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HPV vaccination programme for men who have sex with men (MSM)

Eligibility

  • The human papilloma virus (HPV) vaccine is recommended for all MSM up to and including 45 years of age, attending participating specialist sexual health services (SSHS) or HIV clinics, regardless of risk, sexual behaviour, or disease status
  • MSM older than 45 years are not eligible for HPV vaccination under this NHS England procured service
  • There may be considerable benefit in offering the HPV vaccine to other individuals who have a similar risk profile to that seen in the SHSS-attending MSM population, including some MSM over 45, sex workers, HIV positive women, and HIV positive men
  • Clinicians may exercise their clinical judgement to offer vaccinations outside of the national programme and so HPV vaccination can therefore be considered for such individuals on a case-by-case basis
  • Vaccine centrally procured for the HPV MSM programme should not be used for this purpose

Transgender individuals

  • The eligibility of transgender women (i.e. women who were assigned male at birth) should be a case-by-case clinical decision based on a risk assessment that includes the woman’s sexual behaviour and the sexual behaviour of her partners
  • Transgender women are eligible if their risk of acquiring HPV is equivalent to the risk of MSM eligible for the HPV vaccine
  • Transgender men (i.e. men who were assigned female at birth) are eligible if they have sex with other men, attend specialist sexual health or HIV services, and are aged 45 and under
  • If they have previously completed a course of HPV vaccination as part of the girls’ school year 8 HPV vaccine programme, no further doses need be given

The HPV vaccine

  • The quadrivalent HPV vaccine (Gardasil®) is the recommended vaccine for the MSM vaccination programme. There is only one market authorised quadrivalent HPV vaccine in the UK
  • The quadrivalent vaccine provides protection against four HPV strains: HPV16 and HPV18, the two high risk HPV types that can lead to cancer; and HPV6 and HPV11, the two HPV types that cause approximately 90% of all anogenital warts in males and females
  • The vaccine is approved for use in females and males from 9 years of age
  • To ensure vaccines are ordered, stored and monitored as per national recommendations, healthcare professionals should familiarise themselves with Public Health England’s protocol for ordering, storing and handling of vaccines

Vaccine administration

  • The quadrivalent vaccine is administered by a single intramuscular (IM) injection into the upper arm (deltoid region). One dose has a volume of 0.5 ml and the vaccine is provided in a pre-filled syringe
  • Healthcare professionals should choose the appropriate needle to ensure an intramuscular administration depending on the patient’s size and weight
  • For individuals who have a bleeding disorder, the vaccine should be given by deep subcutaneous injection to reduce the risk of bleeding
  • A small air bubble may be visible in the prefilled syringe. This is not harmful and should not be removed prior to administration

Vaccine schedule

Individuals 15 years of age and older

  • The quadrivalent vaccine should be administered as a three dose schedule of 0.5 ml:
    • the second dose should be administered at least 1 month after the first dose and the third dose should be administered at least 3 months after the second dose
    • all three doses should ideally be given within one year; however a 24 month period is clinically acceptable
  • Whenever possible, immunisations for all individuals should follow the recommended 0, 1, 4–6 month schedule

Individuals under 15 years of age

  • The quadrivalent vaccine can be administered as a two dose schedule of 0.5 ml with the second dose being given at least six to 24 months after the first dose:
    • as long as the first dose was received before the age of 15 years the two dose schedule can be followed
  • If the course is interrupted, it should be resumed but not repeated, even if more than 24 months have elapsed since the first dose.

Contraindications

  • There are very few individuals who cannot receive the HPV vaccine. Where there is doubt, instead of withholding immunisation, appropriate advice should be sought from a consultant with immunisation expertise, a member of the screening and immunisation team or from the local health protection team
  • The quadrivalent vaccine should not be administered to those who have had:
    • a confirmed anaphylactic reaction to a previous dose of the vaccine or
    • a confirmed anaphylactic reaction to any constituent or excipient of the vaccine
  • For the composition and full list of excipients of the vaccine, please refer to the manufacturer’s summary of product characteristics
  • Minor illnesses without fever or systemic upset are not valid reasons to postpone immunisation
  • If an individual is acutely unwell, immunisation may be postponed until they have fully recovered 
  • Eligible MSM with HIV infection should be given HPV vaccine regardless of CD4 count, antiretroviral therapy use, or viral load
  • Yeast allergy is not a contraindication to the HPV vaccine

Concomitant administration with other vaccines

  • The quadrivalent vaccine is an inactivated vaccine and will not be affected by, or interfere with other inactivated or live vaccines given at the same time as or at any interval from each other

What to do if the vaccine course is interrupted or an individual misses a scheduled dose

  • If the vaccine course is interrupted, it should be resumed but not repeated, ideally allowing the appropriate interval between the remaining doses
  • Individuals should be advised that although they will ultimately be protected if they receive the vaccine over a longer period of time, they may remain susceptible to HPV infection prior to completing the course
  • Where vaccines have been given at less than the recommended interval, the dose should be repeated once the recommended time period has elapsed and at least four weeks from the last dose given
  • Patients should be advised this may lead to an increased risk of local reaction
  • In the event that the vaccine is administered at less than the recommended 0.5 ml dose, the vaccination will need to be repeated because the dose that the individual received may not be sufficient to evoke a full immune response.
  • Where possible, the dose should be repeated on the same day or as soon as possible after

full guideline available from…

assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/697362/HPV_MSM_clinical_and_operational_guidance.pdf

Public Health England. HPV vaccination programme for men who have sex with men (MSM). April 2018.

First included: June 2018.