In the United States, there are approximately 13,000 new cases of cervical cancer and nearly 4,000 deaths each year, and the culprit is the human papillomavirus (HPV). There are more than 150 types of HPV, 13 of which can cause cervical cancer, and the most common oncogenic subtypes are HPV16 and 18. Data from the United States show that cervical cancer caused by 16 and 18 types account for 66% of cases, while genotypes 31, 33, 45, 52 and 58 account for a total of 15%. 18, 25% of cases were caused by HPV 31, 33, 45, 52, and 58 infection, and 90% of genital warts were caused mainly by HPV 6 and 11. Thus, HPV is associated with a variety of genital tract cancers, including primarily cervical, vaginal, and vulvar cancers. A man: You see, you women are the only ones who have a lot of problems. In fact, HPV has been shown to cause penile and anal cancers, as well as being associated with oropharyngeal cancer and genital warts. Data from the United States show that an average of 15,793 new cases of anal genital or oropharyngeal cancers in men were associated with HPV16 or HPV18 in 10,200 of them (65%). Available studies have shown that HPV vaccines significantly reduce the incidence of genital warts and reduce the incidence of mother-to-child transmission of HPV. Since the introduction of quadrivalent vaccine in the United States in 2006 (data from 2006 to 2010), HPV infection rates among vaccinated individuals aged 14 to 19 years have decreased by 56%. However, current data show that only 41.9% of women in the United States have received a full course of the vaccine at the appropriate age, and even fewer men, 28.1%, than in other countries. As a result, the American College of Obstetricians and Gynecologists (ACOG) recently released a new guideline opinion on HPV vaccination to replace the document released in September 2015, and we will share this latest guideline below. 1. HPV vaccine status The FDA currently approves three vaccine sizes, two, four and nine valent, and the recommended vaccination age is 11 to 12 years old and up to 26 years old. For those who have already received the first vaccination before the age of 15, they only need to receive 2 doses in total, namely the first dose and the second dose after 6 to 12 months, but if the interval between the two doses is less than 5 months, then they need to receive the third dose; if they receive the first dose after the age of 15, they need to receive a total of 3 doses, namely the first dose and the 1 to 2 months and 6 months after the first dose, i.e. 0, 1 to 2, 6 programs. The length of immunization is still being studied, but if the second or third dose is delayed, there is no need to supplement the first dose. In addition, HPV does not induce earlier sexual activity or increase the risk of sexually transmitted diseases. 2. Timing of vaccination The American Advisory Committee on Immunization Practices (ACIP) and ACOG recommend routine HPV vaccination for children 11 to 12 years of age, regardless of gender. Currently, the efficacy of the bivalent, quadrivalent, and nine-valent vaccines has been demonstrated for females aged 9 to 26 years, and the quadrivalent and nine-valent vaccines have been shown to protect males aged 9 to 26 years. The bivalent vaccine has recently been withdrawn from the U.S. market, and the nine-valent vaccine will replace the quadrivalent vaccine. Studies have shown that for people aged 9 to 14 years who received two doses of the vaccine six months apart, the titers of antibodies to the virus were the same as for those aged 15 to 26 years who received three doses. Therefore, for those vaccinated before age 15, a total of two doses is sufficient, but a 6-month interval is needed to ensure antibody titers and length of immunity, and a third dose is needed if the interval is less than 5 months. Data from the United States show that one-third of the 9th grade cohort is sexually active, and up to two-thirds of the 12th grade cohort, so early vaccination can provide better protection by achieving immunity before exposure and infection with HPV. However, the guidelines state that HPV vaccination is recommended regardless of whether one has been sexually active or previously infected with HPV, as the likelihood of infection with all nine HPV viruses in previously infected individuals is extremely low. In addition, HPV DNA testing is not recommended before vaccination because HPV vaccination is recommended even if the test result is positive. 3. About the nine-valent vaccine This vaccine was approved for use by the FDA in December 2014. A phase III clinical trial that included 14,000 women aged 16-26 years compared the efficacy of quadrivalent and nine-valent vaccines and showed that the nine-valent vaccine better protected women from HPV 31, 33, 45, 52, 58-related cervical intraepithelial neoplasia 2+, vulvar intraepithelial neoplasia 2/3, and vaginal intraepithelial neoplasia 2/3 with no reduction in antibody titers against HPV types 6, 11, 16, and 18. The titers of antibodies against HPV types 6, 11, 16 and 18 did not decrease. The vaccine types and efficacy are shown in the table below. Table 1 Vaccine type and efficacy The supplemental nine-valent vaccine is not routinely recommended for those who have completed a previous three-dose course of bivalent or quadrivalent injections. If the type of vaccine previously administered to female patients is unknown or the hospital does not have a previous vaccine of the same type, it is sufficient to complete the vaccination with the existing type of vaccine, while for males, it is recommended to complete the vaccination course with quadrivalent or nine-valent vaccines. The safety of all three vaccines has been verified, and data from the Vaccine Adverse Event Reporting System show that 60 million doses have been administered since 2006, and there is no evidence of serious side effects related to the vaccines. The quadrivalent and nine-valent vaccines have comparable safety profiles, but the latter has a higher incidence of localized edema and erythema than the quadrivalent, and the incidence of these side effects increases with the number of nine-valent vaccinations. Therefore, the physician should inform the patient after vaccination that these local reactions are normal and that there is no need for anxiety. It is also safe to continue to receive the nine-valent vaccine after previous quadrivalent vaccination, but people with previous fatal allergies to HPV vaccine components or doses should not be vaccinated, so physicians should be careful to ask about any history of severe allergies or moderate to severe febrile illnesses before vaccination. Although HPV vaccination is not recommended during pregnancy, there is no need to routinely screen for pregnancy prior to vaccination, and those who become pregnant after vaccination may receive additional follow-up doses after completing their pregnancy. Since HPV is an inactivated vaccine, it can be administered during breastfeeding without adverse effects on the mother or infant; HIV infection or organ transplantation is not a contraindication to HPV vaccination, but three doses are recommended for this group to ensure a robust immune response. Currently, the HPV vaccine is not approved for use in women over the age of 26 in the United States, although this is a case by case basis since not all women over the age of 26 are sexually active. According to the CDC, a high vaccination rate of 80% for age-appropriate individuals (<12 years) would reduce the number of cervical cancer cases in this population by 53,000, and if there were no annual increase in vaccination rates, an additional 4,400 women would develop cervical cancer. Therefore, the guidelines repeatedly emphasize that physicians should promote HPV vaccine knowledge and actively provide related counseling to address parental concerns so as to seize the best time to vaccinate adolescents. (1) Obstetricians and gynecologists should actively educate parents and patients about the benefits of HPV vaccine and its safety, and physicians' recommendations have an important impact on parents' decisions; (2) Obstetricians and gynecologists need to pursue HPV vaccination when seeing adolescent girls and young women aged 13 to 26 years; (3) Parents of children should actively educate and counsel their children (male or female) about HPV vaccination. (4) Obstetricians and gynecologists can use the opportunity of physical examinations to educate parents about HPV vaccination and encourage them to vaccinate their children at the appropriate age (11 to 12 years). (6) The best age for vaccination is 11 to 12 years old for both sexes, but 26 years old is also acceptable; (7) For those who have received their first vaccination before the age of 15, only 2 doses are required, the first and the second after 6 to 12 months, but if the interval between the two doses is less than 5 months, then a third dose is required; if the first dose is received after the age of 15, a total of 3 doses are required, the first and the first 1-2 months and 6 months after the first dose, i.e., the 0, 1, 2, 6 schedule. (8) HPV DNA testing is not recommended prior to vaccination because HPV vaccination is recommended even if the DNA is positive; (9) Vaccination is recommended for those with previous abnormal cervical smears or a history of genital warts; (10) Care should be taken to ask patients about their history of severe allergies prior to vaccination, and those with moderate to severe febrile illnesses should wait until their condition improves; (11) Vaccination is not recommended during pregnancy but is not recommended for those who are pregnant. (12) Lactating females under 26 years of age who have not been vaccinated before can/should be vaccinated; (13) Vaccine recipients should be informed that there is no need to worry about local discomfort after vaccination. minutes after vaccination.