Building HPV

Vaccine Confidence:
An Educational Toolkit

Overview
HPV is the most common sexually transmitted infection and causes tens of thousands of new cancer cases every year in the US alone. The HPV vaccine is highly
effective at preventing HPV infection and associated cancers, but vaccination rates remain suboptimal among teens and young adults. With the current climate of
vaccine distrust and widespread misinformation, providing clear education that aligns with the values and concerns of patients and their families is essential for
building vaccine confidence.

Pediatricians and primary care providers (PCPs) are well positioned to provide education to eligible patients and their families about HPV and the HPV vaccine.
PCPs have long been recognized as trusted sources of health information, and personalized recommendations from an individual’s own provider have been
shown to highly influence willingness to accept vaccines.

This comprehensive Patient-Provider Learning Toolkit was developed to assist health care professionals (HCPs) in implementing informal, small-group
education sessions to discuss HPV vaccination with patients and their families. This toolkit contains resources and guidance on how to provide a safe and non-
judgmental space where patients and their family members can ask questions about this vaccine and share their concerns with clinicians. During the educational
sessions, HCPs lead their patients through discussions about HPV infection and associated cancers, the science behind the HPV vaccine, and practical
information about insurance coverage, cost, and where to get the vaccine. This toolkit also provides clear and straightforward materials to help HCPs dispel
misinformation and address common questions about HPV vaccine safety and efficacy.

Whether your team is just starting your patient education efforts or scaling up existing initiatives, the resources in this toolkit can serve as a springboard to engage
and empower your patients and maximize success in your clinic(s) and community!

Patient-friendly content covering Speaker notes to help your

key topics using simple language team deliver the information

Clear explanations of vaccine Additional resources

science, benefits, and risks on HPV for your patients

References and Resources

1. Meites E, et al. Human papillomavirus. In: Hall E, et al, eds. Epidemiology and prevention of vaccine-preventable diseases. 14th ed. Washington, DC: Public
Health Foundation; 2021.
2. Meites E, et al. MMWR. 2019;68(32);698–702.
3. Senkomago, V, et al. MMWR. 2019;68(33);724–728.
4. Giuliano AR, et al. Gynecol Oncol. 2019;154(1):110-117.
5. Damme PV, et al. Pediatrics. 2015;136(1):e28-e39.
6. Kjaer SK, et al. EClinicalMedicine. 2020;23:100401.
7. Kjaer SK, et al. Hum Vaccin Immunother. 2021;17(4):943–949.
8. Moreira ED, et al. Pediatrics. 2016;138(2):e20154387.
9. Shimabukuro T, et al. Pediatrics. 2019;144(6):e20191791.
10. Immunize.org. Ask the experts: HPV. Available at: https://www.immunize.org/askexperts/experts_hpv.asp#:~:text=In%20the%20United%20
States%2C%20an,age%2015%20through%2024%20years. Accessed 1/12/23.
11. Centers for Disease Control and Prevention (CDC). HPV vaccine. Available at: https://www.cdc.gov/hpv/parents/vaccine-for-hpv.html. Accessed
1/12/2023.
12. Centers for Disease Control and Prevention (CDC). HPV vaccine safety and effectiveness data. Available at: https://www.cdc.gov/hpv/hcp/vaccine-safety-
data.html. Accessed 1/12/23.
13. Centers for Disease Control and Prevention (CDC). Vaccines for Children Program (VFC). https://www.cdc.gov/vaccines/programs/vfc/index.html.
Accessed 1/12/2023.

For additional CME/CE activities on other disease states, visit www.primeinc.org.

This activity is provided by PRIME® Education. There is no fee to participate. www.primeinc.org

This activity is supported by an educational grant from Merck Sharp & Dohme LLC.
Building HPV
Vaccine Confidence:
An Educational Toolkit

Thank you for presenting this patient education program titled “Building HPV Vaccine Confidence: An Educational Toolkit” in your
clinic. We hope these materials will help increase patients’ engagment in their health care decisions and care plans for years to come.

Instructions to Obtain Credit Learning Objectives

1. Complete the activity in its entirety. • Evaluate the epidemiology, burden, and downstream consequences of HPV infection
among adolescents and young adults, especially within underserved communities
2. Visit PRIME®’s Credit Center at
www.primeinc.org/credit. • Incorporate the latest guidelines and clinical evidence on HPV vaccine safety,
efficacy, patient eligibility, and administration schedule to support protection from
3. Enter program code 72PT221. infection
4. Upon completion of the learner assessment tools,
you will be able to print or save an electronic copy
of your certificate.

Release Date: February 2, 2023

Joint Accreditation Statement

In support of improving patient care, PRIME® is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the
Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the
healthcare team.

Interprofessional Teams
This activity was planned by and for the healthcare team, and learners will receive 1.0 Interprofessional Continuing Education (IPCE)
credits for learning and change.

Physician Credit Designation Statement

PRIME® designates this Enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only credit commensurate
with the extent of their participation in the activity.

Physician Assistant Credit Designation Statement

PRIME® has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance
with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 CME credit. PAs should only claim credit commensurate with the extent
of their participation.

Nurse Practitioner Accreditation Statement

PRIME Education is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education.
Provider number: 060815. This activity is approved for 1.0 contact hour (which includes 0.13 hour of pharmacology).

Pharmacy Credit Designation Statement

This Application-based activity has been approved for 1.0 contact hour (0.1 CEUs) by PRIME® for pharmacists. The Universal Activity Number for this
activity is JA0007144-0000-23-038-H06-P. Pharmacy CE credits will be submitted electronically to the NABP upon successful completion of the
activity. Pharmacists with questions can contact NABP customer service (help@nabp.pharmacy).

Nursing Credit Designation Statement

PRIME® designates this activity for 1.0 contact hour

This activity is provided by PRIME Education. There is no fee to participate. www.primeinc.org

This activity is supported by an educational grant from Merck Sharp & Dohme LLC.
This activity is provided by PRIME Education. There is no fee to participate. This
activity is supported by an educational grant from Merck Sharp & Dohme LLC.
© 2023 PRIME® Education, LLC. All Rights Reserved.

1
 Agenda

• What Is HPV?
• Who Is at Risk for HPV?
• Demystifying the Science Behind HPV Vaccination
• When Should HPV Vaccines Be Given?
• Q&A: What Questions or Concerns Do You Have About HPV Vaccination?
• Take Action: Plan and Prepare for HPV Vaccination

© 2023 PRIME® Education, LLC. All Rights Reserved.

2
HPV: THE BASICS

© 2023 PRIME® Education, LLC. All Rights Reserved.

3
 What Is Human Papillomavirus (HPV)?

HPV is a virus transmitted through prolonged skin-to-skin contact

• Family of viruses with >200 types
• Most commonly transmitted through sexual activity

Most HPV infections do not cause symptoms and resolve on their own.
Some HPV types can cause genital warts; others cause certain types of cancer
HPV-associated cancers include:
- Cervical cancer - Penile cancer
- Vaginal cancer - Anal cancer
- Vulvar cancer - Mouth and throat cancers

People of any gender can get HPV and develop HPV-associated cancer
Meites E, et al. Human Papillomavirus. In: Hall E, et al, eds. Epidemiology and Prevention of Vaccine-Preventable Diseases. 14th ed. Washington, DC: Public Health Foundation; 2021; Meites E, et al. MMWR. 2019;
68(32);698–702. US Center for Disease Control and Prevention (CDC). Reasons to Get HPV Vaccine. https://www.cdc.gov/hpv/parents/vaccine/six-
reasons.html#:~:text=85%25%20of%20people%20will%20get,go%20away%20on%20their%20own. Accessed 1/12/23. © 2023 PRIME® Education, LLC. All Rights Reserved.

Main points:
• HPV is a virus transmitted through skin-to-skin contact.
• HPV is most commonly transmitted through sexual activity,
but “sexual activity” in this context is not limited to
penetrative sex. Any prolonged skin-to-skin contact has the
potential to lead to HPV transmission.
• While most HPV infections are relatively harmless and do not
cause symptoms, some can cause genital warts or cancer
• Anyone can acquire an HPV infection and develop an HPV-
associated cancer, not just girls and women
Additional information about HPV transmission:
• There is some evidence for non-sexual transmission of HPV.
HPV can persist for long periods of time on fomites, including
medical devices, and HPV DNA has been detected in people
who report no history of sexual activity.
Reference: Liu Z, Rashid T, & Nyitray AG. Sexual Health.
2016;13:10-21.

4
 How Common Is HPV Infection?

HPV is the most common sexually transmitted infection in the US

• 85% of people will get an HPV infection during their lifetime
Statistics: • 13 million Americans get it every year
• Half of new infections occur between age 15-24 years old

All people who have had sexual contact are at risk for HPV
Risk Factors: • It’s common to acquire HPV shortly after first sexual encounter
• You can acquire HPV even if you have only had one sex partner

There is no treatment or cure for HPV infection

Castellsagué X, et al. BMC Infect Dis. 2014; 14:551; Winer RL, et al. J Infect Dis; 2008; 197(2):279-282; Meites E, et al. Human Papillomavirus. In: Hall E, et al, eds. Epidemiology and
Prevention of Vaccine-Preventable Diseases. 14th ed. Washington, D.C.: Public Health Foundation; 2021; CDC. Reasons to Get HPV Vaccine. https://www.cdc.gov/hpv/parents/vaccine/six-
reasons.html#:~:text=85%25%20of%20people%20will%20get,go%20away%20on%20their%20own. Accessed 1/12/23; CDC. HPV Infection. https://www.cdc.gov/hpv/parents/about-
hpv.html#:~:text=HPV%20infections%20are%20very%20common,teens%2C%20become%20infected%20each%20year. Accessed 1/12/23. Immunize.org. Ask the Experts: HPV.
https://www.immunize.org/askexperts/experts_hpv.asp#:~:text=In%20the%20United%20States%2C%20an,age%2015%20through%2024%20years. Accessed 1/12/23. © 2023 PRIME® Education, LLC. All Rights Reserved.

Main points:
• HPV is the most common sexually transmitted infection in the
US, and nearly everyone (>85% of sexually active adults) will
get it at some point if they are not vaccinated
• You do not have to have multiple sexual partners to acquire
HPV. You can acquire HPV the first time you have sexual
contact with someone, and it is common for people to
acquire it shortly after they become sexually active during
adolescence or young adulthood. And once again, “sex” does
not have to be penetrative sex. Any intimate sexual contact
can lead to HPV transmission.
• There are no treatments available to treat and cure HPV
infection itself. While there are treatments for genital warts
and HPV-associated cancers, these are often painful and can
be expensive. There is no cure for HPV-associated cancer.

5
 HPV-Associated Cancers in the US
47,199 new cases of HPV-associated cancers every year
New HPV-associated cancer diagnoses
(Annually, from 2015-2019)

Men
21,022 Women
(45%) 26,177
(55%)

Most HPV-associated cancers develop between 50-70 years of age, but HPV infections that
can lead to cancer are likely to occur much earlier in life
Meites E, et al. Hum Vaccines Immunother. 2022;18(1):e2016007; Melkonian SC, et al. MMWR. 2020; 69(37);1283–1287; Zahnd WE, et al. Cancer Epidemiol Biomarkers Prev. 2018;27(11):1265–1274; Lin YY, et al. JNCI Cancer
Spectrum. 2022;6(2):pkac004; CDC. HPV-Associated Cancer Diagnosis by Age. https://www.cdc.gov/cancer/hpv/statistics/age.htm. Accessed 1/12/23; CDC. U.S. Cancer Statistics: Cancers Associated with Human
Papillomavirus, United States – 2015-2019. https://www.cdc.gov/cancer/uscs/about/data-briefs/no31-hpv-assoc-cancers-UnitedStates-2015-2019.htm. Accessed 1/12/23; © 2023 PRIME® Education, LLC. All Rights Reserved.

Main points:
• HPV-associated cancers are prevalent in the US and occur in
both men and women.
− Note: “HPV-associated cancers” includes all cancers
listed on slide 11 (cervical, vaginal, vulvar, penile, anal,
and oropharyngeal). Not all of the cases here were
confirmed to have been caused by HPV, but based on
this data set about 79% of these cancers are caused by
HPV.
• While these cancers are usually not detected until later in
life, exposure to HPV that can lead to cancer is likely to begin
during adolescence and young adulthood

6
QUESTIONS?

© 2023 PRIME® Education, LLC. All Rights Reserved.

7
 Preventing HPV-Associated Cancers Through Vaccination
A majority of anogenital and mouth/throat cancers are caused by HPV
Caused by HPV
HPV type covered HPV type not covered
Cancer type by the HPV vaccine by the HPV vaccine HPV-negative
Cervix 81% 10% 9%
Vagina 73% 2% 25%
Vulva 63% 6% 31%
Penis 57% 6% 37%
Anus 88% 3% 9%
Mouth/throat 66% 5% 29%
Total 73% 6% 21%

The HPV vaccine covers the 9 types of HPV most likely to cause cancer
Senkomago, V, et al. MMWR. 2019; 68(33);724–728; CDC. Human Papillomavirus (HPV) Vaccination: What Everyone Should Know.
https://www.cdc.gov/vaccines/vpd/hpv/public/index.html#:~:text=Three%20HPV%20vaccines%E2%80%949%2Dvalent,that%20cause%20most%20HPV%20cancers. Accessed 1/12/23.
© 2023 PRIME® Education, LLC. All Rights Reserved.

Main points:
• Cancers caused by HPV are not rare. A majority of cancers
that affect the anogenital region, mouth, or throat are
attributed to HPV.
• The green and orange columns both show the % of each
cancer type caused by HPV. As you can see, a majority of
each of these cancers are caused by HPV.
• The good news is that most cancers attributable to HPV are
caused by one of the 9 HPV types covered by the HPV
vaccine* (shown in the green column)
*This presentation refers to the 9-valent HPV vaccine (9vHPV,
Gardasil 9) as “the HPV vaccine” since it is the only one
currently distributed in the US.

8
 How Does the HPV Virus Cause Infection?
The HPV virus causes infection by entering cells and multiplying
HPV virus 1. Virus infects cells 3. Virus infects new cells

Cells

2. Virus multiplies
The virus consists of both protein and genetic material (DNA)

✓ Protein

Both protein and DNA are needed for the virus to infect cells and multiply
✓ DNA

National Cancer Institute. Human Papillomavirus (HPV) Vaccines. https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-vaccine-fact-sheet#:~:text=lasts%20(20).-

,How%20do%20HPV%20vaccines%20work%3F,prevent%20it%20from%20infecting%20cells. Accessed 1/5/23; Children’s Hospital of Philadelphia. A Look at Each Vaccine: Human Papillomavirus.
https://www.chop.edu/centers-programs/vaccine-education-center/vaccine-details/human-papillomavirus. Accessed 1/5/23. © 2023 PRIME® Education, LLC. All Rights Reserved.

Main points:
• As a contrast to how the vaccine works, this slide first
establishes how the HPV virus causes infection
• Point out that the HPV virus has both an outer protein layer
that helps it get inside cells, and also DNA that is necessary
for the virus to replicate and cause infection
• Without either of these components, the virus would not be
able to cause infection or multiply/replicate

9
 How Does the HPV Vaccine Work to Prevent Infection?

The HPV vaccine contains proteins from HPV that cause an immune response,
but does not contain viral DNA

✓ Protein
Immune system responds to HPV proteins in the vaccine
and can protect against HPV infection in the future

X DNA
The vaccine does not contain viral DNA or whole virus
particles and cannot cause infection

You cannot get HPV infection from the HPV vaccine

National Cancer Institute. Human Papillomavirus (HPV) Vaccines. https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-vaccine-fact-sheet#:~:text=lasts%20(20).-
,How%20do%20HPV%20vaccines%20work%3F,prevent%20it%20from%20infecting%20cells. Accessed 1/5/23; Children’s Hospital of Philadelphia. A Look at Each Vaccine: Human Papillomavirus.
https://www.chop.edu/centers-programs/vaccine-education-center/vaccine-details/human-papillomavirus. Accessed 1/5/23. © 2023 PRIME® Education, LLC. All Rights Reserved.

Main points:
• In contrast to HPV virus, the HPV vaccine only consists of proteins from HPV. By seeing these proteins, the immune system
learns how to fight off HPV infection the next time you’re exposed to the virus.
• The HPV vaccine DOES NOT contain DNA or genetic material from the HPV virus. For this reason, the vaccine CANNOT
cause infection.
• The HPV proteins included in the vaccine are made in a lab using yeast. The vaccine DOES NOT contain whole virus (live
attenuated or inactivated virus). There is no chance of HPV infection from the vaccine.
Additional information pertinent to common HPV vaccine questions:
• Protein in the HPV vaccine is grown in a lab in yeast. The manufacturing process does not involve eggs, bacteria, or viruses.
• While the HPV vaccine does not contain viral genetic material, some other vaccines (namely COVID-19 mRNA vaccines) do.
If there is confusion about this, it’s important to emphasize that the COVID mRNA vaccines only contain a small portion of
viral mRNA that encodes one protein from the virus. It’s impossible for just that one protein to cause infection.
• Ingredients in the 9-valent HPV vaccine (Gardasil 9) include:
− Amorphous aluminum hydroxyphosphate sulfate: this is an adjuvant that strengthens the immune response
to the HPV proteins and helps better protect you against HPV. Aluminum salts have been used as adjuvants
in vaccines for 70+ years, and are currently used in other vaccines like PCV vaccines against pneumococcal
pneumonia, HepA/B, and DTaP
− Yeast protein: this is a byproduct of how the HPV proteins are made
− Sodium chloride: this is the same thing as table salt, and is included to help stabilize the acidity or pH and
salinity of the vaccine so that it is safe to inject
− L-histidine: this is an amino acid/protein building block that occurs naturally in your body and helps stabilize
the acidity or pH of the vaccine so that it is safe to inject
− Polysorbate 80: this is a stabilizer that is present in relatively small amounts in the HPV vaccine. This is also
an ingredient in many commercial ice cream brands, and is present in much higher amounts in those food
products.
− Sodium borate: this also helps regulate the acidity or pH of the vaccine, and is not present in high enough
quantities in the vaccine to do any harm
− Water
The HPV vaccine does not contain formaldehyde, mercury, or thimerosol
References:
Merck. Information About Gardasil 9. https://www.gardasil9.com/adolescent/questions/. Accessed 1/4/23.
CDC. Adjuvants and Vaccines. https://www.cdc.gov/vaccinesafety/concerns/adjuvants.html. Accessed 1/4/23.
Children’s Hospital of Philadelphia. Vaccine Ingredients. https://www.chop.edu/centers-programs/vaccine-education-
center/vaccine-ingredients/formaldehyde%C3%A2%C2%80%C2%8B. Accessed 1/4/23.

10
 How Effective Is the HPV Vaccine?

The HPV vaccine is 90-100% effective at preventing

HPV-associated cancers
Shown in studies including over 15,000 participants, both male and female, ages 9-26

Real-world impact:
Since the HPV vaccine was approved in 2006, HPV infections that most
commonly cause cancer and genital warts have dropped by:
➢ 88% in teen girls
➢ 81% in young women
In the future, the HPV vaccine can prevent up to 92% of HPV-associated cancers
US Food and Drug Administration (FDA). Prescribing Information for 9vHPV. https://www.fda.gov/media/90064/download. Accessed 1/12/23. Giuliano AR, et al. Gynecol Oncol. 2019;154(1):110-117; Damme
PV, et al. Pediatrics. 2015; 136(1):e28-e39; Kjaer SK, et al. EClinicalMedicine. 2020; 23:100401; Kjaer SK, et al. Hum Vaccin Immunother. 2021;17(4):943–949; Senkomago, V, et al. MMWR. 2019; 68(33);724–728;
CDC. HPV Vaccine. https://www.cdc.gov/hpv/parents/vaccine-for-hpv.html. Accessed 1/12/23.
© 2023 PRIME® Education, LLC. All Rights Reserved.

Main points:
• The HPV vaccine is highly effective (90%-100%) at preventing HPV-associated
cancers.
Additional information for reference:
- The efficacy is given as a range because efficacy varies by cancer type (eg,
cervical vs. vaginal vs. oropharyngeal). Regardless, this vaccine is highly
effective.
- Efficacy was demonstrated in young girls and women ages 16-26, and is
inferred for girls 9-15 years, boys and men based on comparable antibody
responses.
• We have already seen a substantial drop in HPV-associated cancers and genital warts
among teen girls and young women since the vaccine was first introduced in 2006.
Additional information for reference:
− We likely still have not fully realized the impact of these vaccines, as the
average age of onset for most HPV-associated cancers is between 50-70
years old
Reference: CDC. HPV-Associated Cancer Diagnosis by Age.
https://www.cdc.gov/cancer/hpv/statistics/age.htm. Accessed 12/15/22.
− The drop in genital warts and HPV-associated cancer is slightly lower in
young women because many were coming of age to get the vaccine when
it was first introduced, and so vaccine coverage in that age group is likely
lower than in teenage girls.
• Based on what we know about the prevalence of cancers associated with the 9 HPV
types covered by the vaccine, we estimate that up to 92% of HPV-associated cancers
can be prevented in the future by vaccinating people against HPV.

11
 Is the HPV Vaccine Safe?
The HPV vaccine has been proven safe, with over 135 million doses
administered in the US since 2006

HPV vaccination does not cause:

• Blood clots or stroke • Infertility or premature ovarian failure
• Allergic reactions • Miscarriages or infant/fetal death
• Seizures • Birth defects
• Guillain-Barré Syndrome
(rare cause of paralysis)

The HPV vaccine is very safe in adolescents and young adults

Children’s Hospital of Philadelphia. A Look at Each Vaccine: Human Papillomavirus. https://www.chop.edu/centers-programs/vaccine-education-center/vaccine-details/human-
papillomavirus#:~:text=The%20HPV%20vaccine%20is%20made,reproduce%20itself%20or%20cause%20illness. Accessed 1/4/23; CDC. Reasons to Get HPV Vaccine.
https://www.cdc.gov/hpv/parents/vaccine/six-reasons.html#:~:text=85%25%20of%20people%20will%20get,go%20away%20on%20their%20own. Accessed 1/5/23. © 2023 PRIME® Education, LLC. All Rights Reserved.

Main points:
• Data collected over 16 years and hundreds of millions of doses of vaccines administered have shown that the
HPV vaccine is incredibly safe
• 2 main ways of collecting data on vaccine safety:
1) Clinical trials
2) Monitoring networks like the CDC’s Vaccine Adverse Events Reporting System (VAERS) through which
people who have received vaccines can report any adverse events that happen after vaccination.
− A note about VAERS: events reported through VAERS have not been proven to be caused by the
vaccine. For example, someone could receive the vaccine, get in a car accident on their way
home from the doctor’s office, and report that as an adverse event on VAERS.
• No correlation has been shown between the HPV vaccine and infertility, Guillain-Barre syndrome, blood
clotting or stroke, seizures, etc. based on clinical trials and data collected through VAERS
• Emphasize that just because something happens after you receive a vaccine does not mean the vaccine
caused that event.
Additional information about vaccine safety:
− Helpful numbers from the VAERS from 2014-2017 (during which period over 28 million doses were given):
• For every 10,000 doses administered, fewer than 3 adverse events were reported (only 7,244
adverse events reported out of 28 million doses administered)
• Less than 1 serious adverse event was reported for every 100,000 doses administered (97% of all
adverse events reported were non-serious)
• Note that these adverse events are not even proven to be caused by the vaccine – people can
report any event they experience post-vaccination through VAERS, including injuries and
accidents.
Reference: Shimabukuro T, et al. Pediatrics. 2019;144(6):e20191791
− Helpful numbers from clinical trials of the 9-valent HPV vaccine:
• Included over 15,000 individuals between ages 9-26, both male and female
• Serious, vaccine-related events were rare (<0.05%)
• Serious adverse events affected diverse organ system classes and did not indicate specific safety
concerns
Reference: Moreira ED, et al. Pediatrics. 2016; 138(2):e20154387

12
QUESTIONS?

© 2023 PRIME® Education, LLC. All Rights Reserved.

13
 When to Get the HPV Vaccine

Routine HPV vaccination is recommended for everyone ages 9-12 years

Benefits of starting vaccination early:

✓ Gives you the option to spread out adolescent vaccines, so fewer
shots are needed at 11- to 12-year-old checkups
✓ Adolescents are more likely to be protected by the first time
they are exposed to HPV

HPV vaccination is also recommended for anyone 13-26 years old who has not
already been vaccinated
People 27-45 years old can get the HPV vaccine if they and their health care provider decide it is likely to be beneficial
American Academy of Pediatrics. Human Papillomavirus Vaccines. https://www.aap.org/en/patient-care/immunizations/human-papillomavirus-vaccines/. Accessed 1/12/23; O’Leary ST, et al. AAP News. 2019.
https://publications.aap.org/aapnews/news/14942/Why-AAP-recommends-initiating-HPV-vaccination-as?searchresult=1. Accessed 1/12/23; CDC. HPV Vaccine Schedule and Dosing.
https://www.cdc.gov/hpv/hcp/schedules-recommendations.html. Accessed 1/12/23. Meites E, et al. MMWR. 2019; 68(32);698–702. © 2023 PRIME® Education, LLC. All Rights Reserved.

Main points:
• Ideally the HPV vaccine should be received between ages 9-12
• Benefits to starting early (between 9-10) include:
• Spacing out adolescent vaccines more over time. Tdap
and the first dose of the meningococcal vaccine are both
scheduled to be administered between ages 11-12, and
adolescents should also get the flu shot during flu season.
Getting the HPV vaccine before you’re 11-12 means fewer
shots at your 11-12-year-old checkup.
• More likely to be protected against HPV by the time of
first encounter. The younger you are when you get the
HPV vaccine, the longer you will be protected and the less
likely you are to have been exposed to HPV before you
are protected by the vaccine.
• Emphasize that older adolescents and young adults should get
the HPV vaccine if they haven’t already. The vaccine is still highly
effective in older adolescents and young adults (many clinical
studies were done in girls and women ages 16-26 and showed
protection >90% against HPV-associated cancer).

14
 HPV Vaccine Schedules

A 2-dose series is recommended if the A 3-dose series is recommended if the

first dose is given before 15 years of age first dose is given after turning 15

First dose First Dose

Second Dose: 1-2 months after first dose

Second dose: 6-12 months later Third Dose: 6 months after first dose

Protection from the vaccine remains high for at least 14 years

More studies are ongoing to determine how long protection lasts

Meites E, et al. MMWR. 2016; 65(49):1405-1408; Kjaer SK, et al. EClinicalMedicine. 2020; 23:100401; Kjaer SK, et al. Hum Vaccin Immunother. 2021;17(4):943–949; CDC. HPV Vaccine Schedule and Dosing.
https://www.cdc.gov/hpv/hcp/schedules-recommendations.html. Accessed 1/12/23. © 2023 PRIME® Education, LLC. All Rights Reserved.

Main points:
• Anyone who begins the HPV vaccine series before age 15 is eligible for the 2-dose series
• Anyone who begins HPV vaccination after their 15th birthday will need the 3-dose series. People with
certain immunocompromising conditions should also receive the 3-dose series.
• Protection against HPV is very long-lasting (see bullet below for more detail). This means that even
children who are vaccinated at 9-10 years old are likely to be protected into young adulthood.
• Follow-up clinical trials have shown that protection against HPV-associated cancers (>90%) lasts up
to 14 years after vaccination*.
− Please note that the first HPV vaccine was only approved in 2006, so we have only been
able to observe long-term protection since then. To date, there is no evidence to suggest
substantial loss of protection, but the vaccine has not existed long enough to determine if
protection lasts longer than 14 years.
− Data showing that protection lasts up to 14 years is from studies of the quadrivalent HPV
vaccine, which is no longer distributed in the US. The 9-valent vaccine (Gardasil 9) shows
protection up to 8 years, and studies are ongoing to determine how long this protection
will last as well.
− Since the quadrivalent HPV vaccine is formulated similarly to the 9-valent HPV vaccine, it
is expected that protection from the 9-valent HPV vaccine offer protection for as long as
the quadrivalent vaccine.
References:
Kjaer SK, et al. EClinicalMedicine. 2020; 23:100401
Kjaer SK, et al. Hum Vaccin Immunother. 2021;17(4):943–949

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 Possible Side Effects of the HPV Vaccine
Side effects are a normal part of getting a vaccine, and are usually a
sign that the immune system is doing its job.
The most common side effects of the HPV vaccine are:
• Arm pain, swelling, or redness
• Headache (more common in girls and women)
• Fainting (more common in adolescents)
• Nausea
• Dizziness

These side effects are usually mild and resolve within 1-2 days
FDA. Prescribing Information for 9vHPV. https://www.fda.gov/media/90064/download. Accessed 1/12/23; CDC. HPV Vaccine Safety and Effectiveness Data. https://www.cdc.gov/hpv/hcp/vaccine-safety-
data.html. Accessed 1/12/23; CDC. HPV Vaccine. https://www.cdc.gov/hpv/parents/vaccine-for-hpv.html. Accessed 1/12/23; CDC. HPV Vaccination is Safe and Effective.
https://www.cdc.gov/hpv/parents/vaccinesafety.html#:~:text=Common%20side%20effects%20from%20HPV,where%20the%20shot%20was%20given. Accessed 1/4/23. © 2023 PRIME® Education, LLC. All Rights Reserved.

Main points:
• The HPV vaccine is very safe, but there are some mild and short-
lived side effects that are common
• Many of these side effects (injection-site pain) are common after
other vaccines as well.
• Fainting after any vaccine is more common in adolescents than
adults, and as described on the next slide you can minimize the
risk of fainting or potential for injury during fainting by having
the patient sit or lie down during and after vaccination.
• Emphasize that these side effects are not signs of HPV infection.
They are a normal part of getting the vaccine, and are actually a
sign that your immune system is reacting well to the vaccine
(although the vaccine is still effective even if you don’t have side
effects).
• The benefits of HPV vaccination far outweigh the risk of short-
term side effects.

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 Tips to Reduce Pain and Manage Side Effects

Sit or lie down after vaccination for 15 minutes to avoid

fainting

Ask your health care provider about pain relief options such
as relaxation breaths, cold pack, vibration, or numbing cream

Use distractions like videos or games to draw attention

away from shots

Meg Foundation. Procedural Pain Resources. http://www.megfoundationforpain.org/procedural-pain-resources/. Accessed 1/12/23. © 2023 PRIME® Education, LLC. All Rights Reserved.

Main points:
• Emphasize that patient comfort is important.
• Even if HPV vaccine side effects are short-lived and mild,
there are ways to make them more bearable.
• If your clinic offers specific options for pain management (eg,
vibration devices, numbing cream, games to distract patients
during shots) please share those with the audience.

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QUESTIONS?

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18
 TAKE ACTION:
PLAN AND PREPARE FOR
YOUR HPV VACCINE

© 2023 PRIME® Education, LLC. All Rights Reserved.

19
 Where Can I Get the Vaccine?
Ask your health care provider if their practice offers the HPV vaccine.
If not, ask them for a referral.

Vaccines may also be available at:

→ Community health clinics

→ School-based health centers
→ Pharmacies
→ Local health departments
To find a local health department near you, visit:
https://www.cdc.gov/publichealthgateway/healthdirectories/index.html

U.S. Centers for Disease Control and Prevention (CDC). HPV Vaccination: What Everyone Should Know.
https://www.cdc.gov/vaccines/vpd/hpv/public/index.html#:~:text=HPV%20vaccine%20may%20be%20available,HPV%20vaccine%20in%20your%20community. Accessed 1/4/23. HHS.gov. Immunization:
Where to Go. https://www.hhs.gov/immunization/get-vaccinated/where/index.html. Accessed 1/4/23. © 2023 PRIME® Education, LLC. All Rights Reserved.

Main points:
• There are many places where you can get the HPV vaccine
• If your clinic offers the HPV vaccine, please share this with
the audience
• If your clinic does not provide the HPV vaccine, please be
prepared to share information with the audience about:
− Where they can go in your community to receive this
vaccine
− How to make appointments to get vaccines outside of
your clinic

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 Vaccine Costs

If you have health insurance, the HPV vaccine and other

recommended vaccines should be covered at no cost to you.

Certain groups are also eligible for free childhood vaccines

through the Vaccines for Children program:
Covers children 18 or younger who are:
− American Indian or Alaska Native CDC’s VFC Information Site:
− Medicaid-eligible
− Uninsured
− Underinsured

CDC. VFC Detailed Questions and Answers for Parents. https://www.cdc.gov/vaccines/programs/vfc/parents/qa-detailed.html. Accessed 1/12/23. Stewart, AM, et al. The Affordable Care Act: US Vaccine Policy
and Practice. https://hsrc.himmelfarb.gwu.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1168&context=sphhs_policy_facpubs. Accessed 1/12/23. Meites E, et al. MMWR. 2019; 68(32);698–702.
© 2023 PRIME® Education, LLC. All Rights Reserved.

Main points:
• HPV vaccines should be available for free to anyone under
the Affordable Care Act or through VFC
• If your clinic is a VFC-enrolled clinic, please let the audience
know.
• If you clinic has resources for navigating insurance or
financial assistance programs (brochures, digital resources,
case management or social work services), please share
those resources with the audience.

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 Making an Action Plan

What other questions or concerns do you have about HPV or the

HPV vaccine?

If you are interested in getting the HPV vaccine, what other

information do you need to help prepare?

© 2023 PRIME® Education, LLC. All Rights Reserved.

Additional information to address common HPV vaccine

questions/concerns:
1) The HPV vaccine will encourage sexual activity/promiscuity:
• Studies of sexual behavior have not shown any increase in sexual
activity, risk-taking, or incidence of STI or pregnancy in
vaccinated vs. unvaccinated individuals. If anything, individuals
who had received the HPV vaccine showed lower incidence of
some STIs and increased condom and contraception use.
• Even someone who is abstinent until marriage can acquire an
HPV infection once they become sexually active with their
spouse. Getting vaccinated is the best way to protect against
HPV infection and associated cancers.
References: Kasting ML, et al. Hum Vaccin Immunother. 2016;
12(6):1435-1450.
Ogilvie GS, et al. CMAJ. 2018; 190(41): E1221-E1226.
• There is some evidence for non-sexual transmission of HPV. HPV
can persist for long periods of time on fomites, including medical
devices, and HPV DNA has been detected in people who report
no history of sexual activity.
Reference: Liu Z, Rashid T, & Nyitray AG. Sexual Health. 2016;13:10-
21.

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 Take-home Messages

✓HPV infection is extremely common and is often acquired during adolescence

and early adulthood

✓HPV and HPV-associated cancers can affect anyone of any gender

✓The HPV vaccine is the best way to prevent HPV and associated cancers, and
has been shown to be very safe over more than a decade of monitoring

✓The HPV vaccine is available at no cost for most people and may be offered by
your health care provider, local health departments, or pharmacies

© 2023 PRIME® Education, LLC. All Rights Reserved.

23
QUESTIONS?

© 2023 PRIME® Education, LLC. All Rights Reserved.

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