COMMENTARY

HPV9 Vaccine: Enhanced Cancer Protection, Guidance for Use

Paul A. Offit, MD

Disclosures

January 12, 2015

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My name is Paul Offit. I am talking to you today from the Vaccine Education Center here at the Children's Hospital of Philadelphia.

In December 2014, something interesting happened. The US Food and Drug Administration licensed a new human papillomavirus vaccine. This vaccine contains nine serotypes, compared with the previous vaccine that contained four.

That previous vaccine contains serotypes 6 and 11, which cover about 90% of the strains that cause anal and genital warts, and it also contains serotypes 16 and 18, which cover about 70% of the strains that cause head and neck, anal, genital, and cervical cancers. The new vaccine contains five additional serotypes (31, 33, 45, 52, and 58). That covers now an additional 15% of the causes of cancer in men and women.

Now, instead of preventing about 25,000 cases of cancer yearly in men and women, we will prevent 29,000—an additional 4000 cancers that can be prevented. Therefore, this vaccine is of value.

It hasn't been recommended yet to the Centers for Disease Control and Prevention (CDC) by the Advisory Committee on Immunization Practices. That will happen at the end of February 2015. I suspect that HPV9 will replace HPV4. There are a few interesting considerations, such as what to do about people who are in the midst of an HPV4 immunization schedule or have completed their HPV4 immunization schedule.

The best recommendation will probably be to give HPV9. HPV9 is given on a three-dose schedule, at times zero, 2 months, and 6 months. In all likelihood—and these studies are being done now and should be finished in about a year—this may well be only a two-dose vaccine down the line, because the data looked good for HPV4 as a two-dose vaccine. In all likelihood, that also will be true here and those two doses will be at time zero and then boosting at 6 or 12 months later.

The vaccine doesn't interfere with HPV4 if the patient has already received HPV4. It also can be given concomitantly with Tdap, as well as with the conjugative meningococcal vaccine, which is given also in adolescents aged 11-13 years.

So we have an exciting new vaccine. This will prevent more cancers, and hopefully people will use it. That is one of the problems with the HPV vaccine. Right now, only about 38% of girls and 14% of boys complete the three-dose series of HPV4. We need to do far better, and I'm sure with continued effort, we will.

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