What is the difference between Cervarix (human papillomavirus bivalent vaccine) and Gardasil (human papillomavirus quadrivalent vaccine)?

Key Differences Between Cervarix and Gardasil HPV Vaccines

The main difference between Cervarix and Gardasil is that Cervarix is a bivalent vaccine protecting against HPV types 16 and 18, while Gardasil is a quadrivalent vaccine protecting against HPV types 6,11,16, and 18, with different target populations and immune response profiles. 1

Vaccine Composition and Coverage

• Cervarix (GlaxoSmithKline) is a bivalent vaccine that protects against HPV types 16 and 18, which are responsible for approximately 70% of cervical cancers 1
• Gardasil (Merck & Co.) is a quadrivalent vaccine that protects against HPV types 6,11,16, and 18, covering both cancer-causing types (16,18) and types that cause genital warts (6,11) 1
• Both vaccines are based on virus-like particles (VLPs) containing the L1 capsid protein of HPV, which contain no DNA and are not live/attenuated viruses 1

Target Population

• Gardasil is FDA-approved for use in both males and females aged 9-26 years 1
• Cervarix is approved for use only in females 1
• Both vaccines are ideally administered before the onset of sexual activity to maximize effectiveness 1

Administration Schedule

• Gardasil is administered via intramuscular injection at 0,2, and 6 months 1
• Cervarix is administered via intramuscular injection at 0,1, and 6 months 1, 2

Efficacy and Protection

• Both vaccines demonstrated 100% efficacy in preventing persistent type-specific HPV infections and CIN2/3 (cervical intraepithelial neoplasia grade 2/3) in clinical trials when administered to HPV-naive individuals 1
• Gardasil additionally protects against genital warts and vulvar/vaginal neoplasia caused by HPV types 6 and 11 1
• Cervarix has shown efficacy for up to 6.4 years, while Gardasil's documented efficacy extends to 5 years 3, 4
• Cervarix appears to provide better cross-protection against additional HPV types not included in the vaccine, particularly HPV 31,33, and 45 3, 4

Immune Response Differences

• Cervarix induces 2.3-4.8-fold higher neutralizing antibody titers for HPV-16 and 6.8-9.1-fold higher titers for HPV-18 compared to Gardasil across all age groups 2
• Cervarix generates higher cervicovaginal mucus-neutralizing antibody presence than Gardasil 3, 2
• Cervarix elicits a significantly higher B memory cell response than Gardasil 3, 2
• Cervarix induces higher IgG3 and antibody-dependent complement activating responses, potentially due to its different adjuvant system 5

Safety Profile

• Both vaccines have similar overall safety profiles with few serious adverse events reported 1
• Injection site reactions are more common with Cervarix than with Gardasil 1, 2
• The most common systemic adverse experiences for both vaccines include fever, headache, and nausea 1
• Despite differences in reactogenicity, compliance rates with the three-dose schedules are similarly high (≥84%) for both vaccines 2

Clinical Implications

• The choice between vaccines should consider the target population (male vs. female) and desired protection against genital warts 1
• For prevention of cervical cancer specifically, Cervarix may offer advantages due to its stronger immune response and cross-protection against additional oncogenic HPV types 3, 4
• For broader protection including against genital warts, Gardasil offers advantages due to its coverage of HPV types 6 and 11 1
• The clinical significance of the differences in antibody titers between the vaccines for long-term protection remains to be fully determined 2