April 01, 2015
Area(s) of Interest: Public Health Vaccination
During its February 2015 meeting, the Advisory Committee on Immunization Practices (ACIP) recommended the 9-valent human papillomavirus (HPV) vaccine (9vHPV; Gardasil 9, Merck) as one of three HPV vaccines that can be used for routine vaccination, according to a report published in the March 26 issue of Morbidity and Mortality Weekly Report.
The U.S. Food and Drug Administration approved 9vHPV in December 2014. Based on a review of clinical trials, the committee determined the new vaccine was more cost-effective and had 97 percent efficacy compared with the current 4-valent HPV vaccine. With the addition of five strains, the new vaccine protects against 14 percent more HPV cancers for women and 5 percent more for men. The committee stressed that they did not express a preference of one vaccine over another.
Nearly two-thirds (64 percent) of invasive HPV-associated cancers are caused by HPV types 16 or 18, and about 10 percent are caused by types 31, 33, 45, 52 and 58. HPV types 6 and 11 cause anogenital warts. Similar to quadrivalent HPV vaccine (4vHPV), 9vHPV protects against HPV 6, 11, 16 and 18; 9vHPV also protects against types 31, 33, 45, 52 and 58.
Specific ACIP recommendations are as follows:
- For routine vaccination of females, 9vHPV, 4vHPV or bivalent HPV vaccine can be administered.
- For routine vaccination of males, 9vHPV or 4vHPV can be administered.
- Routine HPV vaccination should begin at 11 or 12 years old, but the series may be started as early as 9 years old.
- Females ages 13 through 26 and males ages 13 through 21 who have not been vaccinated previously or who have not completed the 3-dose series should also be vaccinated.
- Males ages 22 through 26 may also be vaccinated.
- Men who have sex with men and immunocompromised persons through age 26, including those with HIV infection, should also be vaccinated with either 9vHPV or 4vHPV if they were not previously vaccinated.
The evidence underlying these recommendations included findings of a randomized trial enrolling approximately 14,000 females ages 16 through 26. This showed noninferior immunogenicity for the HPV types shared by 4vHPV and 9vHPV and high efficacy for the five additional types. Other trials in clinical development compared antibody responses across age groups and females and males.
Click here to read the full report.