What you need to know about the new HPV vaccine

1. This week, the Food and Drug Administration approved a new Human Papillomavirus (HPV) vaccine called Gardasil 9. This means there are now three HPV vaccines licensed for use in the US.
2. Gardasil 9 protects against more strains of the cancer- and genital warts-causing HPV than the vaccines currently on the market.
3. Doctors are excited about this development and say it seems like an improvement on the existing HPV vaccines.
4. But Gardasil 9 isn't on the market just yet. Until it becomes available, patients should continue getting the other HPV vaccines as recommended.

We now have three HPV vaccine options in the US

There are more than 100 strains of the human papillomavirus, or HPV. Some of them cause cervical, vulvar, vaginal, head, neck, and anal cancers, while others cause genital warts.

In recent years, vaccines have emerged to protect people against the most harmful strains of HPV. In particular, two vaccines have been approved for use in the US: Gardasil and Cervarix. These HPV vaccines are the first-ever vaccines to prevent against cancer.

This week, a third HPV vaccine was licensed here: Gardasil 9. The existing Gardasil vaccine protected against four strains of HPV (6, 11, 16, and 18); the new one will protect against an additional five (31, 33, 45, 52, and 58).

According to the FDA, "Gardasil 9 has the potential to prevent approximately 90 percent of cervical, vulvar, vaginal and anal cancers." That's up from about 70 percent coverage with the current vaccine. It'll also prevent head and neck cancers, which are caused by the HPV 16 strain. So the FDA approved Gardasil 9 for use in females ages 9 through 26, and males ages 9 through 15.

But not so fast: Gardasil 9 isn't quite ready for market

The vaccine isn't yet available in your doctors' offices: it needs to be scaled up and manufactured, insurers will need to decide whether to cover it or not, and the CDC's Advisory Committee on Immunization Practices — which makes recommendations about vaccines — will need to review the evidence about Gardasil 9 and decide how it should be used here.

It's not yet clear, for example, whether people who have already received a dose or two of the original version of Gardasil will be able to continue their vaccine schedule with Gardasil 9.

"We also don't know whether or not you will need to re-vaccinate," said Dr. Lois Ramondetta, a gynecologic oncologist at MD Anderson. "We don't know whether it will replace the vaccine on the market or if Gardasil 9 is just as good if you give it only twice and not three times."

For now, HPV vaccination with one of the two currently available vaccines — Gardasil and Cervarix — is recommended for girls, preferably before they are sexually active. (For men, only Gardasil is the only vaccine available.) It's really up to patients and their doctors to decide on which of the two vaccines they prefer.

"Parents should still know that early HPV vaccination is best — usually the 11 year old visit — because patients respond better immunologically and there is less risk for prior HPV exposure, and prior exposure is what reduces vaccine effectiveness," said Dr. Maria Trent, associate professor of pediatrics at the Johns Hopkins School of Medicine.

"They should also know that except for a small group of people for whom it is contraindicated, the vaccine is safe and effective."

HPV vaccine coverage here majorly lags — other vaccines and other countries

Right now, the CDC's Advisory Committee on Immunization Practices recommends HPV, Tdap (for tetanus, diphtheria and pertussis), and menigococcal vaccines for youth.

While only 57 percent of girls and 35 percent of boys ages 13 to 17 got one or more doses of the HPV vaccine, 86 percent the same cohort had received a Tdap shot and 78 percent received the menigococcal vaccine.

In other industrialized nations, HPV-vaccine coverage hovers around 80 percent.

The World Health Organization recently released new guidance, urging member states to do more to protect women against cervical cancer and emphasized the importance of the HPV vaccine.

Correction: An earlier version of this article stated that Cervarix was approved for boys; only Gardasil and Gardasil 9 have been approved for both boys and girls.

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