Nine-Valent HPV Vaccine Protects Against Additional Oncogenic Strains — Physician’s First Watch

Medical News |
February 19, 2015

Nine-Valent HPV Vaccine Protects Against Additional Oncogenic Strains

By Anna Wald, MD, MPH

The new, nine-valent vaccine against human papillomavirus (HPV) shows nearly 100% efficacy against disease caused by five additional HPV strains, a New England Journal of Medicine study finds.

Industry-funded researchers randomized over 14,000 young women to receive the quadrivalent vaccine (which protects against HPV 6, 11, 16, and 18) or the nine-valent product (which also protects against types 31, 33, 45, 52, and 58).

Among women who were HPV-negative at study entry, the nine-valent vaccine prevented over 96% of high-grade cervical, vaginal, or vulvar neoplasia or cancers related to the five additional strains. Antibody titers against the four original strains were similar in the two groups, suggesting that protection against these viral types was not compromised by the additional antigens.

The successful addition of five more HPV types to the vaccine should extend the prevention of HPV-related cervical cancer to 90%. Coverage in the U.S. remains problematic, however, with only 57% of eligible girls having received one or more dose of HPV vaccine. Reasons include lack of insurance coverage, inconvenience of the three-dose regimen, limited wholehearted support from pediatricians, and moral and religious attitudes in certain parts of the country. The FDA's approval of the nine-valent vaccine raises new questions: What will the product cost? Will it be for girls only? What about those girls who have already begun the quadrivalent vaccine series? We await further guidance from the Advisory Committee on Immunization Practices.

Dr. Wald is an associate editor with NEJM Journal Watch Women's Health, from which this story was adapted.

Reader Comments (2)

Kegel, Daniel BS Bi Other, Other, Private

Abstinence may be effective in the ideal, but teaching abstinence in the real world has not been shown to reduce STI or pregnancy rates repeatably for more than a few months.

The current HPV vaccine, on the other hand, has been shown to reduce CIN3 by about 50% in 20-21 year olds; see

Now, abstinence *enforced by law* might work; it probably does work in highly repressive countries. But that's not an approach DeMedio would seriously advocate. Stoning also went out with the Vikings.

We won't have to wait 40 years to see whether the vaccines prevent cervical cancer. Lehtinen writes in "We have ≥80%
power to provide data on vaccine efficacy against CIN3
in 2014, against ICC in 2022 and against other HPVassociated
cancers in 2024".

William DeMedio MD Physician, Family Medicine/General Practice, Private

The fact is there has been a highly effective method of preventing cervical cancer which has proven itself for over 50 years with the test of time. It is called the traditional Pap smear. This is the only truly "proven effective" method to lower the incidence of cervical cancer deaths. If all women had one done on a regular basis cervical cancer deaths would drop to near zero, as would invasive cervical cancer incidence.

Vaccines for HPV are probably a useful adjunct to the Pap smear. They have been in development for the past 15 to 20 years or so. They have shown themselves to be highly efficacious in preventing HPV infections. However they are not nearly as efficacious as abstinence from sex and monogamy, especially in young men and women. Vaccines today are also very expensive like the rest of medical care. In fact, medical care is so expensive that it costs the average couple nearly as much as a mortgage per month, and this is a mortgage that will never be paid off.

It is surprising that a prestigious journal such as NEJM would publish an article promoting a new expensive vaccine that might help, while putting aside highly effective techniques such as the Pap smear and abstinence that are known to help.

Only the test of time (maybe 40 years) will show that these vaccines are as effective as routine screening and common sense in controlling one's sex drive. Certainly at the present they do not replace routine screening, and people need to be educated regarding proper control of the sex drive. It can be done, just like the Vikings and Saxons were tamed of their blood lust 1000 years ago.

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