Human Papillomavirus (HPV) Vaccine Update

Cheryl Lau, PharmD Candidate Class of 2021; Hayden Carrion, PharmD Candidate Class of 2021; Michele Pisano, PharmD, BCGP, CDE; Carmela Avena-Woods, BS Pharm, PharmD, BCGP


US Pharmacist. 2020;45(9):17-20. 

In This Article


In December 2014, there were three approved vaccines for HPV: Cervarix (2vHPV), Gardasil (4vHPV), and Gardasil9 (9vHPV), all of which are synthetically manufactured virus-like particles. Gardasil, the first available vaccine against HPV, was approved for use in the U.S. in 2006 to protect against four HPV types associated with cancers: 6, 11, 16, and 18.[11] It is indicated for prevention of genital warts, precancerous or dysplastic lesions, and cervical cancer in females and males ages 9 to 26 years.[12] Gardasil was then replaced by Gardasil9 in 2014; Gardasil9 was approved for use against the same four HPV types covered by Gardasil, plus five additional types: 31, 33, 45, 52, and 58.[13] The 9-valent vaccine also contains more than twice the antigenic load for HPV16 and HPV18, the two most prevalent types associated with cervical cancer, proving noninferiority in antibody responses to Gardasil.[13] It is indicated for prevention of genital warts, precancerous or dysplastic lesions, and cervical, vulvular, vaginal, and anal cancers in females 9 to 45 years old.[14] Cervarix is equivalent in efficacy to Gardasil9 in preventing HPV infections and HPV-associated cancers.[11] It is bivalent and targets HPV16 and HPV18, but it is no longer available in the U.S. due to its lower antigenic concentration than that of both Gardasil and Gardasil9. Gardasil9 is the only HPV vaccine currently available in the U.S.

Pervasive myths and misconceptions surrounding vaccines often serve as a barrier to optimal immunization rates. As a vaccine for a sexually transmitted infection, the HPV vaccine consistently lags behind other routine vaccines for adolescents. Many parents assume their preteen children are not sexually active, fearing that immunization may actually encourage sexual activity. However, research indicates that HPV vaccination in the recommended ages did not demonstrate any significant increase in sexual outcomes.[8] HPV is not spread exclusively through sexual contact—although rare, it can also be spread by skin-to-skin contact.[15]

The HPV vaccine is most effective when the series is completed before any sexual activity begins, which is one of the main reasons the vaccine is recommended for boys and girls at an early age. If administered and completed by age 12 years, the vaccine is able to elicit a greater immune response and antibody amount to fight infection.[8] Clinical trial data show that both males and females who received the HPV vaccine at age 11 or 12 years had the highest antibody titers—approximately twice the amount in individuals vaccinated at age 15 years or older.[16]