HPV Prevention: HPV Vaccine (Singapore)

The Human Papillomavirus (HPV) vaccine or HPV immunisation reduces a woman’s risk of getting cervical cancer, one of the most common cancers for women in Singapore. Learn more here.

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About HPV and its link to Cervical Cancer

What is HPV?

HPV stands for Human Papillomavirus, a common virus that can infect many parts of the body.
There are more than 100 different strains of HPV, grouped into (i) high-risk types (may cause cancer) and (ii) low risk types (non-cancer causing).
About 40 HPV strains can infect the genital area.
  • High-risk strains of HPV are associated with cervical, vaginal and vulvar cancer in women, and less commonly, anal or penile cancer in men. The most common high-risk strains are 16 and 18.
  • Low-risk strains of HPV may cause no symptoms or lead to genital warts. HPV types 6 and 11 are responsible for about 90% of genital warts. 
Other HPV strains may infect the skin of the fingers, hands and face.

How is HPV related to Cervical Cancer?

Certain types of HPV can infect the cervix (the lower part of the womb), vagina and vulva. In most cases, the body's immune system can fight off the infection and clear the virus.
However, sometimes the HPV infection can persist and cause abnormal changes to the cells. Some of these abnormal cells may develop into cervical cancer. This usually takes years to develop.
Specifically, HPV subtypes 16 and 18 account for about 70 percent of cervical cancer cases.


What are the risk factors for Cervical Cancer?

Risk factors for development of cervical cancer include the following:
HPV subtypes - Persistent infection with high-risk strains.
Immune status - People who are immunocompromised, such as those living with Human Immunodeficiency Virus (HIV), are more likely to have persistent HPV infections and a more rapid progression to pre-cancer and cancer.
Co-infection with other sexually transmitted agents, such as those that cause herpes, simplex, chlamydia and gonorrhoea.
Multiple sexual partners (in either partner).
Onset of sexual intercourse at an early age.
Tobacco smoking.

How is HPV transmitted?

HPV infection is very common in men and women.
It can be transmitted through skin-to-skin contact such as sexual activity, by sharing contaminated sex toys and very rarely, during delivery from an infected mother to her baby.
HPV cannot be spread by sitting on toilet seats or touching common surfaces.

What are the signs and symptoms of a HPV infection?

Most HPV infections do not have any signs or symptoms. 
Some HPV infection may cause genital warts.
High-risk HPV infection of the cervix does not cause any signs and symptoms. The abnormality on the cervix is detectable by cervical screening (Pap test) and by HPV DNA (genetic material) tests.
Symptoms of cervical cancer include abnormal vaginal bleeding such as bleeding after menstrual periods of after sex. There may also be changes in the amount, colour or smell of the vaginal discharge.

Can HPV be treated?

No treatment is required for asymptomatic HPV infections.
Most HPV infections (90 percent of the cases) are cleared by the body without the need for treament.
Treatment is directed at HPV-associated conditions such as pre-cancerous lesions, cancer or genital warts.
Although HPV virus cannot be treated, regular cervical cancer screening tests can either help to detect changes in the cervical cells caused by HPV infection (Pap test) or to identify high-risk HPV cancer-causing strains.

How can I best protect myself against Cervical Cancer?

Go for regular cervical cancer screening as it is the most effective way to detect abnormal changes in the cervical cells and cervical cancer.
All women aged 25 and above who have ever had sex should have either a Pap test once every three years (for women 25 to 29 years old) or a HPV (or HPV DNA) test once every five years (for women 30 years and above).
Speak to your doctor about the HPV vaccination to determine if you are suitable.
Even if you have received the HPV vaccination, it is important that you still go for regular cervical cancer screening as the HPV immunisation only protects against 70 to 90 percent of high-risk HPV strains.


Where can I go for a Cervical Cancer screening?

You can get screened atyour family doctor's clinic, selected Screen for Life (SFL) GPs or at a polyclinic. Do call your clinic and check if they offer cervical cancer screening services.
You can also call 1800 223 1313 for more information on cervical cancer screening and cervical cancer.

About the HPV vaccine

What is the HPV vaccination?

The HPV vaccination can help to protect against specific types of HPV infection that may lead to cervical cancer. The benefits of HPV vaccination are maximised when given before one starts any sexual activity.

What are the available HPV vaccines in Singapore?

The vaccines approved for use in Singapore are Cervarix, Gardasil and Gardasil 9.
Details of the vaccinations are shown in the table below.


Cervarix
Gardasil
Gardasil 9
​Protect against the following HPV subtypes
​16, 18​
​6, 11, 16, 18
6, 11, 16, 18, 31, 33, 45, 52, 58​
​Approved indications
​​Prevention of cervical cancer and premalignant cervical lesions caused by HPV types 16 and 18
​​Prevention of cervical, vulvar, vaginal and anal cancer caused by HPV types 16 and 18

Prevention of premalignant cervical, vulvar, vaginal and anal lesions caused by types 6, 11, 16 and 18

Prevention of genital warts caused by types 6 and 11
​Prevention of cervical, vulvar, vaginal and anal cancer caused by HPV types 16, 18, 31, 33, 45, 52 and 58

Prevention of dysplastic, premalignant cervical, vulvar, vaginal and anal lesions caused by types 6, 11, 16, 18, 31, 33, 45, 52 and 58

Prevention of genital warts caused by types 6 and 11
​​Approved age for use
​Females aged nine to 25 years old, or as advised by your doctor.
​Females aged nine to 26 years old, or as advised by your doctor
​Females aged nine to 26 years old, or as advised by your doctor
​Vaccination schedule
Females aged nine to 14 years old
Two dose, five to 13 months apart

Females aged 15 to 25 years old
Three doses:
Second dose at 1 to 2.5 months after the first dose
Third dose at five to 12 months after the first dose

Females aged nine to 14 years old
Two doses, six to 12 months apart

Females aged 15 to 26 years old
Three doses at 0, 2 and 6 months


Females aged nine to 14 years old
Two doses, six to 12 months apart

Females aged 15 to 26 years old
Three doses at 0, 2 and 6 months




Who are the HPV vaccines for?

The vaccines are approved for use in females aged nine to 26 years old (depending on the specific vaccine being administered).
The vaccines are most effective if given before first sexual exposure, in girls and women who have yet been exposed to the HPV types covered by the vaccine.
Girls and women who are sexually active may still benefit from the vaccine, as they may not be exposed to the HPV subtypes covered by the vaccine. They should speak to their doctor to determine if they are suitable for vaccination.

Who should NOT be vaccinated?

The HPV immunisation vaccine may not be suitable for you if:
you are sensitive to yeast or any of the vaccine components.
you have a moderate or severe acute infectious illness (please wait until you have recovered from the illness).

Consult your doctor to find out if a vaccination is suitable for you.

Why are HPV vaccines recommended for females aged nine to 26 years old?

In Singapore, the Expert Committee on Immunisation (ECI) recommends the HPV vaccination for females aged nine to 26 years old. This is also the age range recommended by most of the manufacturers and for which the vaccines are approved for use in Singapore by the Health Sciences Authority.
If you are above 26 years old and wish to receive the HPV vaccination, you are advised to speak to your doctor to find out if you are suitable for it.

I have a young daughter. Should she be vaccinated?

The vaccine is recommended for females aged 9 to 26 years old (depending on the specific vaccine being administered).
The vaccines are most effective in protecting against the selected HPV subtypes if they are given prior to exposure of HPV.
It is advisable to speak to your doctor to find out more about the HPV vaccination.
Once you have understood the benefits, risk and limitations of the vaccines, the decision to proceed with the HPV vaccine is a personal one.

Is HPV vaccination compulsory?

No, the HPV vaccination is not compulsory in Singapore, but it is highly recommended as a way to protect women against cervical cancer. HPV vaccination has also been included in the National Childhood Immunisation Schedule (NCIS) and National Adult Immunisation Schedule (NAIS) for the target population of females aged 9 to 26 years old.

How long does the vaccine protection last?

Current evidence shows a sustained protection against vaccine-targeted HPV-related diseases in long-term follow-up studies for the HPV vaccines. 
There is currently no recommendation for additional doses or booster shots.

Are the vaccines safe and effective?

Clinical trials and post-marketing surveillance have shown that HPV vaccines are safe and effective in preventing infections with selected HPV subtypes.
The vaccines do not contain any live viruses or infectious material. This means you cannot become infected with HPV from the vaccines.

Are there any HPV vaccine side effects?

Pain, swelling, itching redness at the site of injection and fever are some common side effects — consult your doctor if you notice any of these symptoms. 
Isolated reports of fainting immediately after HPV vaccination have been noted in some countries.

Are vaccines completely effective for HPV prevention?

No. As with any vaccination, HPV vaccinations do not guarantee a 100 percent protection. 
HPV vaccinations are not substitutes for routine cervical cancer screening. Women who have received vaccination are still encouraged to continue going for Pap tests once every three years (if you are between 25 to 29 years old) or HPV test once every five years (if you are 30 years and above). 


I have been vaccinated for HPV. Should I still go for Cervical Cancer screening?

Yes. You should go for a Pap test once every three years (if you are between 25 to 29 years old) or HPV test once every five years (if you are 30 years and above).
Cervical cancer can be caused by other HPV subtypes which the vaccines do not protect against. In other words, the HPV vaccines do not protect against all cancer-causing HPV subtypes.
As such, regular screening is still your best protection against cervical cancer.

I am pregnant/breastfeeding. Should I be vaccinated?

HPV vaccines are not recommended for pregnant women.
If a woman is found to be pregnant during the HPV vaccination schedule, it is recommended that the remaining dose(s) of the series should be postponed until after delivery.
If the HPV vaccine has been administered during pregnancy, please consult your doctor for further evaluation. Usually no further intervention is required.
Available data is not sufficient to assess the effects of HPV vaccination on the breastfed infant or on milk production/excretion. You may wish to discuss this with your doctor.

Where can I get the HPV vaccine?

You can receive HPV vaccination at a polyclinic, GP clinic or any medical clinic which carries the HPV vaccine. It is advisable to speak to your doctor to find out more about HPV vaccination.

I was diagnosed with a cervical abnormality that my Doctor said may lead to Cervical Cancer (e.g. "Cervical Intraepithelial Neoplasia" or CIN). Should I get the HPV caccine?

It is best to consult your doctor who will advise you if the vaccine is suitable for you, and also check how often you should be going for Pap or HPV tests.

Is HPV vaccination for boys included in the National Childhood Immunisation Schedule (NCIS)?

HPV vaccination for boys is not included in the NCIS. Based on the recommendations by the Expert Committee on Immunisation (ECI), HPV vaccination is recommended only for females aged nine to 26 years old under the NCIS/NAIS. It is advisable to speak to your doctor to find out more about the benefits and limitations of vaccinating your son against HPV.


Does my son need vaccination for HPV prevention?

Currently, the National Childhood Immunisation Schedule (NCIS) only includes HPV vaccination for females aged nine to 26 years old.
The decision to proceed with vaccination is a personal choice.
Consult your doctor to find out more about the benefits and limitations of vaccinating your son against HPV.

About Medisave use for HPV vaccination

Can Medisave be used to pay for HPV vaccination in Singapore?

Since June 2018, patients can use up to $500 per Medisave account per year under the Medisave500 scheme to pay for HPV immunisation, if the person receiving the vaccination is a female aged 9 to 26 years old.
However, the scheme is only applicable for the Cervarix or Gardasil (4-valent HPV vaccine) vaccines.
Patients can use their own Medisave or that of their immediate family members (e.g. parents or spouse) to help pay for the vaccination.
The deductible and co-payment rules will not apply for HPV vaccinations.

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HPV Prevention: HPV Vaccine (Singapore)

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