What is the HPV vaccine?

Human papillomavirus (HPV) is a sexually transmitted infection (STI) that is part of the Papillomavirus family of DNA, nonenveloped viruses.¹ HPV is currently the most common STI in the United States.² The virus resolves on its own in 90% of people but in about 10%, the virus remains and puts those individuals at risk for cancers later in life.³ HPV can cause cervical cancer in females and skin warts, genital warts, anal cancer, and head and neck cancer in females and males.⁴

HPV is highly prevalent in cervical carcinomas.⁵ 98% of cervical cancers have been attributed to HPV. There are several different genotypes of HPV and some are considered more high risk than others.⁶ HPV-16 and 18 are the main cause of cervical cancer.⁵ HPV-16 and 18 also cause about 84% of anal cancers,⁷ while HPV-6 and 11 cause a significant portion of genital warts.⁸ There can also be co-infections with several different types of HPV, with HPV 16 and 18 being the most common co-infection.⁵

There are three types of HPV vaccines: the 9-valent (Gardasil^® 9, 9vHPV), quadrivalent (Gardasil^®, 4vHPV), and bivalent vaccines (Cervarix^®, 2vHPV).⁹ All three have been approved by the FDA and protect against HPV-16 and 18, but currently, only the 9-valent vaccine is available in the US. The 9-valent HPV vaccine is a virus like particle vaccine and protects against types 6, 11, 16, 18, 31, 33, 45, 52, and 58.¹⁰ The vaccine is not a live virus and cannot cause HPV in vaccinated individuals.¹¹

Currently, about 42 million people are infected with HPV and 13 million people will acquire a new HPV infection in the US.¹² This vaccine can protect females against cervical cancer, vulvar and vaginal cancers, anal cancer, head and neck cancers, and genital warts.¹³ The vaccine can protect males against anal cancer, head and neck cancers, and genital warts. The 9-valent HPV vaccine has been found to produce very strong immune responses against all 9 genotypes of HPV.¹⁴ Most individuals have greater than 99% seroconversions for all 9 types of HPV after taking the 9-valent vaccine.¹⁰ The vaccine has reduced the number of HPV infections that are highly associated with cancers and genital warts by 88% in teenage girls.¹⁵

The HPV vaccine is found to be most effective in individuals that have never had HPV, so it is offered as early as age 9 in girls and boys.¹⁶  However, there is a reduction in HPV related pre-cancerous lesions when the vaccine is given to individuals with and without HPV. More patients have been getting the HPV vaccine between ages 18-26 every year with an increase of 17.8% getting vaccinated between 2013 and 2018.¹⁷ The percentage of males getting vaccinated tripled in the same time period.

References

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3. Centers for Disease Control and Prevention. Human Papillomavirus (HPV): HPV Infection. 2021; https://www.cdc.gov/hpv/parents/about-hpv.html. Accessed 19 Dec 2021.
4. Egawa N, Doorbar J. The low-risk papillomaviruses. Virus Res 2017; 231: 119-127.
5. Huang LW, Chao SL, Chen PH, et al. Multiple HPV genotypes in cervical carcinomas: improved DNA detection and typing in archival tissues. J Clin Virol 2004; 29 (4): 271-276.
6. de Cremoux P, de la Rochefordière A, Savignoni A, et al. Different outcome of invasive cervical cancer associated with high-risk versus intermediate-risk HPV genotype. Int J Cancer 2009; 124 (4): 778-782.
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8. Garland SM, Steben M, Sings HL, et al. Natural history of genital warts: analysis of the placebo arm of 2 randomized phase III trials of a quadrivalent human papillomavirus (types 6, 11, 16, and 18) vaccine. J Infect Dis 2009; 199 (6): 805-814.
9. Centers for Disease Control and Prevention. Vaccines and Preventable Diseases: Human Papillomavirus (HPV) Vaccination: What Everyone Should Know. 2021; https://www.cdc.gov/vaccines/vpd/hpv/public/index.html. Accessed 19 Dec 2021.
10. Petrosky E, Bocchini JA, Jr., Hariri S, et al. Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV vaccination recommendations of the advisory committee on immunization practices. MMWR Morb Mortal Wkly Rep 2015; 64 (11): 300-304.
11. The American College of Obstetricians and Gynecologists. Human Papillomavirus (HPV) Vaccination. 2021; https://www.acog.org/womens-health/faqs/hpv-vaccination. Accessed 19 Dec 2021.
12. Lewis RM, Laprise JF, Gargano JW, et al. Estimated prevalence and incidence of disease-associated human papillomavirus types among 15- to 59-year-olds in the United States. Sex Transm Dis 2021; 48 (4): 273-277.
13. GARDASlL 9 Vaccine [package insert]. Whitehouse Station, NJ: Merck Sharp & Dohme Corp.; 2021.
14. Lopalco PL. Spotlight on the 9-valent HPV vaccine. Drug Des Devel Ther 2017; 11: 35-44.
15. Centers for Disease Control and Prevention. Human Papillomavirus (HPV): Reasons to Get HPV Vaccine. 2021; https://www.cdc.gov/hpv/parents/vaccine/six-reasons.html. Accessed 19 Dec 2021.
16. Braaten KP, Laufer MR. Human papillomavirus (HPV), HPV-related disease, and the HPV vaccine. Rev Obstet Gynecol 2008; 1 (1): 2-10.
17. Boersma P, Black LI. Human papillomavirus vaccination among adults aged 18-26, 2013-2018. NCHS Data Brief 2020; (354): 1-8.