American resources |
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Canadian resources |
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National Advisory Committee on Immunization (NACI) is a national committee of recognized experts in the fields of pediatrics, infectious diseases, immunology, medical microbiology, internal medicine, and public health. Recommendations from NACI on vaccine use in Canada are published every 4 years in the Canadian Immunization Guide. Publications are available from http://www.phac-aspc.gc.ca/naci-ccni/is-si/index.html. -
The Society of Obstetricians and Gynaecologists of Canada (SOGC) convened a consensus working group made up of representatives from 6 national specialty societies to develop guidelines on HPV prevention that were published in early 2007. Publications are available from http://www.sogc.org/guidelines. -
The SOGC has also launched a website with educational materials on HPV, available from http://www.hpvinfo.ca.
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Who should be vaccinated? |
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Sexually active women |
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Women who were sexually active before immunization might be infected by HPV, but not necessarily by types 6, 11, 16, or 18. Immunization is, therefore, still a good strategy to prevent cervical and anal cancer.
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Gardasil indications and use | Gardasil is indicated for prevention of the following diseases caused by HPV types 6, 11, 16, and 18:
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Cervical cancer -
Genital warts (condylomata acuminata) and for the following precancerous or dysplastic lesions: -
Cervical adenocarcinoma in situ -
Cervical intraepithelial neoplasia grade 2 and grade 3 -
Vulvar intraepithelial neoplasia grade 2 and grade 3 -
Vaginal intraepithelial neoplasia grade 2 and grade 3 -
Cervical intraepithelial neoplasia grade 1
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Gardasil contraindications and precautions |
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Gardasil is not intended to be used for treatment of active genital warts, cervical cancer, cervical intraepithelial neoplasia, vulvar intraepithelial neoplasia, or vaginal intraepithelial neoplasia. -
This vaccine will not protect against diseases that are not caused by HPV. -
The vaccine is not shown to protect against diseases due to HPV types other than 6, 11, 16, and 18. -
As with all injectable vaccines, appropriate medical treatment should always be readily available in case of rare anaphylactic reactions following administration of the vaccine. -
The decision to administer or delay vaccination because of a current or recent febrile illness depends largely on the severity of the symptoms and their origin. Low-grade fever itself and mild upper respiratory infection are not generally contraindications to vaccination. -
Patients with impaired immune responsiveness, whether due to the use of immunosuppressive therapy, a genetic defect, human immunodefficiency virus (HIV) infection, or other causes, can have reduced antibody response to active immunization. -
As with other intramuscular injections, Gardasil should not be given to individuals with bleeding disorders, such as hemophilia or thrombocytopenia, or to persons receiving anticoagulant therapy unless the potential benefits clearly outweigh the risk of administration.
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Information for the patient, parent, or guardian |
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The health care provider should inform the patient, parent, or guardian that vaccination does not substitute for routine cervical cancer screening. -
Gardasil is not recommended for use in pregnancy. -
Note: Women who receive Gardasil should continue to undergo cervical cancer screening according to usual standard of care.
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Practical information |
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Gardasil is given as 3 injections over 6 months (0, 2, and 6 mo). -
Gardasil requires strict cold-chain protocol for storage and transportation. -
The HPV vaccine series is not currently a reimbursable cost.
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