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.
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:|
| ||3||0, 2 and 6 months|
| ||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 ||3||0, 2 and 6 monthsg|
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.
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.
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
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.
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.
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.