A. Human Papillomavirus Vaccine
Three human papillomavirus (HPV) vaccines are available: a quadrivalent HPV vaccine that includes capsid proteins against four HPV types (6, 11, 16, and 18); a bivalent vaccine (includes capsid proteins against HPV types 16 and 18); and a nine-valent vaccine (includes capsid proteins against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58). These vaccines are recommended by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) for routine vaccination of girls, adolescents, and women aged 9–10 or 11–12 years with “catch-up” vaccinations of unvaccinated individuals up to age 26 years to prevent disease associated with these HPV types (see Chapter 18-06). The Advisory Committee on Immunization Practices (ACIP) also recommends routine vaccination for boys and adolescents aged 11–12 years with catch-up vaccinations up to age 21 years. Published studies show a high degree of efficacy in prevention of vaccine-associated genital warts, persistent HPV infections, and cervical intraepithelial neoplasia. Protection has not been shown against strains that are not contained in the vaccine administered or against strains that had already infected an individual before vaccination.
Unanswered questions about these vaccines include their long-term effects and their duration of protection against infection. Receipt of a vaccine should not change cervical cancer screening intervals in women. For those who start the vaccine series before the age of 15, two doses are recommended, whereas for those who start the series between age 15 and 26 years, a three-dose vaccine series is recommended.
Hepatitis B vaccine is routinely administered to children and adolescents aged 0–18 years. For adults who have not previously been vaccinated, individuals who are at risk for sexual or blood-borne transmission of hepatitis B should be vaccinated. Rates of hepatitis B are higher in individuals with diabetes mellitus than in the rest of the population, and outbreaks of hepatitis B have been associated with blood glucose monitoring. Hepatitis B vaccination is therefore also recommended for individuals with diabetes mellitus.
Hepatitis A can also be sexually transmitted. Hepatitis A vaccination is currently recommended for all children aged 12 months and older and for all adults requesting protection against hepatitis A (eg, travelers, health care workers). Individuals who use injection or noninjection illicit drugs and those with high-risk sexual behaviors will receive greater benefit.