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Human Papilloma Virus Vaccine
Aka: Human Papilloma Virus Vaccine, Quadrivalent Human Papillomavirus Vaccine, HPV Vaccine, Gardasil, Gardasil-9, Cervarix
- See Also
- Human Papillomavirus (HPV)
- Cervical Cancer Screening
- Epidemiology
- Under-Vaccination despite high efficacy and potential to prevent anogenital and oropharyngeal cancer
- Girls: 57.3% vaccinated (as of 2013 in U.S.)
- Boys: 34.6% vaccinated (as of 2013 in U.S.)
- Indications
- General indications
- Prevention of Cervical Dysplasia
- Prevention of anal cancer (receptive anal intercourse)
- Girls and women: Part of Primary Series
- Females routinely at age 11-12 and catch-up age <26 years
- Vaccination may start as early as age 9 years
- As of 2018, approved for use in 27-45 year old women at risk (e.g. new partners)
- More than half of HPV infections in this age group are new exposures
- Prevents 88% of HPV infections if not already exposed (47% overall effectiveness)
- (2018) Presc Lett 25(12):68
- Boys and men
- Part of Primary Series in United States as of 2012
- Males routinely at age 11 to 12 years and catch-up age 21 years
- Routine use in males ages 22 to 26 years old who have HIV Infection or who have sex with men
- Permissive use of Vaccine in males ages 22 to 26 years old
- As of 2018, approved for use in 27-45 year old men at risk
- Reduces risk of Genital Warts, precancerous lesions and transmission to sexual partners
- Preparations: Gardasil-9
- Released in 2015 with additional coverage for 5 HPV Antigens in addition to the 4 in the original Gardasil
- Replaces original Gardasil Vaccine
- Originally approved for males and females 9 to 26 years old
- Extended to include 27-45 year olds at risk as of 2018
- Improves coverage against Cervical Cancer causing HPV from 70% with Gardasil to 90% with Gardasil-9
- Gardasil-9 also reduces the risk of vulvar, vaginal and anal cancers when compared with Gardasil
- Gardasil-9 causes more local reactions than Gardasil (in which local reactions were already very common)
- Two low risk HPV types (but cause 90% of Genital Warts)
- HPV 6
- HPV 11
- Two high risk HPV types (cause 70% of Cervical Cancers)
- HPV 16
- HPV 18
- Additional HPV types responsible for cervical, vulvar, vaginal and anal cancers (added to Gardasil-9)
- HPV 31
- HPV 33
- HPV 45
- HPV 52
- HPV 58
- Preparations: Gardasil (original version)
- No longer available in U.S., was replaced by Gardasil-9 as of 2015
- Mixture of primary capsid proteins of 4 HPV types (Quadrivalent)
- Two low risk HPV types (but cause 90% of Genital Warts)
- HPV 6
- HPV 11
- Two high risk HPV types (cause 70% of Cervical Cancers)
- HPV 16
- HPV 18
- Preparations: Cervarix
- Human Papillomavirus Bivalent Vaccine
- Not available in United States
- Approved only for girls and women ages 9 to 25 years old
- Covers only two high risk types and none related to Genital Warts (contrast with Gardasil)
- HPV 16
- HPV 18
- Contraindications
- Pregnancy
- Anaphylaxis to yeast
- Adverse Effects
- Local pain at injection site
- Gardasil: 84.9%
- Gardasil-9: 90.7%
- Local redness or swelling: 25%
- Fever
- Low grade in 10%
- Over 102 degrees in 1.4%
- Other reactions
- Headache (11-14%)
- Syncope (rare)
- Efficacy
- Highest efficacy when administered prior to onset of sexual activity (prior to exposure)
- Dosing
- Intramuscular Injection
- Two dose schedule as of 2017 (indicated if started before age 15 years and immunocompetent)
- Indicated for ages 9-14 years old
- Age >15 years old should use 3 dose schedules (or if immunocompromised, e.g. HIV)
- Schedule: Two doses at 6-12 months apart (U.S. Primary Series starts series at age 11-12 years old)
- Dose 1: Month 0
- Dose 2: Month 6-12 (at least 5 months after dose 1)
- (2016) Presc Lett 23(12): 67
- Three dose schedule (age of first dose >15 years old or immunocompromised)
- If one dose given before age 15 years old, may give a single booster dose age 15-26 years old
- Schedule: 0, 2, and 6 months
- Dose 1: Month 0
- Dose 2: Month 1-2 (at least 1 month after dose 1)
- Dose 3: Month 6 (at least 3 months after dose 2, and at least 5 months after dose 1)
- Cost
- Three doses: >$1000 for Gardasil-9 (covered by most U.S. insurance plans)
- Original Gardasil was priced at >$400 for three doses
- Resources
- CDC Immunization Schedules (last accessed 10/28/2020)
- https://www.cdc.gov/vaccines/schedules/
- CDC MMWR
- http://www.cdc.gov/mmwr/pdf/rr/rr6002.pdf
- References
- Goeser (2007) Am Fam Physician 76:573-4
- Joura (2015) N Engl J Med 372:711-23 [PubMed]
- Rerucha (2018) Am Fam Physician 97(7): 441-8 [PubMed]
- Villa (2005) Lancet Oncol 6:271-8 [PubMed]