HPV vaccination has changed the landscape

There are two different types of HPV vaccines in the US:

The 4-valent HPV vaccine

Initially approved by the FDA in 2006 for use in women aged 9–26 years old for the prevention of cervical cancer, precancerous genital lesions and genital warts due to HPV types 6, 11, 16 and 18.¹ It is no longer distributed in the US.

The 9-valent HPV vaccine

Targets 9 HPV genotypes (6, 11, 16, 18, 31, 33, 45, 52 & 58) and was approved in 2014 for use in women 9–26 years and men aged 9–15 years.² It was extended to individuals up to 45 years old in 2018.³

While the 9-valent HPV vaccine is now exclusively used, women who received the 4-valent vaccine are not protected from all hr-HPV genotypes and have now entered the screening population

The HPV vaccine is administered differently according to age:^4,5

11 to 12 year-old females

recommended for routine use – 2 doses

13 to 26 year-old females

recommended as a “catch-up” – 2 to 3 doses depending on age of first dose

27 to 45 year-old females

not recommended for everyone

The HPV vaccine does not protect against existing HPV infection, therefore it works best when given prior to any HPV exposure⁴

However, by age 50, at least 4 out of every 5 women will have been infected with HPV at one point in their lives⁶ and there is a delay of years, to decades, between HPV infection and onset of cervical cancer, therefore many women remain at risk for cervical cancer.⁷

The HPV vaccine was approved for use in 2006¹, and there are age-specific recommendations for dosing, meaning that in 2021 many women remain unvaccinated and at risk.⁸

In the US, in 2017

68.6% of females ages 13-17 had received a single dose⁵

In the US, in 2017

53.1% of females ages 13-17 had completed vaccination⁵

In the US, in 2017

Vaccination rates in females 18-26 years was 53.6% for a single dose⁹

Additionally, as the vaccinated population increases, HPV 16 and 18 - high-risk genotypes covered by both the 4-valent and 9-valent vaccines - are decreasing in prevalence.⁵

Prevalence of HPV genotypes by age group and vaccine status
(Adapted from Wright 2019)

The prevalence of HPV 16 & 18 was significantly lower in vaccinated women* as compared to unvaccinated women⁵
The prevalence of the other 9 hr-HPV genotypes (pooled results) were increased in vaccinated women*⁵

*The majority of known vaccinated women (89.2%) received the 4-valent vaccine⁵
**Some HPV 16, 18, 31, or 33/58 results include mixed results with one or more of genotypes 45, 51, 52, 35/39/58, and 56/59/66

This means screening that can identify other hr-HPV genotypes, such as HPV 31, 33, 52 & 58, is vital.

FDA, Food and Drug Administration; HPV, human papillomavirus; hr, high-risk; OR, odds ratio; US, United States

1. FDA Licenses New Vaccine for Prevention of Cervical Cancer and Other Diseases in Females Caused by Human Papillomavirus. FDA. 2006. Accessed 3 Nov 2021.
2. FDA approves Gardasil 9 for prevention of certain cancers caused by five additional types of HPV. FDA. 2014. Accessed 3 Nov 2021.
3. FDA approves expanded use of Gardasil 9 to include individuals 27 through 45 years old. FDA. 2018. Accessed 3 Nov 2021.
4. Human Papillomavirus (HPV) Vaccination & Cancer Prevention. CDC. 2020. Accessed 3 Nov 2021.
5. Wright TC et al. Gynecol Oncol. 2019;153(2):259-265
6. Basic Information about HPV and Cancer. CDC. 2020. Accessed 3 Nov 2021.
7. Cancers Caused by HPV. CDCAccessed 3 Nov 2021.
8. HPV Vaccine Recommendations. CDC. 2020. Accessed 5 Nov 2021.
9. Human Papillomavirus Vaccination Among Adults Aged 18−26, 2013-2018. CDC. 2020. Accessed 3 Nov 2021.