Human Papilloma

Virus (HPV) Vaccine

Expanded Program on Immunization
DOH RO VI
 Global burden of
Cervical Cancer
The second most common cancer in
women
Every year:
530,000 new cases diagnosed
275,000 deaths
Over 85% in developing countries
By 2050:
one million cases
90% in developing countries

Department of Health
Region Office VI
| Human Papilloma Virus Vaccine Expanded Program on
| Immunization
 What is cervical cancer?
The cervix is the lower part of
uterus (womb)
Cervical cancer is the
uncontrolled growth of
abnormal cells in the cervix,
which usually starts on the
surface
Cervical cancer is invasive,
which means it can grow
deep into the cervix and
uterus
It can spread to other parts of
the body (metastasize) in
some cases
Department of Health
Region Office VI
| Human Papilloma Virus Vaccine Expanded Program on
| Immunization
 What causes cervical
cancer?
Human papillomavirus (HPV) is the
main cause of cervical cancer

HPV is a common virus, which is

Easily spread by skin-to-skin contact
during sexual activity with another
infected person
Human Papillomavirus

Department of Health
Region Office VI
| Human Papilloma Virus Vaccine Expanded Program on
| Immunization
 What causes cervical
cancer?
HPV types 16 and 18 are associated with
about 70% of all cervical cancer cases

Risk factors for HPV infection and

cervical cancer:
Early sexual intercourse
Multiple sexual partners
Tobacco use
Human Papillomavirus

Department of Health
Region Office VI
| Human Papilloma Virus Vaccine Expanded Program on
| Immunization
 Symptoms of advanced
cervical cancer
HPV infection is often asymptomatic
Symptoms appear after cancer reaches an advanced stage
Main symptoms include:
Irregular vaginal bleeding or bleeding after sexual intercourse
Back, leg or pelvic pain
Fatigue, weight loss, loss of appetite
Vaginal discomfort or odorous discharge
Single swollen leg
More severe symptoms (usually more advanced):
Severe anaemia
Renal failure
Fistulae
Lymphoedema

Department of Health
Region Office VI
| Human Papilloma Virus Vaccine Expanded Program on
| Immunization
 How does HPV infection
lead to cervical cancer?

Department of Health
Region Office VI
| Human Papilloma Virus Vaccine Expanded Program on
| Immunization
 Prevention and
Treatment

HPV vaccination prevents 95% of

HPV infections with types 16 & 18

Department of Health
Region Office VI
| Human Papilloma Virus Vaccine Expanded Program on
| Immunization
 What is the
presentation of the HPV
Vaccine?
HPV Vaccine is available in a liquid formulation:
as a single dose vial
intramuscular injection

1 vial has 0.5mL suspension

Each vial contains a Vaccine Vial Monitor (VVM)

Vaccine vials are available in pack sizes of 1, 10,

and 100
Department of Health
Region Office VI
| Human Papilloma Virus Vaccine Expanded Program on
| Immunization
 Is the quadrivalent
vaccine effective?
The quadrivalent vaccine aims to prevent from:
Infection due to HPV types 16 & 18 that cause the
majority of cervical cancers
Infection due to HPV types 6 & 11 that are responsible
for genital warts

High efficacy of the quadrivalent vaccine against

persistent infection with HPV types has been
demonstrated in females

There is no evidence of waning immunity

Department of Health
Region Office VI
| Human Papilloma Virus Vaccine Expanded Program on
| Immunization
 Is the quadrivalent
vaccine safe?
The vaccine is well-tolerated with no
major safety concerns

Injection site reactions such as

redness, pain and swelling can
occur

Mild adverse events include fever,

Department of Health
Region Office VI
dizziness and nausea
| Human Papilloma Virus Vaccine
|
Expanded Program on
Immunization
 Is the quadrivalent
vaccine safe?
Syncope can occur after any medical
procedure and is not uncommon in
adolescents following receipt of a
vaccine.

It is recommended that adolescents be

seated during HPV vaccine administration
and observed for 15 minutes afterwards

Department of Health
Region Office VI
| Human Papilloma Virus Vaccine Expanded Program on
| Immunization
 HPV vaccine storage
conditions
HPV vaccines
should be stored
between +2oC and
+8oC
HPV vaccine is
freeze sensitive
HPV vaccine is light
sensitive
Department of Health
Region Office VI
| Human Papilloma Virus Vaccine Expanded Program on
| Immunization
 Temperature sensitivity
of vaccines
Heat
OPV
sensitivity
Most Rotavirus
sensitive MMR
Measles
Penta-
valent
BC Pneumo Vaccine formulation
G Vaccines to the PS-PCV Freeze dried
left of the line HPV Liquid, no adjuvant
are not damaged
by freezing Liquid, with alum
adjuvant

HepB
Least
sensitive
Least Most
sensitive
Freeze sensitivity sensitive

Department of Health
Region Office VI
| Human Papilloma Virus Vaccine Expanded Program on
| Immunization
 Where to place HPV
vaccine in the
refrigerator?

Department of Health
Region Office VI
| Human Papilloma Virus Vaccine Expanded Program on
| Immunization
 Vaccine Administration

Dose 1 Dose 2

2 doses at a minimum interval of 6

months
Department of Health
Region Office VI
| Human Papilloma Virus Vaccine Expanded Program on
| Immunization
 Who should get HPV
vaccine?

Department of Health
Region Office VI
| Human Papilloma Virus Vaccine Expanded Program on
| Immunization
 Are there
contraindications to
HPV vaccination?
HPV vaccine is not recommended for:

SEVERE

FEBRIL
E
ILLNESS
A minor infection such as a cold is not a contraindication

Department of Health
Region Office VI
| Human Papilloma Virus Vaccine Expanded Program on
| Immunization
 Immunization sessions:
Phases & Critical
Activities

Phase 1 Phase 2 Phase 3

Before girls come When girls come for After all girls leave
for immunization immunization immunization AREA

Department of Health
Region Office VI
| Human Papilloma Virus Vaccine Expanded Program on
| Immunization
 Phase 1:
Before girls come for immunization

1. Take vaccines and

vials out of the
refrigerator
2. Check expiry date
and VVM status for
each vial
3. Collect & arrange
supplies and
monitoring tools for
immunization session
4. Prepare an AEFI Kit
Department of Health
Region Office VI
| Human Papilloma Virus Vaccine Expanded Program on
| Immunization
 How to ensure that
vaccine is of good
quality?
Check the temperature inside the
refrigerator, if vaccine freezing is
suspected perform the Shake test to
confirm

Check VVM status

Check the expiry date on the vials

Department of Health
Region Office VI
| Human Papilloma Virus Vaccine Expanded Program on
| Immunization
 Phase 2:
When girls came for immunization
1. Check eligibility of girls
2. Prepare injection using aseptic techniques
3. Administer vaccine according to the
recommended techniques and injection site
4. Dispose used syringes immediately into
safety box after each injection
5. Complete immunization card and tally
sheet
6. Give key messages to girl/caregiver/parent:
inform about vaccines given, side effects,
and date of return

Department of Health
Region Office VI
| Human Papilloma Virus Vaccine Expanded Program on
| Immunization
 What to do when the
girls come for
immunization?

3.Prepare
for vaccine
1.Greet the 2.Verify, register, 4.Inject in
girl explain HPV the upper
vaccine benefits arm

5.Determine date
for next vaccine
6.Return dose
7.Observe
the
the girl for Department of Health
updated
15 Region Office VI
card
| Human Papilloma Virus Vaccine Expanded Program on
| Immunization
 How to prepare for
vaccination?
Shake the vial well

Open AD syringe package

and remove the syringe
and needle from plastic
wrapping

Ensure that you do not

touch any part of the
needle

Department of Health
Region Office VI
| Human Papilloma Virus Vaccine Expanded Program on
| Immunization
 How to prepare for
vaccination?
Take off the needle
cap when you are
ready to give the
vaccine

Insert the needle

into the vaccine vial

Draw vaccine from

the vial into the
0.5mL syringe
Department of Health
Region Office VI
| Human Papilloma Virus Vaccine Expanded Program on
| Immunization
 Route and site of
administration
Injection route:
Intramuscular

Injection site: the

upper arm, check
national policy on
which arm (left or
right)

The injection angle-

90 degree angle
Department of Health
Region Office VI
| Human Papilloma Virus Vaccine Expanded Program on
| Immunization
 Phase 3:
After all the girls leave
immunization site

1. Complete Immunization tally sheet by counting

the number of doses given

2. Return unopened vaccine vials to the refrigerator

3. Put safety box in a safe location

4. Inform community of the next session and

activities planned to reach unvaccinated girls

Department of Health
Region Office VI
| Human Papilloma Virus Vaccine Expanded Program on
| Immunization
 Considerations of AEFI
related to HPV vaccine
HPV vaccine is a safe vaccine but mild
adverse events can occur after
administering the vaccine
Redness, pain or swelling at the
injection site
Syncope (fainting)

In extremely rare instances it can cause

anaphylaxis
One per 1.7 million doses Department of Health
Region Office VI
| Human Papilloma Virus Vaccine Expanded Program on
| Immunization
 Considerations of AEFI
related to HPV vaccine
Girls should be observed carefully
for 15 minutes after administration
of vaccine

Manage and document any adverse

reaction accordingly to the national
reporting procedures

Department of Health
Region Office VI
| Human Papilloma Virus Vaccine Expanded Program on
| Immunization
Thank you!!!