Module 9: Human Papillomavirus

Human Papillomavirus (HPV)

- Small DNA virus
- Over 200 types
- Sexually transmitted
- Cutaneous
- Mucosal: high risk, low risk

HPV or human papillomavirus infections that infect a non-mucosal, cutaneous epithelium usually leads to which of the following?

- Anal warts
- Palmar warts
- Plantar warts

Natural History of HPV

Prevention

- No specific treatment recommended for asymptomatic HPV infection.
- Medical management consists of targeting the clinical manifestation
- 2006: 4vHPV (Gardasil)
- 2009: 2vHPV (Cervarix
- 2014: 9vHPV (Gardasil-9)

The human papillomavirus 9-valent vaccine, recombinant, or 9vHPV, provides protection against how many HPV serotypes?

- 9

9vHPV Vaccine

- Human papillomavirus 9-valent vaccine, recombinant: virus-like particles of the major capsid L1 protein
- Adjuvant: amorphous aluminum hydroxyphosphate sulfate
- HPV types 6, 11, 16, 18, 31, 33, 45, 52, 58
- Prevents cancer resulting from the above HPV types: cervical, vulvar, vaginal, anal, oropharyngeal, other head and neck
- Genital warts
- Precancerous or dysplastic lesions: cervical, vulvar, vaginal, or anal intraepithelial neoplasia

ACIP Recommendations: 9vHPV

Shared Clinical Decision-Making
Risk for HPV Infection

- Lower risk: persons in a long-term, mutually monogamous sexual partnership
- Higher risk: persons who have had multiple sex partners
- Most sexually active adults have been exposed to HPV

Shared Clinical Decision-Making
Vaccine Effectiveness

- Vaccine effectiveness might be low among persons with risk factors for HPV infection or disease
- HPV vaccines are prophylactic and do not prevent progression of HPV infection to disease

9vHPV Vaccination Series

Age 9-14 years
- 2 doses
- 0, 6-12 months
- persons with immunocompromising conditions should receive the 3-dose series

Age 15 years and older
- 3 doses
- 1, 1-2, 6 months

The Advisory Committee on Immunization Practices recommends that routine HPV vaccination be initiated for the 9vHPV at which age group?

- 11-12 years of age

Adverse Reactions

- Injection site: pain (89%), swelling (40%), erythema (34%)

Warnings and Precautions

- Syncope may increase falling with injury; observe patients for 15 minutes after vaccination
- Pregnancy; vaccine should be delayed until the completion of pregnancy

Strategies to Improve HPV Vaccination

- HPV Immunization: Pharmacist Resource Center
- APhA and NACDS (Nation Association of Chain Drug Stores) resource to support pharmacists' activities in the immunization neighborhood to improve awareness, access to, and administration of HPV vaccine.

A 25-year-old female comes to the pharmacy inquiring about the 9vHPV series. What would be the recommended vaccination series?

- 3 doses administered intramuscularly at 0, 1-2, 6 months

Which of the below statements regarding HPV serotypes is true?

- High risk serotypes are estimated to cause 99% of cervical pre-cancers

A 16-year-old patient presents to the pharmacy for her first dose of 9vHPV. The patient is instructed to wait in the pharmacy for 15 minutes after receiving the dose. Three minutes after receiving the dose, the patient experiences syncope. What is the recommended response to treat the patient's syncope.

- Lay the patient flat on the ground and elevate her legs. Monitor the patient's vitals and initiate emergency services if the patient does not regain consciousness.

What percentage of HPV infections are cleared by the body and do not develop into CIN2 or CIN3

- 70%

Which of the following factors does not need to be considered when utilizing shared decision-making to evaluate the need to vaccinate an adult (27-45 years of age) with 9vHPV vaccine?

- HPV antibody test results