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HPV vaccination

    • 4 posts
    October 15, 2014 4:35:05 PM PDT

    Hello Doctor, my 18 y/o son received his 1st HPV vaccination in December 2013. His 2nd vaccination was in August 2014. Considering the time past between two immunizations (8 months), would receiving one last HPV vaccination be sufficient to protect him against the virus or he needs to start over? We are trying to avoid the unnecessary immunization. Please share with me your opinion about this vaccine, its safety and necessity for males. Thank you!

    • Moderator
    • 1957 posts
    October 15, 2014 5:35:02 PM PDT

    Greetings I, 

     

    Thank you for your question.

     

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    1. If you live in the USA your son probably* received Gardasil. There have been clinical trials showing efficacy in males who have received Cervarix. If you are sure that it was Gardasil, and for, example, your son did not* have a serious reaction to the first dose, then you may be interested in following the recommendations from UpToDate, a medical reference. An excerpt is below. 


    2. If the vaccine was Gardasil, please go to number 3. below.  If it was not Gardasil, please reply with text.


    3. The recommendation is to "continue the series." Meaning, if someone waits for a year between the first and second doses of the vaccines, then they are recommended (in general), to continue the series. 


    4. How is tomorrow for getting the second dose, and February for the third dose?   


    Please consider keeping me updated.

    Kind regards,

    -BrettMD

     

     

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    VACCINE DOSE AND ADMINISTRATION

    Immunization schedule — In the United States, the HPV vaccine series is three vaccine doses given over a minimum of 24 weeks [40]. The minimum interval between the first two doses is four weeks and the minimum interval between the second and third doses is 12 weeks. The quadrivalent vaccine (Gardasil) is typically administered in three doses at time zero, and at two and six months of follow-up. The bivalent vaccine (Cervarix) is typically administered in three doses at time zero, and at one and six months of follow-up. HPV vaccine can be safely administered at the same time as other age-appropriate vaccines at a different anatomic site.

    In some countries, two doses of HPV vaccine are recommended because of evidence of generally comparable immunogenicity after two or three doses. This evidence is discussed in detail elsewhere (see 'Missed doses/alternate schedules'below). As an example, the Strategic Advisory Group of Experts on Immunizations (SAGE) of the World Health Organization recommends two doses for females under the age of 15 and three doses for those who initiate vaccination later [61]. Practitioners outside the United States should consult local guidelines for the recommended immunization schedule in their country.

    Missed doses/alternate schedules — Patients often do not follow up for their immunizations on schedule [62]. The Advisory Committee on Immunization Practices (ACIP) recommends that if the vaccination series is interrupted for any length of time, it can be resumed without restarting the series. The same formulation should be used to complete the series, if possible.

     http://www.uptodate.com/contents/recommendations-for-the-use-of-human-papillomavirus-vaccines

     

    ----------------------------------------------------------------------

    What are the risks from this vaccine (Gardasil)

    This HPV vaccine has been used in the U.S. and around the world for about six years and has been very safe.

    However, any medicine could possibly cause a serious problem, such as a severe allergic reaction. The risk of any vaccine causing a serious injury, or death, is extremely small.

    Life-threatening allergic reactions from vaccines are very rare. If they do occur, it would be within a few minutes to a few hours after the vaccination.

    Several mild to moderate problems are known to occur with this HPV vaccine. These do not last long and go away on their own.

    • Reactions in the arm where the shot was given:
      • Pain (about 8 people in 10)
      • Redness or swelling (about 1 person in 4)
    • Fever:
      • Mild (100° F) (about 1 person in 10)
      • Moderate (102° F) (about 1 person in 65)
    • Other problems:
      • Headache (about 1 person in 3)
    • Fainting: Brief fainting spells and related symptoms (such as jerking movements) can happen after any medical procedure, including vaccination. Sitting or lying down for about 15 minutes after a vaccination can help prevent fainting and injuries caused by falls. Tell your doctor if the patient feels dizzy or light-headed, or has vision changes or ringing in the ears.

      Like all vaccines, HPV vaccines will continue to be monitored for unusual or severe problems.

    What if there is a serious reaction?

    What should I look for?

    • Look for anything that concerns you, such as signs of a severe allergic reaction, very high fever, or behavior changes.

      Signs of a severe allergic reaction can include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, and weakness. These would start a few minutes to a few hours after the vaccination.

    What should I do?

    • If you think it is a severe allergic reaction or other emergency that can’t wait, call 9-1-1 or get the person to the nearest hospital. Otherwise, call your doctor.
    • Afterward, the reaction should be reported to the Vaccine Adverse Event Reporting System (VAERS). Your doctor might file this report, or you can do it yourself through the VAERS websiteExternal Web Site Icon, or by calling 1-800-822-7967.

    VAERS is only for reporting reactions. They do not give medical advice.

     

    The National Vaccine Injury Compensation Program

    The National Vaccine Injury Compensation Program (VICP) is a federal program that was created to compensate people who may have been injured by certain vaccines.

    Persons who believe they may have been injured by a vaccine can learn about the program and about filing a claim by calling 1-800-338-2382 or visiting the VICP websiteExternal Web Site Icon.

    Top of Page

    How can I learn more?

     http://www.cdc.gov/vaccines/hcp/vis/vis-statements/hpv-gardasil.html

     

    Reference: http://www.cdc.gov/vaccines/hcp/vis/index.html


    This post was edited by Brett Snodgrass at October 15, 2014 5:43:53 PM PDT
    • 4 posts
    October 16, 2014 11:42:17 AM PDT

    Hello Dr. Snodgrass, thank you so much for your recommendation. Yes, my son got the Gardasil. Just to clarify, his 1st immunization was in December of 2013 and the 2nd shot was 8 months later, in August of 2014, past the recommended protocol schedule. Are you saying that he doesn't have to restart the series? If he just needs one last shot, when shoud he do it, having the 2nd done back in August? Thank you so much!

    • Moderator
    • 1957 posts
    October 16, 2014 2:23:30 PM PDT
    Greetings,

    Thank you for the reply.

    Although there has been some research, that shows that two doses of the vaccine may be effective, the FDA recommendation, is to receive three doses. If your son took the third dose of Gardasil in December, it would be three months after the second dose ( the second dose was in August). So, the key here, is that people should have three months between the second and the third dose. Anyone*, who misses a dose, Including your son,is recommended to continue the series without regard to any maximum interval. What I mean, is it if someone gets her first dose of vaccine, and they get very sick from the vaccine, reaction, then they probably shouldn't get another dose. If your son, or any person, received the vaccine, and had no problems, and had no change in health status, then, if they wanted to receive the vaccine as recommended by the FDA, then they should take the third dose.,
    There is no restarting. If it's been three years four years five years, six years, the recommendation, is to continue as normal. The key here, is there must be a minimum Time, between the doses. This means that there should never be less then three months between the second and the third doses.



    If your son wanted to follow the guidelines by the FDA, he could receive the third dose of gardasil in December:

    Please consider keeping me updated.
    Kind regards,
    BrettMD
    This post was edited by Brett Snodgrass at October 16, 2014 2:29:36 PM PDT
    • 4 posts
    October 17, 2014 11:23:34 AM PDT

    Thank you for your recommendation!

    • Moderator
    • 1957 posts
    October 17, 2014 11:42:26 AM PDT
    Dear I,

    You are welcome for the information as the recommendation technically came from the FDA.

    I would like to say Kudos that your son is getting vaccinated. More than half of those eligible for the HPV vaccine never receive it. Hopefully that will change with time to where the vast majority of adolescents receive the vaccines.

    Please consider keeping me updated.
    Best regards,
    -BrettMD
    This post was edited by Brett Snodgrass at October 17, 2014 11:43:19 AM PDT