The reaction to the federal funding and subsequent uptake from provinces and territories for the HPV vaccine to be offered in schools has been the subject of several fact sheets, media reports, position statements and journal articles. This page lists and supplements those items. This collection of resources has been supported by a HPV Awareness Program operated by the Society of Obstetricians and Gaynecologists of Canada. More information can be found at: www.hpvinfo.ca

Fact Sheets

10 Common HPV Vaccine Myths - Get your questions answered....web site sponsored by Government of BC

• New VIDEO for kids about HPV

Should my daughter get the HPV vaccine? (BC Health Guide)
This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation


HPV Vaccine:what are the risks? (University of Manitoba-What Your Patient reads)
The Globe and Mail reported on Sept 2, 2008 of possible adverse reactions to the HPV vaccine. The article refers to an Australian study, published in CMAJ, where an �estimated rate of anaphylaxis incidence was five to 20 times higher with the HPV vaccine than other vaccines.� The article also refers to a reported case of pancreatitis after a HPV vaccine. The Gardasil vaccine is reported to cost $400 for the 3 shots, with some experts questioning the speed with which the vaccination program was implemented. The Globe and Mail states experts are unconvinced of the need for the vaccine. Dr. Lippman questioned the lack of data about the length of immunity Merck Frost claims the Gardasil vaccine covers. The Public Health Agency of Canada reports no confirmed cases of anaphylaxis in Canada stating Gardasil is safe and effective.
References:
Tu Thanh Ha. Allergy to HPV vaccine is rare, but still dangerous, Australian study finds. The Globe and Mail. 2 Sept 2008: A.1
Brotherton JM, Gold MS, Kemp AS, McIntyre PB, Burgess MA, Campbell-Lloyd S. Anaphylaxis following quadrivalent human papillomavirus vaccination. CMAJ. 2008 Sep 1.[Epub ahead of print]


HPV Vaccine Information For Young Women (Centers for Disease Control)
There is now a vaccine that prevents the types of genital human papillomavirus (HPV) that cause most cases of cervical cancer and genital warts. The vaccine, Gardasil�, is given in three shots over six-months. The vaccine is routinely recommended for 11 and 12 year old girls. It is also recommended for girls and women age 13 through 26 who have not yet been vaccinated or completed the vaccine series


Media Reports

HPV and Other Vaccines for Teens (Wall Street Journal)
The Centers for Disease Control and Prevention said about 25% of teenage girls received at least one dose of Merck & Co.'s Gardasil vaccine in 2007, providing the first national estimate of vaccine use. The data, released Thursday, were included in a survey designed to track vaccination rates among 13-to-17 year olds.Since 2005, three new vaccines have been added to the list of recommended vaccines for adolescents along with an additional dose of varicella, which is designed to protect against chicken pox.


Several Alberta Catholic School Boards Refuse HPV Vaccine (Canadian Press)
Alberta is scrambling to come up with a backup plan to vaccinate girls against a virus that causes cervical cancer as more Catholic school boards opt out over a program they say condones premarital sex. So far at least six of Alberta's 20 Catholic boards have voted against allowing girls in Grades 5 and 9 to be inoculated against HPV in schools. More boards are expected to say no after Calgary Bishop Fred Henry spoke out against the program during a meeting with school trustees. Ted Paszek, president of the Alberta Catholic School Trustees' Association, said the bishop's message at a meeting last month resonated with many of the boards. About 8,000 girls in the Catholic system are eligible to receive the vaccine this fall. "The bishop said it would be unacceptable for Catholic schools to be offering this vaccine, that it would tacitly condone premarital sexual activity," said Paszek, who is also president of the Elk Island Catholic School Division, which is to vote on the HPV vaccine this Thursday

Another school board rejects HPV vaccine (Winnipeg Sun)
In a meeting Tuesday night, the board voted unanimously not to allow the HPV vaccine to be offered in local Catholic schools. A number of Alberta Catholic ...

Mother questions HPV vaccine (StarPhoenix-Saskatoon)
The HPV vaccination began being administered voluntarily last week to grade 6 and 7 students at schools in Saskatoon. Consent forms were sent home to ...

Alberta health minister critical of Catholic school boards' ban on ... (The Canadian Press)
Alberta announced in June that the HPV vaccine would be offered to Grade 5 girls beginning in September and to Grade 9 girls starting next year - but only...


B.C.'s health officer insists HPV vaccine Gardasil is safe (www.straight.com)
BC's health officer is standing by Gardasil, the HPV (human papillomavirus) vaccine used to protect against cervical cancer, amid mounting public concern over its safety.

Severe side effects from HPV vaccine rare: study (CBC News)
Severe side effects of the HPV vaccine Gardasil appear to be rare, according to a study that may help calm the fears of some parents as schools

Should your daughter get the HPV vaccine? (Globe & Mail)
John Sexton of Newmarket, Ont., began researching the HPV vaccine after he took his basketball-crazy 13-year-old daughter, Erika, to the doctor with a knee injury, and the physician recommended she get it. "My first thought was there was no way I wanted to be dealing with this", says the teacher and single dad, who has a son and two other daughters, aged 15 and 20. "At 13 and 15, you like to think your kids are pretty innocent. And this is not something you want them to have to worry about. And yet, as soon as you have a chance to reflect on it, you think, Hey, this is a different age.' He hasn't heard whether his Catholic school will be offering the vaccine yet, but either way, he plans to order it for his daughters. If a doctor said, I can give you a shot to help prevent cancer in your foot,' you wouldn't even think twice about it. But because it's dealing with sex, it's just a little more sensitive". But in Victoria, Alan Cassels, the father of a Grade 6 daughter, is relieved British Columbia has delayed its vaccine program for at least a year. "She's 10 years old," he protests. "It's hard for me to imagine her going there." Mr. Cassels, a drug policy researcher at the University of Victoria, has a professional perspective on this issue, as well. He is uneasy about the massive marketing campaign, and wonders why provinces dealing with the same set of facts reached different conclusions.

Position Statements

The FACTS on the Safety and Effectiveness of HPV Vaccine (Public Health Agency of Canada)
The Gardasil vaccine was approved in Canada in July 2006. The vaccine is effective in preventing the strains of human papillomavirus that are responsible for 70 per cent of cervical cancer. HPV is one of the most common sexually transmitted infections in Canada, and the majority of cervical cancers are caused by this infection. Despite the effectiveness of HPV vaccination, vaccinated females must continue to have regular cervical cancer screening. In February, 2007, based on sound scientific consideration, the National Advisory Committee on Immunization (NACI) issued recommendations for the use of Gardasil� for females aged 9 to 26. The Chief Public Health Officer of the Public Health Agency of Canada (PHAC) reviewed these recommendations and strongly supports this vaccine.

National Advisory Committee on Immunization statement on Gardasil In January 2007 the National Advisory Committee on Immunization (NACI) released its recommendations on the Health Canada approved human papillomavirus vaccine, which protects against HPV types 6, 11, 16 and 18. HPV 6 and 11 are linked to 90% of genital warts. HPV 16 and 18 are linked to approximately 70% of cervical cancers. The recommendations state that the following groups of people be vaccinated with the approved vaccine:

• females between the age of 9 and 13 years who have not yet become sexually active
• females between the ages of 14 and 26 years, even if they have become sexually active, as they would benefit from the vaccine
• females between the age of 14 and 26 years who have had previous Pap abnormalities, including cervical cancer, or have had genital warts or known HPV infection, as they could still benefit from the vaccine (they may not have been infected with the HPV types covered by the vaccine)

Ob/gyns to Provinces: Do not delay HPV Vaccine Roll-Out (SOGC)
The Society of Obstetricians and Gynaecologists of Canada (SOGC) is urging the provinces and territories to move quickly to immunize females aged 9 to 26 against the Human Papillomavirus (HPV), the virus that can cause cervical cancer. The recommendations are part of the clinical guidelines released today in Ottawa on the diagnosis, treatment and prevention of HPV. The call for provincial publicly funded immunization programs comes as the SOGC releases the national clinical guideline on HPV. Produced by the SOGC in collaboration with six national health organizations, the comprehensive guideline is the culmination of an exhaustive review of scientific evidence regarding the management, treatment, and prevention of HPV. The SOGC Guidelines on HPV Immunization were produced by SOGC, in collaboration with:

• Association of Medical Microbiology and Infectious Disease Canada (AMMI Canada)
• Canadian Dermatology Association (CDA)
• Canadian Paediatric and Adolescent Gynaecology/Obstetrics Committee (CANPAGO)
• Canadian Paediatric Society
• College of Family Physicians of Canada (CFPC)
• Health Canada
• Society of Canadian Colposcopists (SCC)
• Society of Gynecologic Oncologists of Canada (GOC)

HPV, Vaccines, and Gender: Policy Considerations (Canadian Womens' Health Network, 2007)
A careful review of the literature, including that which was submitted by the manufacturer with its application for approval of Gardasil, reveals a sufficient number of unanswered questions to lead us to conclude that a universal immunization program aimed at girls and women in Canada is, at this time, premature and could possibly have unintended negative consequences for individuals and for society as a whole. We suggest that rather than giving widespread administration of this vaccine a "green light," a more appropriate policy at this time would be a "yellow light" of caution. We recommend that the funding announced by the federal government be used to support the research needed to answer the many questions outlined below; to fund a public education campaign to quell the unfounded anxiety that has been instilled by marketers of the vaccine that HPV represents a "new" or "imminent" threat; and to ensure equal access to Pap testing, including timely follow-up and application of improvements in testing. Only when there is a solid evidence base and an appropriately-provisioned cervical screening program accessible to all can we determine the most appropriate holistic strategy - and the place of vaccination in it - to address cervical cancer and the transmission of HPV between and among Canadian girls, boys, women, and men. We have been given an exciting opportunity to establish effective guidelines and to create a model of how to approach future vaccines. We must take full advantage of it. In this paper, we summarize some of the major questions and concerns that need to be addressed before there is a full-scale roll-out of an HPV vaccination program. These closely reflect issues raised in the analytical framework created by Erickson et al.[i] in the context of the development of the National Immunization Strategy (NIS), and support efforts to ensure a comprehensive and systematic evaluation of all relevant factors before decisions regarding the importance of a new immunization program are made. As well, they echo some of the research questions identified as important in the Final Report from the Canadian Human Papillomavirus Vaccine Research Priorities Workshop held in Quebec City in 2005.[ii]We hope raising these questions now will contribute to the deliberations necessary to ensure a responsible and transparent evidence-based decision-making process. See also:

The HPV vaccine, one year later (Canadian Womens' Health Network 2008) In PEI, Nova Scotia and Newfoundland, uptake of the vaccination programs which began last September has been high (around 80%), but in Ontario only 50% of girls eligible for the vaccine have actually received it so far. School-based vaccination programs usually have very high uptake rates, and the low rate in Ontario, where most of the investigative media reports were published, may be because parents have decided to wait until further evidence is known.
The governments of Quebec, British Columbia and Manitoba all recently announced they will be unrolling vaccination programs in the fall of 2008. Without the usual National Immunization Strategy to guide provinces in the implementation of a vaccination program (the Strategy was not used in this case), the authorities in Quebec have decided to provide only two doses of the vaccine to Grade 4 girls, then a third shot when the girls reach Grade 9. The vaccine is approved for use in three doses within six months, so Quebec’s plan would be an “off-label” (unapproved) use of the vaccine. A clinical trial is currently underway to evaluate this method, which may or may not prove to be effective in the long term, but it has not yet concluded.

Canadian Cancer Society perspective on HPV vaccines
Because of their potential impact in reducing the number of cervical cancers diagnosed in Canada, the Canadian Cancer Society believes that HPV vaccines should be available and affordable to the public. However, vaccines should be used as a complement, not a replacement, for cervical cancer screening. Gardasil � the quadrivalent vaccine The quadrivalent vaccine is manufactured by Merck Frosst Canada Ltd. and marketed under the name Gardasil. Gardasil protects against infection with HPV type 6, 11, 16 and 18 in women not previously infected by these HPV types. The vaccine prevents nearly 100% of the precancerous changes that happen to cells in the cervix from persistent infection with HPV type 16 and 18. Based on current research, Gardasil provides protection for at least 5 years.

HPV vaccine (Human papillomavirus) (Canadian Pediatric Society)
Human papillomavirus (HPV) is the most common sexually transmitted infection in Canada. There are many different types of HPV. Many of them can affect the genital area of men and women including the skin of the penis, vulva (area outside the vagina) or anus, and the linings of the vagina, cervix, or rectum. Most people with HPV infection do not know they have it because it usually causes no symptoms. But, HPV is the major cause of cervical cancer in women. The virus must be present for many years before it develops into cancer. It can also cause genital warts in both men and women. A vaccine can help protect girls from several types of HPV that cause cancer and warts. In Canada, girls 9 to 13 years old should get the vaccine, which is given in 3 doses.

Human Papillomavirus (HPV) Vaccine Position Statement (Canadian Federation for Sexual Health)
The Canadian Federation for Sexual Health believes that the human papillomavirus vaccination, like any vaccination, if proven to be safe and effective, should be equally available to all in Canada, and should be medically supervised, safe and fully funded.


Journal Articles

Researchers Question Wide Use of HPV Vaccines (New York Times)
Two vaccines against cervical cancer are being widely used without sufficient evidence about whether they are worth their high cost or even whether they will effectively stop women from getting the disease, two articles in this week�s New England Journal of Medicine conclude.

Public Health Fact sheet: Patient information about HPV and the HPV vaccine
Tav van Zyl*, Eric Wooltorton, MD MSc and Noni MacDonald, MD MSc
CMAJ August 28, 2007; 177 (5). doi:10.1503/cmaj.071061.
The vaccine is primarily effective in females who have not yet been exposed to HPV; thus, it is recommended that females be vaccinated before they become sexually active. The vaccine offers protection for at least 5.5 years, and studies are being performed to determine whether a booster dose will be required. Even with the vaccine, regular Pap smears are essential because the vaccine does not protect against all types of HPV that can cause cervical cancer. The most common side effect is soreness around the injection site in the arm. Few other minor side effects were reported in the studies

Article Human Papillomavirus Vaccine Uptake, With and Without a School Mandate (J of Ado Health Sep-10) http://is.gd/gCfXb

Article Voluntary School-Based Human Papillomavirus Vaccination: An Efficient Acceptable Model (J of Ado Health Sep-10) http://is.gd/gCfJV

Article Parent Perspectives: The Vaccines They Are Willing to Receive Using School Immunization, (J of Ado Health Sep-10) http://is.gd/gCg9G