose is given at age 15 years or older a 3rd HPV dose is recommended and funded. Give the 3rd HPV dose at least 4 months after the 2nd.
dFor children aged 14 years and under, the 2nd dose is preferably given at least 6 months after the 1st. However, if the 2nd dose is given less than 5 months after the 1st, a 3rd HPV dose is recommended and funded. Give the 3rd HPV dose at least 6 months after the 1st.
eThe decision to vaccinate older age groups should follow an assessment of the potential benefits of vaccination – based on their likely previous HPV exposure and future risks.
fIndividuals who were under age 27 years when they commenced HPV vaccination are currently funded to complete the 3-dose course, even if they are older than 27 years when they complete it.
gIf a shortened schedule is required, give the 2nd dose at least 1 month after the 1st dose and the 3rd dose at least 3 months after the 2nd dose.
hSee section 4.3 for more information about HIV, including other recommended vaccines.
iSee section 4.3.3 for more information about transplants and chemotherapy.
jHPV vaccines are registered for use in females aged 9–45 years and in males aged 9–26 years. However, there are no theoretical concerns that the efficacy or safety of HPV vaccine in males up to the age of 45 years will differ significantly from females of the same age or younger males.

Immunisation should be completed before the onset of sexual activity. The optimal time for HPV administration is at age 9–13 years, as most males and females in this age group would be naïve to all HPV types. However, individuals who have begun sexual activity may still benefit from vaccination. The decision to vaccinate older age groups should follow an assessment of the potential benefits of vaccination – based on their likely previous HPV exposure and future risks.

Note:

9.5.2 Recommended but not fundedTop

Individuals aged 27 years and older

The decision to vaccinate older age groups should follow an assessment of the potential benefits of vaccination – based on their likely previous HPV exposure and future risks.

The data from the pivotal studies for HPV4 has demonstrated potential benefit to some women older than 25 years. HPV4 has been shown to be effective at preventing infection and disease from the vaccine types in women aged 24–45 years who were uninfected at baseline.66 However, pre-vaccination testing for cervical cytological abnormalities or for HPV infection is not recommended.

HPV9 and HPV4 vaccines are registered for use in females aged 9–45 years and in males aged 9–26 years. However, there are no theoretical concerns that the efficacy or safety of HPV vaccine in males up to the age of 45 years will differ significantly from females of the same age or younger males.

9.5.3 Pregnancy and breastfeedingTop

HPV vaccines are not recommended for pregnant women, however enquiring about the possibility of pregnancy is not necessary before vaccination.67

Data to date show no adverse effects of HPV vaccines on pregnancy outcomes.2, 68 However, if a vaccine dose has been administered around the time of conception or during pregnancy, health professionals are advised to report this to CARM (see section 2.5) and the vaccine manufacturer, to assist with ongoing safety monitoring. If a woman is found to be pregnant after starting the HPV vaccine schedule, the remaining doses should be delayed until after pregnancy.

HPV vaccines may be given to breastfeeding women.16

9.5.4 Variations from the vaccine data sheetsTop

HPV vaccines are registered for use in females aged 9–45 years and in males aged 9–26 years. However, there are no theoretical concerns that the efficacy or safety of HPV vaccine in males up to the age of 45 years will differ significantly from females of the same age or younger males.

For the three-dose schedules, the HPV vaccine data sheets recommend that all three doses are given within a 12-month period. The Ministry recommends that if the three-dose schedule has been interrupted, prior doses do not need to be repeated regardless of how long ago the previous doses were given.

HPV9 (Gardasil 9)

The data sheet states that there are no studies on the interchangeability of HPV vaccines. The Ministry recommends that all HPV vaccines may be used interchangeably for completion of a course.65 Those individuals who started with HPV4 may complete their remaining doses with HPV4 or with HPV9 when available.

HPV4 (Gardasil)

In New Zealand, HPV4 is registered as a three-dose schedule for all age groups. However, the Ministry recommends a two-dose schedule for children aged 14 years and under, with at least six months between doses. A two-dose HPV4 schedule is also recommended by the WHO62 for this age group (see ‘International recommendations’ in section 9.4.2 above). Two doses of HPV4 are more immunogenic in recipients aged between 9–15 years than older age groups and comparable to three doses in older recipients.43 HPV4 is expected to be effective when used in a two-dose schedule for individuals aged under 14 years.