Is New Gardasil 9 Better Than the Older HPV Vaccine?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Gardasil 9, the new human papillomavirus (HPV) vaccine, targets nine HPV types and became available early in 2015. There’s some confusion surrounding this vaccine so here are 10 points to help clear it up.

  1. Why do we care? Infection with human papillomavirus (HPV) types 16, 18, 31, 33, 45, 52, and 58 is implicated in 90 percent of cervical cancers. Gardasil 9 targets those seven listed above, in addition to the two types associated with genital warts (6 and 11).
  2. Is Gardasil 9 better than the quadrivalent HPV vaccine (Gardasil) we’ve been using? Immune response to the two vaccines are similar for the HPV types targeted by both (6, 11, 16, and 18). Gardasil 9 is also 97 percent effective for preventing precancerous and cancerous lesions of the cervix and vagina associated with the other targeted HPV types (31, 33, 45, 52, and 58). Hence, the Gardasil 9 is favored for its broader HPV coverage.
  3. When should you get Gardasil 9? Immunization should be offered to boys and girls ages eleven to twelve, but can be administered as early as nine years of age. Catch-up vaccination should be offered for guys between the ages of 13 to 21 and girls between 13 to 26 years who have not been vaccinated.
  4. If I had the Gardasil vaccinations already, do I get the new one? No. Re-vaccination with Gardasil 9 is not warranted for those who have completed the series with a different HPV vaccine.
  5. The girls. To summarize the recommendation for girls: either the quadrivalent or Gardasil 9 HPV vaccine is recommended for the prevention of anal cancer, cervical cancer and its precursor lesions, and genital warts in females. Again, the newer Gardasil 9 is preferred given its greater HPV type coverage.
  6. I’ve already had HPV infection, will the vaccine help? Neither vaccine treats or accelerates the clearance of pre-existing HPV infections.
  7. What if I’ve already had an abnormal pap from HPV? Females who are sexually active should still be vaccinated consistent with age-specific recommendations and a history of an abnormal pap, genital warts, or HPV infection is NOT a contraindication to the vaccine. Having said that, Gardasil vaccine is less beneficial for females who have already been infected with one or more of the HPV vaccine types.
  8. The guys. Gardasil 9 is also recommended over the quadrivalent vaccine (Gardasil) for males given its greater HPV type coverage.
  9. Why vaccinate the boys if the girls are vaccinated? Several reasons:
    • Immunization rates in young girls are generally low so vaccinating males will help prevent infection in unimmunized females.
    • Gardasil 9 vaccination will protect against HPV-related infection and disease in men who have sex with men.
    • HPV infection is common in males and is readily transmitted, influencing disease infection rates in both males and females.
  10. Does the Gardasil 9 vaccine prevent HPV related head and neck cancers? We don’t know yet. While the Gardasil 9 works to prevent 93% of oral HPV, whether HPV vaccination can prevent the development of HPV-related head and neck cancer has not yet been evaluated.

Dr O.

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