The human papillomavirus, more commonly referred to by its acronym HPV, is a major public health concern worldwide. This is a common infection, which can unfortunately lead to serious consequences. At the heart of this issue is HPV vaccination : a revolutionary medical advance that nevertheless raises questions and even concerns. The vaccination campaign planned in colleges for 5th graders from the start of the 2023 school year also accentuates this debate. This approach indeed raises many questions: what is the interest of this vaccination? What are the real risks?
What is human papillomavirus?
Human papillomavirus (or HPV) is a sexually transmitted disease. It is a very common condition: it is estimated that 80% of men and women will develop this infection during their lifetime. Generally, this pathology manifests itself at the beginning of sexual life.
What are the potential consequences of this infection?
The risks associated with HPV are significant. Among the 200 existing types of HPV, 12 are carcinogenic . Therefore, although most of these infections disappear within a few months, some can lead to cancer. We mainly think of cervical cancer , and for good reason: 100% of these cancers are caused by the human papillomavirus. However, these are not the only potential cancers.
This infection can also progress to cancer of the oropharynx, penis, anus, vagina or vulva. Contrary to popular belief, men are therefore also concerned since they represent 25% of those affected. It is also important to note that the vaccination of boys would also improve the protection of unvaccinated girls.
The key elements of vaccination
Who is HPV vaccination for?
In France, vaccination against the human papillomavirus is not compulsory. However, it is strongly recommended for everyone from 11 years old. The primary objective is to ensure vaccination between 11 and 14 years of age in order to ensure protection before the start of sexual life. It is also possible to be vaccinated later (from 15 to 19 years of age) for girls and boys in catch-up. In addition, men who have already had sex with other men can also be vaccinated up to the age of 26 in order to reduce the spread of the virus.
What is the purpose of HPV vaccination?
It is important to note that this vaccination is one of the few preventive measures available against cancerous and precancerous lesions . The objective of vaccination against human papillomavirus infections is to reduce the incidence of precancerous genital lesions, both in women and in men . The aim is thus to reduce the risk of developing cancers of the cervix , vulva and vagina in women, as well as cancers of the penis and anus in men.
Is the vaccine effective?
Yes, the human papillomavirus vaccine has demonstrated significant effectiveness . In fact, it prevents up to 90% of infections responsible for cancer. Several studies have also been able to demonstrate that this vaccine contributes significantly to reducing the risk of cancer of the cervix as well as pre-cancerous lesions.
We can notably cite a study carried out in Sweden, which provided proof of this effectiveness. In this research, it was established that the vaccination of Swedish women between the ages of 10 and 30 led to a considerable reduction in the risk of invasive cancer of the cervix. It is also likely that vaccination can reduce the risk of oropharyngeal cancer .
However, it is important to note that vaccination against papillomaviruses does not cure an existing HPV infection. It is limited to preventive action by avoiding these infections.
What are the risks of the vaccine?
Vaccination against HPV is the subject of international surveillance and numerous studies. The results of this research also confirmed an excellent level of security . Recognition has also been issued by the World Health Organization (WHO).
Adverse effects the most frequent correspond to reactions common to those of other vaccines . It is mainly a reaction at the injection site (manifested by redness, pain, itching, etc.), joint or muscle pain and fever. These reactions are short-lived. Although very rare, allergic reactions can also occur. These appear quickly after the injection.
It should be noted that no link could be established between this vaccination and autoimmune diseases such as multiple sclerosis.
How does the vaccination take place?
Although there are two different vaccines against papillomaviruses, all vaccination must now be done with the Gardasil 9 vaccine. The latter is composed of 9 strains of papillomavirus. It is also this vaccine that protects against 90% of cancers of the cervix.
For a complete vaccination schedule:
- For girls and boys aged 11 to 14: 2 doses of Gardasil 9 should be taken. These must be spaced 6 to 13 months apart.
- For girls and men up to 19 years old, in catch-up: it is necessary to receive 3 doses. To do this, the first two doses must be spaced 2 months apart. The third dose should take place 6 months after the first dose.
- For men up to 26 years old who have had sex with other men: this is the same scenario as for catch-up, i.e. you must receive 3 doses of Gardasil 9 with an interval of 2 months between the first two doses . The third dose must be administered 6 months after the first.
However, a recent government measure has just extended vaccination to 5th grade students in colleges, free of charge ( subject to parental authorization ) from the start of the 2023 school year.
To carry out a vaccination against papillomaviruses, it is possible to contact a doctor, a midwife, a pharmacist, a nurse or a departmental or municipal vaccination service. Public sector vaccination services also carry out HPV vaccinations free of charge.
It should be noted that the attending physician occupies a central position in this process. Indeed, this health professional is a privileged contact capable of advising, listening and guiding.
The question of cervical screening
The issue of cervical cancer screening is of capital importance in the overall prevention strategy for these cancers. It is essential to understand that vaccination cannot replace screening . Indeed, vaccines do not confer total protection against all types of human papillomavirus (HPV) responsible for these cancers. This is why prevention is based on complementarity between vaccination and screening by cervico-uterine sample.
Since 2018, France has implemented a national screening program for cervical cancer. From the age of 25, all women, whether vaccinated or not, should benefit from regular Pap smear screening . This approach aims to detect cellular abnormalities early and prevent the subsequent development of cancer.
However, it is essential to recognize that vaccination against HPV-related infections is also a crucial means of combating certain cancers for which there is simply no screening device. Indeed, to date there are no screening methods for precancerous lesions and cancers of the vagina, vulva, anus and penis. In these cases, vaccination remains one of the few options to prevent these serious conditions.
In short, vaccination against papillomaviruses is an essential tool for preventing HPV-related cancers. Indeed, it plays a crucial role in the protection of public health and in the prevention of potentially fatal cancers. Despite the controversies and concerns, vaccination is overall safe and effective. Thus, the potential benefits appear to outweigh the potential risks. However, it is still important to learn about HPV vaccination, discuss its benefits and risks with a healthcare professional in order to make an informed decision about vaccination for yourself or your children.
References :
French Republic. National Cancer Institute. The key arguments on vaccination against cancers linked to human papillomaviruses (HPV).
French Republic. National Cancer Institute. Vaccination against HPV cancers.
Vidal. The papillomavirus vaccine.
Lei J, Ploner A, Elfström KM, Wang J, Roth A, Fang F, Sundström K, Dillner J, Sparén P. N Engl J Med. (October 2020). HPV Vaccination and the Risk of Invasive Cervical Cancer .
