HPV Vaccine Extended Dosing Schedule for Grade 6

Report
HPV Vaccine Extended Dosing
Schedule for Grade 6
September 2010
1
HPV Vaccine Program Change:


Girls entering grade 6 in fall 2010
Grade 6 HPV Vaccine Schedule
Change


Extended dosing schedule: 2 doses in grade 6, 3rd dose in
grade 11
Why is the grade 6 program
changing?

Provides comparable protection in this age group due to
their strong immune response.
2
Why the change?
Who qualifies?
3
Why is the schedule changing?


Newly introduced vaccine programs may
change as additional evidence becomes
available.
Data from the BCCH affiliated Vaccine
Evaluation Centre confirms that two doses of
HPV vaccine are protective in this age group
due to a strong immune response in girls 913 years after two doses given at 0 & 6
months.
4
Who qualifies for new schedule?

Only girls entering grade 6 in
September 2010 and subsequent years
of the grade 6 program
5
Is the new grade 6 schedule “offlabel” based on the current Gardasil
product monograph?


Yes it is. However, the BC Communicable Disease
Policy Advisory Committee has reviewed the results
at 24 months of a study of two doses given at 0 and
6 months to girls aged 9-13 years and has
recommended this schedule for girls in grade 6 in the
BC program. The third dose is being planned to
ensure sustained protection into sexually active years
of life.
This is a similar situation to the 2007 Pneumococcal
Conjugate program schedule change from 2, 4, 6 &
12 months to 2, 4 & 12 months.
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What about girls with impaired
immune responses?


Girls who are known to have immune system
defects associated with solid organ
transplant, stem cell transplant, or HIV
infection and who attend grade 6 should
receive HPV vaccine in the three dose
schedule at 0, 2 and 6 months.
The immunosuppressed state results in a less
robust immune response, and those with
such conditions are at risk of persistent HPV
infection and associated HPV disease if they
become infected.
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Are other jurisdictions using an extended
HPV vaccine schedule?


In Canada, Quebec has been using a 0, 6 &
60 month schedule in their grade 4 program
since 2008.
Around the world, many countries and
agencies are investigating the use of altered
or extended schedules.
8
School based program
considerations:
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What dose volume will be used in
the grade six extended schedule?

For all doses the volume remains 0.5mL.
10
Will HPV dose #2 timing coincide with
the hepatitis B vaccine scheduling?

Yes, in the school vaccination setting,
these will both be offered six months
after dose one.
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What process will be in place to
track girls for receipt of dose #3?

a)
b)

All HPV vaccines given in schools are
recorded by nurses in 2 steps:
manually on consent forms
in registries (iPHIS or PARIS).
Registries allow the bringing forward of
clients for doses for which they are eligible.
12
Are grade six consents being changed
to reflect the new schedule?


For the 2010-2011 school year, grade 6
consent forms were sent out with a cover
letter, explaining the schedule change.
For the 2011-2012 grade 6 school year, the
provincial Informed Consent Working Group
will revise the consent form to list only the 2
doses given in grade 6.
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Will girls on the extended schedule need
to be re-consented for the 3rd dose?


Yes. Due to the long interval between the
second and third dose, health authorities
should plan to re-consent girls before their
third dose.
When the grade 11 program is conducted,
the girls’ prior record in the immunization
registry will be brought forward for review. As
well, parents will be able to record previous
HPV dose receipt on the consent form.
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For more information:

ImmunizeBC.ca
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