Dr. Shivani Samlall, MBBS, is a specialist in Obstetrics and Gynecology with a sub-specialty in Gynecology Oncology, and with over 10 years of medical practice. Dr Samlall can be contacted at drshivanisamlall26@gmail.com.

WITH any new vaccine, there are always questions surrounding safety and efficacy. In the case of the Human Papilloma Virus (HPV) vaccines, despite being around for over a decade and its numerous health benefits, there are several misconceptions that still exist regarding its use. Lack of education of parents and adolescents is a principal factor. This has contributed to the vaccine’s uptake being sub-optimal in many countries. This week’s column examines the most common myths associated with the HPV vaccines including concerns regarding vaccination safety, parental attitudes amongst others, and discusses the evidence that debunks them.

MYTH #1: HPV VACCINES ARE NOT SAFE OR HPV VACCINES CAUSE MEDICAL PROBLEMS
The HPV vaccines are safe and do not cause any serious health issues. Similar to other childhood vaccines, there may be mild side effects such as pain or redness in the arm where the shot was given. Other side effects may include a low grade fever, headache, nausea and dizziness — all of which are transient and resolve on their own. Because of the dizziness, persons who were vaccinated are recommended to rest for 15 minutes after the vaccines are administered.
The safety of these vaccines have been extensively studied since their introduction in 2006 and are continuously monitored by the WHO’s Global Advisory Committee on Vaccine Safety (GAVCS). There are other vaccines monitoring systems where any person who experiences an adverse effect can report them freely. Besides direct self-reporting, there is a requirement for governments to report any adverse event observed during vaccination.

MYTH #2: ONLY GIRLS GET INFECTED WITH HPV
As discussed in last week’s column, HPV is common among both men and women. It can generally cause genital warts, penile, anal and oral cancer in men. Men have a higher risk of oral HPV infection and oral HPV associated cancers than women. In 2018, there were 120,000 reported cases of anogenital and oropharyngeal HPV related diseases, most of which occurred in men.

MYTH #3: YOU MUST HAVE SEXUAL INTERCOURSE TO GET HPV
Although HPV is primarily (99 per cent) transmitted through sexual contact, persons can still become infected without having intercourse through intimate skin-to-skin contact. Other forms of transmission have also been reported. Using condoms therefore does not completely protect against the HPV (60 per cent according to some studies). This is because it does not cover the entire genital skin, so any unprotected area of contact is enough for transmission.

MYTH #4: THE HPV VACCINE CAUSES ADOLESCENTS TO BECOME SEXUALLY ACTIVE
No evidence has linked the HPV vaccines to increased sexual activity or riskier sexual behaviour. Boys and girls who received the vaccine do not have sex earlier than those who haven’t received the vaccine. In fact, a recent systematic review which involved pooling data from numerous studies, comprising over half million individuals, has confirmed this.

MYTH #5: PEOPLE WITH HPV SHOW SYMPTOMS
HPV can be easily transmitted to a sex partner without either of the partners knowing that they are infected. In reality, about 90 per cent of persons infected with the virus do not have any symptoms, and clear the infection through the body’s immune’s response within a two-year period.

MYTH #6: HPV VACCINATION CAN LEAD TO INFERTILITY
Claims of HPV vaccine-induced infertility due to Primary Ovarian Insufficiency (POI) are false. This was demonstrated by a large study in 2018 of nearly 200,000 females aged 11–34 years, in which no link was found between the vaccines and infertility. Overall, in a nine-year period, there have been only six POI cases out of 170 million doses of HPV vaccines, which correspond with the rate of this condition in an unvaccinated population.
As a matter of fact, we can say that the vaccines protect fertility, since they prevent women from developing Cervical Cancer and thus the need for disease-related treatment, such as a hysterectomy (removing the uterus), or conization (removing part of the cervix) or the entire cervix.

MYTH #7: IF VACCINATED AGAINST HPV, THERE IS NO NEED FOR FURTHER SCREENING
Absolutely not. There are 13 strains of HPV that causes Cervical Cancer, but because the vaccines do not prevent all 13 of these strains, vaccinated women are still required to perform screening. This can be done through HPV testing, Pap Smears or VIA (Visual Inspection using Acetic Acid). The WHO’s recommendation in its strategy to eliminate Cervical Cancer is for at least two lifetime screens at age 35 and 45 using HPV testing.

In conclusion, studies have identified several reasons for the refusal of the HPV vaccines. Time and time again, the safety and effectiveness of HPV vaccination have been confirmed through well-conducted research. However, the spread of misinformation through social media can overwhelm efforts by public health and medical practitioners to address those misconceptions. Surveillance needs to continue in order to address these concerns. In cases where the vaccines are refused, it should be registered but efforts should continue to discuss the benefits of immunisation in subsequent visits, since some may reconsider their decision not to vaccinate. Reasons for refusal to vaccinate should be addressed with facts and data by all professionals so as to reduce or eliminate the false stigmas associated with the vaccine.