Human papillomavirus quadrivalent (types 6, 11, 16, and 18) vaccine, recombinant

(Gardasil®)

Gardasil®

Drug updated on 12/11/2024

Dosage FormInjection (intramuscular; 0.5 mL)
Drug ClassVaccines
Ongoing and
Completed Studies
ClinicalTrials.gov

Indication

  • Indicated in girls and women 9- through 26 years of age for the prevention of infection caused by the Human Papillomavirus (HPV) types 6, 11, 16, and 18 and the following diseases associated with the HPV types included in the vaccine: Ccervical, vulvar, and vaginal and anal cancer caused by HPV types 16 and 18, and genital warts (condyloma acuminata) caused by HPV types 6 and 11
  • Indicated for the following precancerous or dysplastic lesions caused by HPV types 6, 11, 16, and 18: Cervical adenocarcinoma in situ (AIS), cervical intraepithelial neoplasia (CIN) grade 2 and grade 3, vulvar intraepithelial neoplasia (VIN) grade 2 and grade 3, vaginal intraepithelial neoplasia (VaIN) grade 2 and grade 3, and cervical intraepithelial neoplasia (CIN) grade 1
  • Indicated in boys and men 9 through 26 years of age for the prevention of infection caused by HPV types 6, 11, 16, and 18 and the following diseases associated with the HPV types included in the vaccine: aAnal cancer caused by HPV types16 and 18, genital warts (condyloma acuminata) caused by HPV types 6 and 11, and anal intraepithelial neoplasia (AIN) grades 1, 2, and 3 caused by HPV types 6, 11, 16, and 18.

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Summary
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  • This summary is based on the review of 16 systematic review(s)/meta-analysis(es). [1-16]
  • The quadrivalent (4v-HPV) and bivalent (2v-HPV) vaccines show comparable effectiveness in preventing human papillomavirus (HPV) infections involving carcinogenic strains (16/18/31/33/45/52/58) among female HPV infection-naive populations, while the 9-valent HPV (9v-HPV) vaccine demonstrates superior effectiveness against HPV 31/33/45/52/58 infections.
  • For persistent HPV infections, the 9v-HPV vaccine was most effective for HPV 16 at 97%, and the 2v-HPV (Cecolin) vaccine was most effective for HPV 18 at 98%. The 4v-HPV vaccine showed effectiveness of 99% and 97% against CIN2+ associated with HPV 16 and 18, respectively, while 9v-HPV was ≥ 95% effective against persistent infections involving HPV 31, 33, 45, 52, and 58.
  • HPV vaccination programs contributed to significant reductions in genital infections and HPV-related disease outcomes, with notable effectiveness among women with prior or ongoing HPV-related anogenital disease and individuals with recurrent respiratory papillomatosis (RRP).
  • Studies report comparable antibody responses between two-dose and three-dose HPV vaccine schedules, with high immunogenicity in people living with HIV (PLHIV), who exhibit robust seroconversion rates that remain high over time despite slight antibody titer declines.
  • No significant risk of premature ovarian insufficiency (POI) was observed with the quadrivalent HPV vaccine (4v-HPV) compared to controls or other HPV vaccines (2v-HPV and 9v-HPV).
  • Inadvertent HPV vaccination during pregnancy did not significantly increase the risk of adverse pregnancy outcomes, including spontaneous abortion, stillbirth, small for gestational age, preterm birth, or birth defects.
  • Most studies found no significant difference in serious adverse events between vaccinated groups and controls, with the nonavalent vaccine showing slightly more local adverse events (e.g., pain, redness) compared to the quadrivalent vaccine.
  • There is no population types or subgroups information available in the reviewed studies.

Product Monograph / Prescribing Information

Systematic Reviews / Meta-Analyses

Document TitleYearSource
A Systematic Review of Human Papillomavirus Vaccination Challenges and Strategies to Enhance Uptake2024Vaccines
Comparative Effects of Bivalent, Quadrivalent, and Nonavalent Human Papillomavirus Vaccines in The Prevention of Genotype-Specific Infection: A Systematic Review and Network Meta-Analysis2024Infection & Chemotherapy
Comparative efficacy of human papillomavirus vaccines: systematic review and network meta-analysis2023Expert Review Of Vaccines
Risk of Premature Ovarian Insufficiency after Human Papilloma Virus Vaccination: A PRISMA Systematic Review and Meta-Analysis of Current Evidence2023Vaccines
Real-world impact and effectiveness of the quadrivalent HPV vaccine: an updated systematic literature review2022Expert Review Of Vaccines
Human Papillomavirus Vaccine Impact and Effectiveness in Six High-Risk Populations: A Systematic Literature Review2022Vaccines
Human papillomavirus vaccine effectiveness by number of doses: Updated systematic review of data from national immunization programs2022Vaccine
Immunogenicity, safety, and efficacy of the HPV vaccines among people living with HIV: A systematic review and meta-analysis2022Eclinicalmedicine
Cost-effectiveness of human papillomavirus vaccination in girls living in Latin American countries: A systematic review and meta-analysis2022Vaccine
Real-world impact and effectiveness assessment of the quadrivalent HPV vaccine: a systematic review of study designs and data sources2022Expert Review Of Vaccines
Sex difference in the immunogenicity of the quadrivalent Human Papilloma Virus vaccine: Systematic review and meta-analysis2021Vaccine
Prophylactic HPV vaccination after conization: A systematic review and meta-analysis2020Vaccine
The quadrivalent HPV vaccine is protective against genital warts: a meta-analysis2020Bmc Public Health
Pregnancy Outcomes After Human Papillomavirus Vaccination in Periconceptional Period or During Pregnancy: A Systematic Review and Meta-analysis2020Human Vaccines & Immunotherapeutics
A systematic review of immunogenicity, clinical efficacy and safety of human papillomavirus vaccines in people living with the human immunodeficiency virus2020Human Vaccines & Immunotherapeutics
Comparison of different human papillomavirus (HPV) vaccine types and dose schedules for prevention of HPV-related disease in females and males2019The Cochrane Database Of Systematic Reviews

Clinical Practice Guidelines