What is the recommended vaccine for the prevention of cervical cancer?

HPV Vaccination for Cervical Cancer Prevention

The nine-valent HPV vaccine (9vHPV, Gardasil 9) is the recommended vaccine for prevention of cervical cancer as it provides the broadest protection against HPV types that cause cervical cancer. 1, 2

HPV Vaccines Available

• Three HPV vaccines have been licensed: bivalent (2vHPV), quadrivalent (4vHPV), and nine-valent (9vHPV) vaccines 1
• All three vaccines protect against HPV types 16 and 18, which cause approximately 70% of cervical cancers 1
• The quadrivalent vaccine (4vHPV) additionally protects against HPV types 6 and 11, which cause 90% of genital warts 1
• The nine-valent vaccine (9vHPV) provides the most comprehensive protection by covering five additional oncogenic HPV types (31,33,45,52, and 58), increasing potential protection from ~70% to ~90% of cervical cancers 2, 3

Efficacy and Benefits

• All HPV vaccines have demonstrated high efficacy against HPV-related infection and cervical, vaginal, vulvar, and anal dysplasia 1
• The 9vHPV vaccine has comparable safety and immunogenicity to the 4vHPV vaccine for the original four types, with additional protection against five more oncogenic types 2
• Population-level benefits have been observed as early as 3 years after introduction of HPV vaccination programs, including decreases in:
  • High-grade cervical abnormalities
  • Prevalence of vaccine HPV types
  • Incidence of genital warts 1
• HPV vaccination is expected to prevent >70% of cervical cancers based on surrogate markers 1

Recommended Age and Schedule

• Routine HPV vaccination is recommended for females aged 11 to 12 years 1
• Females as young as age 9 years may receive HPV vaccination 1
• Catch-up vaccination is recommended for females aged 13 to 18 years who missed vaccination or need to complete the series 1
• The original recommended schedule was a 3-dose series with the second and third doses administered 2 and 6 months after the first dose 1
• More recent evidence supports that a 2-dose schedule provides comparable immunogenicity in younger age groups (9-14 years) 4

Special Considerations

• Vaccination is most effective when administered before potential exposure to HPV through sexual intercourse 1
• HPV vaccination does not eliminate the need for cervical cancer screening, as not all HPV types that cause cervical cancer are included in the vaccines 1
• Vaccinated women should continue cervical cancer screening according to established guidelines 1
• The benefit of vaccination diminishes with increasing number of lifetime sexual partners 1

Safety Profile

• All HPV vaccines have demonstrated good safety profiles in clinical trials 1
• The 9vHPV vaccine has slightly more local adverse events than the 4vHPV vaccine (90.5% vs 84.6%) but a similar overall safety profile 3, 4
• Common adverse events include injection-site reactions such as pain, redness, and swelling 3
• Serious adverse events are rare and similar between vaccine and control groups 4

Pitfalls to Avoid

• Delaying vaccination until sexual debut may reduce vaccine effectiveness 1
• Assuming vaccination eliminates the need for cervical cancer screening 1
• Overlooking the importance of completing the full vaccine series for optimal protection 1
• Failing to recommend the 9vHPV vaccine, which provides the broadest protection against cervical cancer-causing HPV types 2, 3

The 9vHPV vaccine represents the most comprehensive option for cervical cancer prevention through vaccination, offering protection against approximately 90% of cervical cancer-causing HPV types compared to the 70% coverage provided by earlier vaccines 2, 3.