Should You Still Administer the HPV-4 Vaccine?

Paul A. Offit, MD


February 16, 2016

Editorial Collaboration

Medscape &

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Hi. My name is Paul Offit. I'm talking to you today from the Vaccine Education Center at Children's Hospital of Philadelphia. I want to talk about an ethical dilemma associated with the human papillomavirus (HPV) vaccine.

Right now there are essentially two HPV vaccines on the market. One is HPV-4, which was licensed about 10 years ago. The other is HPV-9, which was only recently licensed. The HPV-4 vaccine contains serotypes 6, 11, 16, and 18. Serotypes 6 and 11 protect against about 90% of what causes anal and genital warts. Serotypes 16 and 18 protect against about 70% of what causes head and neck, anal and genital, and cervical cancers.

The HPV-9 vaccine has five more serotypes—31, 33, 45, 52, and 58. These protect against an additional 14% of what causes cancer in girls and young women, and another 4% of what causes cancers in boys and young men.

The HPV-9 is a better vaccine. It protects against more serotypes; therefore, it's better, and you could argue that there is no reason to give HPV-4 when there is a better vaccine out there. The problem is that the HPV-4 vaccine is still being made. It probably will be made at least through the second quarter of this year. Many physicians' offices still have HPV-4 vaccine in stock. The company that makes the HPV-4 vaccine is not going to be buying it back, and it's not an inexpensive vaccine. So, what to do?

Because the [new HPV-9] vaccine clearly offers better protection against disease in girls than boys, I would recommend that if you are going to finish using the stock that you have, that you use the HPV-4 vaccine only in boys and use the HPV-9 vaccine in girls. Don't buy any more of the HPV-4 vaccine. That's the best way to resolve a difficult situation.

Thank you for your attention.