Who is the HPV vaccine for, and when?

The HPV family contains more than 100 types, 40 of which may infect the genital tract. Some types, called “lower cancer risk,” cause benign skin or anogenital warts (condylomas) or warts in the airways (respiratory papillomatosis). However, the “high-risk of cancer” types are associated with several cancers, such as cervical, vulvar, and vaginal cancer in women, cancer of the penis in men, and mouth, throat, and anal cancer in people of both sexes [2].

The different types of HPV are identified with a number. More than 40 genotypes can cause genital infections. Of those, 14 are associated with cervical cancer, with types 16 and 18 being the most worrisome. With reference to the low-risk types, HPV 6 and 11 are responsible for the majority of anogenital warts [3].

It is estimated that 75% of Canada’s sexually active population will contract at least one HPV during their lifetime [4]. This high prevalence is explained by the highly contagious nature of the virus: skin-to-skin contact in the anogenital or oral area, even without penetration, is often enough to transmit the virus. Given the wide diversity in types of HPV and the fact that this virus, by not killing cells, does not trigger any long-term protective immune reaction, an individual may be infected with multiple types of HPV over their lifetime or even be infected by the same genotype more than once.

Most HPV lesions appear and disappear, in a few weeks or a few years, due to an immune response. However, HPV may be present without creating any lesions and therefore go completely unnoticed. Even though some lesions caused by HPV, such as anogenital warts or precancerous lesions of the vulva, can be treated,there is currently no effective treatment for getting rid of the infection itself [5]! Aside from refraining from any sexual activity, vaccination is the only effective way to protect yourself from HPV infection. A condom can provide good protection, but it has to be worn from the start of and throughout all sexual contact, including areas not covered, limiting its effectiveness.

Smoking can increase the risk of developing cervical cancer. Smoking cessation is therefore recommended. Lastly, immunosuppressed individuals need periodic monitoring to prevent lesions which are not very symptomatic becoming cancerous.

Since approval of the first HPV vaccine in 2006 [6], vaccine composition and administration protocols have evolved. Vaccines now provide protection for an increasing number of genotypes. In 2024, Quebec is prioritizing the vaccine that covers low-risk HPV (6 and 11) plus seven high-risk HPVs (16, 18, 31, 33, 45, 52, and 58). The immunization program is adapted by age and other risk factors [7].

HPV vaccination is recommended for people aged 9–45 years, and even older, depending on risk factors. These are the main target groups:

1. Individuals aged 9–20 years, ideally before they first become sexually active;
2. Men aged ≤ 26 years who have sexual relations with other men;
3. Individuals aged 21–45 who are immunosuppressed or have the human immunodeficiency virus (HIV).

These three groups are eligible for the Quebec Immunization Program for free.

Quebec also recommends vaccination for all individuals aged 21–45 who are sexually active. The vaccine can be given during pregnancy, but most will wait until the end of the pregnancy to complete their vaccination. For people aged > 20 years, consulting a healthcare professional to make a decision is recommended [8].

Overall, the Quebec Immunization Committee does not recommend HPV vaccination after age 45. The National Advisory Committee on Immunization has not set any maximum vaccination age.

HPV vaccine is less effective against HPV genotypes already present in an individual but does protect a large proportion of carriers to develop lesions [9]. Its effectiveness is particularly evident if people are exposed to new HPVs. For that reason, it is most effective when given before people are sexually active.

That is also the reason why, even though vaccination is not recommended for or provided free of charge to individuals > age 45, the vaccine is nonetheless authorized for this age group. This makes it available to people who want to reduce their risk of contracting new infections with the HPVs targeted by the vaccines [8].

Even though HPV vaccination is safe and effective, it does not provide full protection against the nine most common genotypes or against the others, which are much less common, but may also cause cancers. As a result, even after vaccination, it is essential that women continue to have screening tests to prevent cervical cancer [10].

Choose simplicity with cervical cancer screening at Biron. Our staff can issue your medical prescription on-site and provide you with fast, confidential service all in a single appointment

• HPV testing with cytology triage

Book an appointment online or contact Biron Health Group Customer Service at 1 833 590-2712.