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 Papilloma Virus, 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 30 to 40 HPV strains can infect the genital area; some can cause genital warts in both men and women, but only 14 are associated with cervical cancer in women and less commonly, anal or penile cancer in men. These 14 strains are known as high-risk HPV.
Other HPV strains may infect the skin of the fingers, hands and face.

How is HPV Related to Cervical Cancer?

Some types of HPV can infect the cervix (the lower part of the womb), causing normal cells to change. In about 90 percent of the infection cases, the virus clears by itself and the cells return to normal.
In some cases, the infection can persist and cause the cells to grow abnormally. If this goes undetected by a Pap test at an early stage, some of these abnormal cells may develop into cervical cancer.
Specifically, HPV subtypes 16 and 18 account for about 70 percent of cervical cancer cases, while HPV subtypes 6 and 11 are responsible for about 90 percent of genital warts cases. Thus, a HPV DNA test is a more sensitive test as it will be able to detect these high risk HPV strains even before the cells become abnormal.


Who is At Risk of HPV Infection?

HPV is a common skin infection. Most people infected by genital HPV have no clear history of contact. However, the risk of infection is seen to be higher for:
Those with multiple sexual partners: the greater the number of sexual partners, the higher your risk of HPV infection. Sexual activity with a partner who has had multiple sex partners may also increase your risk. While using condoms can help reduce the risk of HPV infection, it does not cover all genital skin nor guarantee 100-percent protection.
Those with a weakened immune system: people with weakened immune systems (e.g. due to Human Immunodeficiency Virus (HIV) / Acquired Immune Deficiency Syndrome (AIDS) or on 2 or more immune-system suppressing drugs) are at higher risk of HPV infection.

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 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.

Can HPV Be Treated?

The virus itself cannot be treated. Most HPV infections (90 percent of the cases) go away without the need for treatment.
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.
Cervical cancer can be prevented when the abnormal or pre-cancerous cells are identified and treated appropriately.

How Can I Best Protect Myself Against Cervical Cancer?

Go for regular cervical cancer screening as it is the most effective way to detect 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 test once every five years (for women 30 years and above).
Speak to your doctor about HPV vaccination to determine if you are suitable.
Women should still for go for cervical cancer screening despite being vaccinated as the HPV vaccines cover only 70-90% of the high-risk HPV strains.


Where Can I Go for a Cervical Cancer Screening?

At your family doctor's clinic, selected Screen For Life (SFL) GPs or at any polyclinic.
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 Vaccine?

The HPV immunisation vaccine can help prevent specific types of HPV infection that may lead to cervical cancer. The benefits of HPV vaccination are maximised when given before any sexual activity where HPV exposure may occur.

What are the Available HPV Vaccines in Singapore?

Three vaccines, Gardasil 4, Gardasil 9 and Cervarix, are currently approved for use in Singapore.
The characteristics of the three vaccines are shown in the table below.


Gardasil
Cervarix
​Protect against the following HPV subtypes
​6, 11, 16, 18
16, 18​
​Vaccination schedule
​Two-dose schedule
Interval at zero and six months for females from age nine to 13 years inclusive

Three-dose schedule
Interval at zero, two and six months for females from age 14 to 26 years inclusive

Two-dose schedule
Interval at zero and six months for females from age nine to 13 years inclusive

Three-dose schedule
Interval at zero, one and six months for females from age 14 to 25 years inclusive
​Approved indications
​Prevention of cervical cancer, vulvar cancer, vaginal cancer and genital warts
​Prevention of cervical cancer
​Approved age for use
​Girls and women aged nine to 26 years, or as advised by your doctor.
​Girls and women aged nine to 25 years, or as advised by your doctor.

Who are 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 (HPV subtypes 6, 11, 16, 18).
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).
you have a bleeding disorder that causes you to bruise or bleed easily or if you are on medication that thins your blood (anticoagulant therapy), unless otherwise advised by your doctor.

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?

This is the age range as recommended by the manufacturers and which the vaccines are approved for use in Singapore by the Health Sciences Authority.
If you are above 26 and wish to go for HPV vaccination, it is best that you 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 approved for females aged nine to 26 years old (depending on the specific vaccine being administered).
The vaccines are most effective in protecting against the selected HPV subtypes if given before your daughter is exposed to them (usually through sexual activity).
It is advisable to speak to your doctor to find out more about HPV immunisation.
Once you have understood the benefits, risks and limitations of the vaccines, the decision to proceed with HPV vaccine is a personal one.

Are HPV Vaccinations Compulsory?

No, HPV vaccination is not compulsory in Singapore but is highly recommended as prevention against cervical cancer.

How Long Does 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?

The three vaccines have been approved as safe and effective. 
Long-term safety and efficacy are still under evaluation.
The vaccines consist of neither the viruses or any infectious material. This means you cannot get HPV infection 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 100-percent Effective for HPV Prevention?

No. As with any vaccination, HPV vaccinations do not guarantee 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've Been Vaccinated for HPV. Must 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).
About 10 to 30 percent of cervical cancer cases are caused by HPV subtypes which the vaccines do not protect against. In other words, the HPV vaccines do not protect against all cancer-causing HPV subtypes.
Regular cervical cancer screen is still your best protection against cervical cancer.

I'm Pregnant/Breastfeeding. Should I Be Vaccinated?

HPV vaccines are not recommended for pregnant women.
If you discover that you are pregnant after receiving the first doses of the vaccine, it is recommended that you postpone the remaining dose(s) until after you deliver.
If you discover that you are pregnant after completing three doses of the vaccine, it is not necessary to terminate your pregnancy.
Gardasil may be given to breastfeeding women as available data does not indicate any safety concerns. However, Cervarix's safety data for lactating females is not available yet.

Where Can I Get the HPV Vaccine?

You can receive HPV vaccination at a polyclinic or GP clinic.
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 Vaccine?

It is best to consult your doctor who will advise you if the vaccine is suitable for you. Also check how often you should be going for Pap smears.

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, HPV vaccination is recommended only for females aged nine to 26 years old under the NCIS.
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?

Yes. With effect from 1 November 2010, patients can use up to $400 per Medisave account per year under the Medisave400 scheme to pay for HPV immunisation.
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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