STD Awareness: Can Older Adults Receive the HPV Vaccine?

female-patient-with-female-doctorWhen the human papillomavirus (HPV) vaccines were introduced, a lot of people were excited about protection from a sexually transmitted virus that could cause cancers, including cervical cancer, anal cancer, and head-and-neck cancer. It wasn’t just any old vaccine, it was a shot that could prevent cancer. Cancer!

In fact, a lot of people were disappointed they were too old to take advantage of an anti-cancer vaccine, which was initially approved for people as old as 26. We were given a lot of reasons why people above that age were “too old,” such as the assumption that anyone older than 26 has probably been sexually active for years and would have already contracted the most common strains of HPV.

While getting vaccinated before becoming sexually active is optimal, the HPV vaccine can still benefit people who have already had sex.

But there are compelling reasons to vaccinate people in their late 20s and beyond. In fact, Gardasil 9 was recently approved for people as old as 45. That’s great news for those of us who missed out on the HPV vaccine the first time around. We might never have had any sexual contact, and therefore were never at risk for catching the sexually transmitted virus. We might have found ourselves widowed or divorced after years or decades of monogamy. We might have been sexually active with multiple partners during that time. Whatever our circumstances, those of us who are 45 or younger can now consider HPV vaccination.

HPV and the “Older” Individual

When Cervarix and Gardasil, the first HPV vaccines, were released, they only protected against two cancer-causing HPV strains, HPV-16 and HPV-18, which are responsible for 70 percent of cervical cancers (Gardasil protects against two additional wart-causing HPV strains). A few years ago, Gardasil 9 hit the market, targeting five additional cancer-causing HPV strains — increasing the chances that even sexually active recipients could be protected from HPV strains they hadn’t encountered.

Although expanding protection against HPV from two strains to nine strains increases the odds that sexually active recipients haven’t already encountered all vaccine-targeted strains, the assumption that most sexually active people have been exposed to HPV — and therefore wouldn’t benefit from vaccination — isn’t exactly fair. In fact, the FDA referenced a study of women, ages 27 to 45, which found that Gardasil was 88 percent effective in that age group. Furthermore, an Australian study found that only 24 percent of women between 30 and 64 years of age — with a history of normal Pap tests — showed evidence of past exposure to HPV-16 or HPV-18. Even among women who had a history of cervical “precancer,” 44 percent — fewer than half — showed evidence of exposure to HPV-16 or HPV-18.

Other evidence indicates sexually active folks might still benefit from vaccination. Gardasil 9 teaches the body to defend itself against nine strains of HPV without being infected with the virus — and there is evidence that vaccine-induced immunity might be stronger than the immune response to a natural infection. Therefore, people who have already been exposed to HPV might still be less likely to be re-infected after receiving the vaccine.

Vaccinating When Younger Still Best

While we older folks might appreciate the opportunity to get Gardasil’d, it’s still best to aim to vaccinate people who have not engaged in any sexual contact, protecting them from HPV before they encounter the virus. Countries with high vaccine coverage in the “tween” population are already seeing results. For example, Australia expects to eliminate cervical cancer and genital warts.

Eliminating any type of cancer is cause for celebration, but there is a good reason to celebrate the elimination of genital warts, too. Gardasil might reduce the risk of transmitting wart-causing strains of HPV to babies during childbirth — an occurrence that is rare but can cause a serious condition called recurrent respiratory papillomatosis, or RRP. Children with RRP develop warts in their throats, which can make it difficult to breathe, in addition to other symptoms such as hoarseness and chronic coughing. Though it might spontaneously resolve, the condition can’t be cured and is treated with surgery — which must be repeated if the warts grow back. It is a terrible circumstance for a family to find itself in, and the hope is that RRP can be eliminated if enough people are vaccinated with Gardasil. In Australia, RRP diagnoses have declined in tandem with widespread vaccination.

In order to maximize its effectiveness, the vaccine is best given before becoming sexually active. But if you’ve been sexually active, haven’t received the vaccine, and are interested in cancer prevention — but don’t have a time machine — getting vaccinated now versus never is the next best thing.

How Do I Get Vaccinated?

FDA approval means that Merck, the manufacturer of Gardasil 9, can start marketing it to us wizened old folks in the 27-to-45 age bracket — it doesn’t mean health insurance will cover it.

Many health care providers have been offering the HPV vaccine to “older” patients all along. The catch is that, generally, insurance wouldn’t cover the vaccine for people 27 and older, and the three-dose series isn’t cheap: up to $240 a dose (that’s $720 for all three, not counting whatever other fees get tacked onto your bill).

At this time, we “oldsters” between the ages of 27 and 45 might still have to pay out of pocket for the vaccine. If you have health insurance, you’ll have to check with your insurer to be sure, but until the Advisory Committee on Immunization Practices recommends vaccinating people up to the age of 45, insurers probably won’t follow suit.

Gardasil 9 protects against the seven strains of HPV responsible for 90 percent of cervical and anal cancers, plus two HPV strains responsible for 90 percent of genital warts. Planned Parenthood Arizona offers this vaccine to patients of all ages, but at this time health insurance might not cover the cost for recipients between the ages of 27 and 45.

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