Source: MedPage Today
Author: John Gever

The American College of Obstetricians and Gynecologists is adding its weight to recommendations that 11- and 12-year-old girls be vaccinated against human papillomavirus (HPV) and that “catch-up” shots are a good idea for unvaccinated teens and young women up to age 26.

In a new statement, ACOG’s Committee on Adolescent Health Care also stressed that Pap smears are still necessary for women starting at 21, even if they’ve been vaccinated against HPV. Current vaccines do not protect against all viral strains, and vaccination does not clear preexisting infections.

Two HPV vaccines are now available: a bivalent product (Cervarix) that protects against genotypes 16 and 18; and a quadrivalent product (Gardasil) that protects against the same two strains plus genotypes 6 and 11.

The new statement, published online in Obstetrics & Gynecology, updates one issued in 2006 when the quadrivalent product was approved. The bivalent vaccine was approved last October.

The federal Advisory Committee on Immunization Practices has recommended that girls first receive HPV immunization at age 11 or 12, before becoming sexually active, and the ACOG committee said that was appropriate in most cases.

“Depending on the circumstances, the vaccine can be given to individuals as young as age 9 years,” the committee indicated.

Vaccination before the start of sexual activity ensures maximal effectiveness, but ACIP has recommended catch-up vaccination for sexually active young women who have not received either product.

The ACOG committee endorsed the recommendation, noting that the vaccines may even be given to young women with a history of possible HPV infection as indicated by previous cervical intraepithelial neoplasia or genital warts.

Unvaccinated sexually active women “should be counseled that the vaccine may be less effective in individuals who have been exposed to HPV,” according to the ACOG statement. However, HPV testing is not necessary or recommended before giving the vaccine, because a positive result would not be a contraindication.

“If the patient is tested and the results are positive, vaccination is still recommended because the chance that all vaccine preventable types are present is low,” the committee explained.

It also advised that vaccination is not recommended for women who are pregnant or trying to get pregnant, but that women who are breastfeeding may safely receive the vaccines without endangering their babies.

To be safe, sexually active women starting the three-dose vaccination series should use contraception until it is completed.

If pregnancy occurs while the series is underway, dosing should be delayed until the pregnancy ends, and the pregnancy and its outcome should be reported to the vaccine manufacturer’s registry.