ACIP Publishes Recommendations for Nine-Valent HPV Vaccine — Physician’s First Watch

Medical News |
March 27, 2015

ACIP Publishes Recommendations for Nine-Valent HPV Vaccine

By Kelly Young

Edited by André Sofair, MD, MPH

The CDC's Advisory Committee on Immunization Practices has published its recommendations for vaccinating against human papillomavirus with the nine-valent HPV vaccine (Gardasil 9) in MMWR.

The nine-valent vaccine targets five more strains than the quadrivalent version, and these five strains (31, 33, 45, 52, and 58) cause roughly 15% of cervical cancers.

The recommendations for administration are the same as for other HPV vaccines: routine vaccination should be started at age 11 or 12 years, but may begin as early as age 9. Vaccination is also advised for females aged 13–26 and males aged 13–21 who have not been vaccinated or have not received all three doses. In addition, vaccination is also recommended through age 26 for men who have sex with men and for patients who are immunocompromised.

ACIP notes: "If vaccination providers do not know or do not have available the HPV vaccine product previously administered, or are in settings transitioning to 9vHPV, any available HPV vaccine product may be used to continue or complete the series for females for protection against HPV 16 and 18; 9vHPV or 4vHPV may be used to continue or complete the series for males."

Anna Wald of NEJM Journal Watch Women's Health comments: "If someone has completed the series with either bivalent or quadrivalent HPV vaccine (for girls) and quadrivalent (for boys), they are considered fully vaccinated. The nine-valent adds protection against additional oncogenic HPV types, but the most important goal is to prevent HPV 16 and 18, and all three vaccines do that."

Reader Comments (3)

T.K. Physician, Family Medicine/General Practice

SAE rate seems high.

robert miller, md. Physician, Dermatology, office, west hills calif.

worthwhile read. thanks.

SteveHinks Other Healthcare Professional, Unspecified, Retired

The incidence rate of cervical cancer is 9/100,000. The mortality rate has reduced from 8 to 2/100,000 over the last 40 years, with no vaccine, and at this rate could be zero within 10 years.

The incident rate of SERIOUS adverse events (SAE, typically disabling autoimmune reactions) during the vaccine trials done on healthy adults was:

Cervarix: 2844 SAE /100,000 see European Medicine Agency report 'Scientific discussion' http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Scientific_D...

Gardasil: 2300 SAE /100,000 see Merck's 'Highlights of Prescribing Information' https://www.merck.com/product/usa/pi_circulars/g/gardasil_9/gardasil_9_p...

We were told 'it is safe' and now we are told 'the benefits outweigh the risks and the risk/benefit ratio is positive'. Our daughter and thousands of others are severely disabled and those that are supposed to gain benefit won't know for 20 years (the time it takes to develop cervical cancer) by which time it would have been eliminated any way.

The UK government quoted a vaccine cost of £2.25 billion in their Impact Assessment and didn't consider the cost of any adverse reactions.

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