What Human Papillomavirus (HPV) vaccines are available in Canada?

HPV Vaccines Available in Canada

Three HPV vaccines are currently available in Canada: the bivalent vaccine (Cervarix), the quadrivalent vaccine (Gardasil), and the 9-valent vaccine (Gardasil-9), with Gardasil-9 now being the preferred and most commonly used formulation. 1, 2

Vaccine Formulations and Coverage

Bivalent Vaccine (Cervarix)

• Protects against HPV types 16 and 18 - the high-risk oncogenic types responsible for approximately 70% of cervical cancers 3, 4
• Approved for use in females only 4
• Contains virus-like particles (VLPs) of the L1 capsid protein with no viral DNA 3

Quadrivalent Vaccine (Gardasil)

• Protects against HPV types 6,11,16, and 18 3, 2
• Covers both cancer-causing types (16,18) and genital wart-causing types (6,11) 4
• Approved for use in both males and females aged 9-26 years 4
• Historically used in Canadian school-based immunization programs 2

9-Valent Vaccine (Gardasil-9) - Current Standard

• Protects against HPV types 6,11,16,18,31,33,45,52, and 58 3, 4, 5
• Provides protection against approximately 84% of HPV-related cancers in women (70% from types 16/18 plus an additional 14% from the five additional types) 4
• Covers 90% of genital warts through types 6 and 11 4
• Demonstrated 97% efficacy in preventing cervical, vulvar, and vaginal cancer precursor lesions related to the five additional types 4

Current Canadian Dosing Recommendations

Simplified 1-Dose Schedule (Ages 9-20 Years)

The National Advisory Committee on Immunization (NACI) now recommends a single dose of 9vHPV (Gardasil-9) for individuals aged 9 to 20 years, representing a major simplification from previous multi-dose schedules 1. This recommendation is based on:

• High effectiveness against HPV infection in younger populations with up to 11 years of follow-up data 1
• Infectious disease modeling showing similar health outcomes between 1-dose and 2-dose strategies in Canada 1
• Improved feasibility and potential for better coverage rates compared to multi-dose programs 1

2-Dose Schedule (Ages 21 Years and Older)

• Individuals 21 years and older should receive a 2-dose schedule 1

3-Dose Schedule (Immunocompromised Populations)

• Immunocompromised individuals and those with HIV infection require a 3-dose series regardless of age 1
• This includes patients with primary or secondary immunocompromising conditions 3

Special Populations in Canada

Canadian guidelines specifically include HPV vaccination recommendations for high-risk groups 3:

• Individuals with abnormal cervical cytology or history of cervical cancer and/or genital warts 3
• Men who have sex with men (MSM) 3
• Immunocompromised individuals 3

Updated Guidance

Discretionary Vaccination (Ages 27+)

NACI issued a discretionary recommendation for HPV vaccination in individuals 27 years and older, expanding beyond the traditional age limits 1

Pregnancy

NACI updated guidance now allows HPV vaccine administration during pregnancy, removing a previous contraindication 1

Important Clinical Considerations

Coverage Gaps

• Despite school-based programs and public funding, HPV vaccine uptake in Canada remains significantly below rates for other vaccine-preventable diseases and falls short of the national goal of 90% coverage for two or more doses by age 17 1, 2
• Healthcare provider recommendation is the single biggest influence on vaccine uptake 2

Screening Still Required

Cervical cancer screening remains essential even in vaccinated individuals because vaccines do not cover all cancer-causing HPV types 4

Availability and Access

• Both Gardasil and Cervarix are available in Canada, though Gardasil-9 is now the preferred formulation 2, 6
• All provinces and territories provide publicly funded HPV vaccination for females through school-based clinics 2
• The simplified 1-dose schedule addresses previous barriers related to completion of multi-dose series 1