What is Human Papilloma Virus , वह सब जो आपको HPV VACCINATION के बारे में पता होना चाहिए : Dr Sharda Jain

1. Dr Sharda Jain Ms. Malti

2. वह सब जो आपको
HPV
VACCINATION
क
े बारे में पता होना चाहहए

3. In India, nearly 1 person
dies of HPV-related cancer
every 5 minutes 1
Everything you need to
know about HPV

4. What is Human Papillomavirus?
Human Papillomavirus (HPV) is a
sexually transmitted virus. Like all
viruses, HPV causes infection by
entering the cells.
There are many different types of HPV.
Some types can cause serious health
problems, including genital warts and

5. How common is HPV infection?
It is one of the most common sexually
transmitted viral infections. Data
suggest that almost 80% of
unvaccinated adults will have an HPV
infection at some point in their life.
Therefore, protection against HPV is
very important.
Data on file. MSDIN, September 1, 2021.

6. How does a person acquire HPV infection?
Human Papillomavirus infection is usually acquired through direct skin-
to-skin contact during intimate sexual contact with someone who is
infected. The virus can be transmitted by penetrative as well as
nonpenetrative sexual contact (ie, vaginal, anal, or oral sex).
A person with HPV can pass the infection to someone even when they
have no signs or symptoms Data suggest that women are at a high risk
of almost 30% of acquiring an HPV infection from the single male
partner within 1 year of intercourse, with the risk increasing to almost
50% by 3 years

7. What diseases does HPV cause?
• High-risk HPV types can infect
cervical cells and cause cervical
cancer. They can also infect certain
other cells to cause anal cancer,
vaginal cancer, and vulvar cancer
and high-grade dysplasia
• Low-risk HPV types can cause
genital warts and low-grade
dysplasia. Genital warts do not
turn into cancer

8. What diseases does HPV cause?
Persistent infection is the most important risk factor for disease
progression and the development of cancers.
A lesion that develops as a result of HPV infection is also known
as a central intraepithelial neoplasia (CIN) and is classified
according to its severity. Eventually, low-grade lesions (LSIL)
advance to high-grade lesions (HSIL).
ultimately leading to invasive cancer. Tumor may regress in
response to initial treatment (as illustrated by the green
arrows). However, most cases of latent infection prevent
complete clearance of the viral infection, and eventually results
in the lesion occurring again.

9. What is dysplasia is it common in India
• Dysplasia refers to the presence of abnormal cells
within a tissue or organ. Although not a cancer, it
may sometimes progress to become a cancer.
Dysplasia can be low-grade or high-grade,
depending on how abnormal the cells look under
a microscope and how much of the tissue or
organ is affected.“
• Low-grade dysplasia is characterized by early
changes in size, shape, and number of abnormal
cells formed on the surface of the affected tissue
or organ.

10. What is dysplasia is it common in India
• High-grade dysplasia is characterized by a large
number of precancerous cells on the surface of the
affected tissue/organ that are distinctly different from
normal cells. They have the potential to become
cancerous cells and invade deeper tissues
• More than 30 million cases of low-grade dysplasia and
10 million cases of high-grade dysplasia have been
reported in women globally. Data suggests that around
2% women in India are at a risk of developing cervical
dysplasia," with the high-risk HPV types accounting for
almost 28% of low-grade lesions and 63% of high-
grade lesions 10. Human papillomavirus and related diseases report. Available at:
https://hpvcentre.net/statistics/reports/IND.pdf. Accessed on 18 August 2022.

11. What are genital warts?
Genital warts are growths that can appear on the
outside or inside of the vagina or on the penis. Warts
also can spread to nearby skin and can grow around the
anus, on the vulva, or on the cervix. Genital warts
usually appear as a small bump or group of bumps in
the genital area.
They can be small or large, raised or flat, or shaped like
a cauliflower. Warts may cause itching or pain, or they
may not cause any symptoms. A healthcare provider can
usually diagnose warts by examining the genital area.
Centers for Disease Control and Prevention. Genital HPV Infection-Basic Fact Sheet. Available at:
https://www.cdc.gov/std/hpv/stdfact-hpv.htm. Accessed on: 26 July 2022.
American College of Obstetricians and Gynecologists. Human Papillomavirus (HPV) Vaccination. Frequently asked questions.
Available at: https://www.acog.org/womens-health/faqs/hpv-vaccination. Accessed on: 26 July 2022.

12. How are Genital Warts Treated?
Warts can be removed with
medication or surgery.
Talk with your healthcare
practitioner about treatment.
Wart removers found in the
pharmacy should not be used
on genital warts.
American College of Obstetricians and Gynecologists. Human Papillomavirus (HPV)
Vaccination. Frequently asked questions. Available at: https://www.acog.org/womens-
health/faqs/hpv-vaccination. Accessed on: 26 July 2022.

13. Is HPV common in India?
• Approximately 690,000 people around the world are
diagnosed with a certain HPV-related cancer each
year.
• Human papillomavirus- related cancers are the
second most common cancer in women in India after
breast cancer. 10 Data suggest that at any given time,
about 6.6% of women in the general population in
India are estimated to harbor cervical HPV infection.
Seth S, Malhotra N, Malhotra J., HPV Vaccination-An Update. In: Sekaran SK, Patel M. Suman A,
et al. (eds). FOGSIS update in obstetrics and gynaecology, Volume 2, Evangel Publishing, 2022,
pp. 165-174.
Lu Y, Li P. Luo G, et al. Cancer attributable to human papillomavirus infection in China: Burden and trends.
Cancer. 2020;126(16):3719-3732. 16. Kaarthigeyan K. Cervical cancer in India and HPV vaccination. Indian J Med
Paediatr Oncol. 2012;33(1):7-12.

14. Is HPV common in India?
The incidence rises at 30-34 years of age and peaks at 55-65
years, with a median age of 38 years.
This largely preventable disease is the second most common
cause of cancer mortality among Indian women, accounting for
nearly one-fourth of the world's cervical cancer deaths.
Every five minutes, one patient dies of HPV cancer in India.
Seth S, Malhotra N, Malhotra J., HPV Vaccination-An Update. In: Sekaran SK, Patel M. Suman A, et al. (eds). FOGSIS
update in obstetrics and gynaecology, Volume 2, Evangel Publishing, 2022, pp. 165-174.
Lu Y, Li P. Luo G, et al. Cancer attributable to human papillomavirus infection in China: Burden and trends. Cancer.
2020;126(16):3719-3732. 16. Kaarthigeyan K. Cervical cancer in India and HPV vaccination. Indian J Med Paediatr Oncol.
2012;33(1):7-12.
Reichheld A, Mukherjee PK, Rahman SM, et al. Prevalence of Cervical Cancer Screening and Awareness among Women in
an Urban Community in South India-A Cross Sectional Study. Ann Glob Health. 2020;86(1):30.

15. How long does it take for
cervical cancer to develop?
It can take 3-7 years for certain changes in the cells on the cervix to
become cancer. Research has shown that HPV-infected cells can
develop into a cancerous tumor 10-20 years after infection, or even
longer too. Therefore, regular screening and vaccination are
important.
The purpose of cervical cancer screening is to detect these changes
while they are still easily treatable. Women with "high-grade"
changes can get treatment to have the cells removed from the cervix.
Women with "low-grade" changes can be tested over time to see if
the cells go back to normal.
American College of Obstetricians and Gynecologists. Human Papillomavirus (HPV) Vaccination.
Frequently asked questions. Available at: https://www.acog.org/womens-health/faqs/hpv-vaccination.
Accessed on: 26 July 2022.
National Cancer Institute. HPV and cancer. Available at: https://www.cancer.gov/about-cancer/causes-
prevention/risk/infectious-a gents/hpv-and-cancer. Accessed on: 18 August 2022.

16. How can one avoid getting
infected with HPV?
• There are several things one can do to lower the chances of
getting HPV infection.2,3
• Get vaccinated: The HPV vaccine is safe and effective. It can help
protect against various HPV-related infections and diseases
(including cancers) when given in the recommended age groups.
• Get screened for cervical cancer: Routine screening for women
aged 21 to 65 years can help prevent cervical cancer.¹ If you are
sexually active: Being in a mutually monogamous relationship and
using condoms during sexual intercourse can provide some
protection against HPV infection.
Seth S, Malhotra N, Malhotra J., HPV Vaccination-An Update. In: Sekaran SK, Patel M. Suman A, et al. (eds). FOGSIS update in
obstetrics and gynaecology, Volume 2, Evangel Publishing, 2022, pp. 165-174.
Centers for Disease Control and Prevention. Genital HPV Infection-Basic Fact Sheet. Available at:
https://www.cdc.gov/std/hpv/stdfact-hpv.htm. Accessed on: 26 July 2022.

17. Why is cervical cancer prevention
important for postpartum women?
Human Papillomavirus infection may occur or persist during pregnancy
because of hormonal changes and decreased immunity.19 Studies
have demonstrated that the prevalence of HPV infection is higher in
pregnant women compared to their age-matched cohort of
nonpregnant women (17% vs. 12%), especially in Asian countries. India
has the highest mortality rate of almost 60% for cervical cancer-related
deaths globally.¹
Therefore, cervical cancer prevention during the postpartum period
provides an important opportunity to prevent cervical cancer.21 The
World Health Organization (WHO) aims at screening and vaccinating at
least 70% of women by the age of 35 years as a strategy to eliminate
cervical cancer.
World Health Organization. Screening for cervical cancer. Available at:
https://www.who.int/activities/screening-for-cervical cancer. Accessed on: 20 August 2022.
Sankaranarayanan R, Basu P. Kaur P, et al. Current status of human
papillomavirus vaccination in India's cervical cancer prevention efforts. Lancet Oncol. 2019;20(11):e637-e644.

18. Which HPV vaccines are available in India?
Four HPV vaccines are licensed for use in India, namely the
bivalent, quadrivalent and the nine-valent vaccine.
Almost 140 countries/territories globally have a National HPV
Vaccination Program.
The Ministry of Health and Family Welfare, Government of
India, too has recommended to include HPV vaccination as
part of the Universal Immunization Program,
Sankaranarayanan R, Basu P. Kaur P, et al. Current status of human
17th NTAGI Meeting Minutes June 28,2022. Available at:
https://main.mohfw.gov.in/sites/default/files/17th%20NTAGI%20Meeting
%20Minutes%20June%2028%2C%202022.pdf. Accessed on: 19 August 2022.

20. Do both HPV vaccines -Quadrivalent
/Nanovalent offer the same protection
against HPV infection?
The nine-valent HPV offers more protection than the
quadrivalent vaccine as it has a wider serotype
coverage than the quadrivalent vaccine. Lower rates
of cervical, vulvar, and vaginal neoplasia have been
reported after HPV vaccination with the nine-valent
vaccine compared to the quadrivalent vaccine. The
nine-valent vaccine provides a better cervical cancer
protection than the quadrivalent vaccine,
Joura EA, Giuliano AR, Iversen OE, et al. A 9-valent HPV vaccine against infection and intraepithelial
neoplasia in women. N Engl J Med. 2015,372(8):711-723.
Cheng L, Wang Y, Du J. Human papillomavirus vaccines: An updated

21. Can I receive the HPV vaccine after
childbirth?
Yes, the quadrivalent vaccine is recommended
through the ages of 9 to 45 years in girls and
women28 and the nine-valent vaccine is
recommended in girls and women aged 9 to 26
years.
For complete recommendation, please consult
your doctor.
GARDASIL 9 Prescribing information. MSDIN, 11/20.

22. Is HPV vaccination beneficial
after childbirth?
Injuries to the cervix during vaginal delivery may
increase the risk of HPV infection in women after
childbirth. Moreover, women with multiple vaginal
deliveries and those of young age at their first
full-term delivery have a higher risk of cervical
cancer. Therefore, HPV vaccination is beneficial for
women after childbirth.
For complete recommendation, please consult
your doctor.
Lee CY, Tseng CJ, Chang CC, et al. Postpartum HPV Vaccination Rate and Differences in Background
Characteristics Between HPV Vaccinated and Unvaccinated Postpartum Women: Strict Monitoring and Follow-
Up of Postpartum HPV Vaccination Program. Front Immunol. 2021:12:626582.

23. What is the recommended dosage schedule for HPV
vaccination in women after childbirth?
• If you are aged up to 26 years, either the
quadrivalent or nine-valent vaccine can be
administered according to a 3-dose schedule
(at 0, 2, and 6 months),
• If you are aged above 26 years, the
quadrivalent vaccine can be administered
according to a 3-dose schedule (at 0, 2, and 6
months)
GARDASIL Prescribing information. MSDIN, 10/21..GARDASIL
Prescribing information. MSDIN,

24. Is HPV vaccine effective in a
sexually active person?
Yes. Although the vaccination works best when it is
taken before a person is sexually active and exposed to
HPV, vaccination can still reduce the risk of getting HPV
for people who have already been sexually active.
If you have had sex, you may already be infected with
one or more types of HPV, but the vaccine may still
protect you against HPV types you do not have yet.
Studies have demonstrated that only 0.4% of women
are exposed to the four most prevalent HPV serotypes
(6, 11,16, and 18) and 99.6% of sexually active women
may still benefit from the vaccine.
Velicer C, Zhu X, Vuocolo S, et al. Prevalence and incidence of HPV genital
infection in women. Sex Transm Dis. 2009;36(11):696-703.

25. Can HPV be passed from a mother to her
child during pregnancy?
Though rare, HPV infection can pass through
mother-to-child transmission when the infant
passes through an infected birth canal.
Pan American Health Organization/World Health Organization.
Frequently asked questions on HPV. Available at:
https://www.paho.org/en/documents/frequently-asked-questions-hpv.
Accessed on: 9 August 2022..

26. Can a woman who is breastfeeding
receive HPV vaccination?
Yes, HPV vaccine may be administered to a
woman who is breastfeeding. There have been
no evidences of serious adverse experiences
reported in babies who were nursing during the
vaccination period.
For complete recommendation, please consult
your doctor.
GARDASIL Prescribing information. MSDIN, 10/21.
GARDASIL 9 Prescribing information. MSDIN, 11/20.

27. How can one get tested for HPV infection?
There is no test to find out a person's HPV
status. However, there are HPV tests that can
screen for cervical cancer. Healthcare providers
only use these tests for screening women aged
30 years and older. Human Papillomavirus tests
are not recommended to screen men,
adolescents, or women under the age of 30
years.
Centers for Disease Control and Prevention. Genital HPV Infection-Basic
Fact Sheet. Available at: https://www.cdc.gov/std/hpv/stdfact-hpv.htm.
Accessed on: 26 July 2022.

28. Do I still need cervical cancer screening if I
have had HPV vaccine?
Human Papillomavirus vaccination helps prevent HPV
infection, but it is not a cure for an HPV infection you
already have. Women who have been vaccinated still
need to have regular cervical cancer screening. Data
suggest that combining cervical cancer screening with
vaccination can reduce cervical cancer risk by 61%.
Talk to your healthcare practitioner about when and
how often you should be screened.
Diaz M, Kim JJ, Albero G, et al. Health and economic impact of HPV 16

29. Is the HPV vaccine safe?
Human Papillomavirus vaccine is well-tolerated
and generally doesn't contribute to any serious
health issues. The typical side effects are
usually mild and include pain, redness or
swelling at the injection site, fever, headache,
dizziness, nausea, or muscle or joint pain - all of
which are temporary,
American College of Obstetricians and Gynecologists. Human Papillomavirus (HPV) Vaccination. Frequently asked
questions. Available at: https://www.acog.org/womens-health/faqs/hpv-vaccination. Accessed on: 26 July 2022.
GARDASIL Prescribing information. MSDIN, 10/21.
GARDASIL 9 Prescribing information. MSDIN, 11/20.

30. Is the HPV vaccine safe in the postpartum
period and breastfeeding women?
Yes. The available evidence does not indicate
an increased risk of adverse events linked to
the vaccine in either the mothers or their
babies after administration of HPV vaccine to
lactating females.
Human papillomavirus vaccines: WHO position paper 2017. Available
at:https://www.who.int/teams/immunization-vaccines-and-biologicals/pol
icies/position-papers/human-papillomavirus-(hpv). Accessed on: 9 August
2022

31. What should I do if I got a dose of the HPV vaccine
before I knew I was already pregnant?
The HPV vaccine is not recommended for use in pregnant women, as the data
on the safety of HPV vaccination during pregnancy are limited. However, if
you find out that you are pregnant or have conceived around the time of
vaccination, any further HPV vaccination should be postponed. Termination of
pregnancy is not indicated if vaccination was carried out inadvertently during
pregnancy. There is no evidence to date that the HPV vaccine will have caused
any harm to you, the pregnancy, or the fetus. As per the Federation of
Obstetric and Gynecological Societies of India (FOGSI)
recommendations, the course of HPV vaccination may be completed 6 weeks
after delivery
Pan American Health Organization/World Health Organization. Frequently asked questions on HPV. Available at:
https://www.paho.org/en/documents/frequently-asked-questions-hpv. Accessed on: 9 August 2022..
Bhatla N, Meena J. Gupta K, et al. Human papillomavirus vaccination: Good clinical practice recommendations
from the Federation of Obstetric and Gynecological Societies of India. J Obstet Gynaecol Res. 2020,46(9):1651-
1660.

32. Can HPV vaccine cause fertility
issues in the future?
There is no evidence available that suggests
that the HPV vaccine has an effect on future
fertility. There is no link with miscarriage,
premature labor, or other types of pregnancy
complications.
Frequently asked questions about HPV. Available at: https://www.hpv.org.nz/about-
hpv/hpv-faq-questions. Accessed on: 26 July 2022
GARDASIL Prescribing information. MSDIN, 10/21.
GARDASIL 9 Prescribing information. MSDIN, 11/20.

33. Do condoms prevent HPV-related
infections?
Human Papillomavirus is transmitted through intimate,
skin-to-skin contact with an infected person during
vaginal, penile, anal, or oral sex. You can get HPV
infection even if you do not have sexual intercourse.
Therefore, condom use during sexual intercourse can
provide some protection against infection. However, as
condoms do not cover the entire skin surface that
comes into contact during sexual intercourse, they may
not offer 100% protection.
Frequently asked questions about HPV. Available at: https://www.hpv.org.nz/about-hpv/hpv-faq-questions. Accessed
on: 26 July 2022
American College of Obstetricians and Gynecologists. Human Papillomavirus (HPV) Vaccination. Frequently asked
questions. Available at: https://www.acog.org/womens-health/faqs/hpv-vaccination. Accessed on: 26 July 2022.
Dis. 2008;197(2):279-282.
National Cancer Institute. Understanding cervical changes-A health guide. Available at:

34. Do any national or international
medical organizations recommend
HPV vaccination in postpartum women?
Various medical organizations, namely, FOGSI,
American College of Obstetricians and
Gynecologists (ACOG), Centers for Disease
Control and Prevention (CDC), World Health
Organization (WHO), and Pan American Health
Organization (PAHO) recommend HPV
vaccination in postpartum women.
Pan American Health Organization/World Health Organization. Frequently asked questions on HPV. Available at:
https://www.paho.org/en/documents/frequently-asked-questions-hpv. Accessed on: 9 August 2022..
Human papillomavirus vaccines: WHO position paper 2017. Available at:https://www.who.int/teams/immunization-vaccines-and-biologicals/pol
icies/position-papers/human-papillomavirus-(hpv). Accessed on: 9 August
2022
Centers for Disease Control and Prevention, Human papillomavirus. Available at: https://www.cdc.gov/vaccines/pubs/pinkbook/hpv.html. Accessed on:
17 August 2022.