Nonavalent HPV Vaccine (Gardasil-9) Available Soon at BJU

Great news for women aged 16-26: The nonavalent HPV vaccination (Gardasil-9) is now approved for use in China! The vaccine protects women against the nine most pathogenic strains of HPV, including those most likely to cause cervical cancer and genital warts. This vaccine will be available at Beijing United Family Hospital (BJU) as early as September. Not sure the new HPV vaccine is for you? Read on as BJU's Pharmacy Manager, Kathleen Tao, explains more.

What is the nonavalent HPV vaccine?

HPV vaccines prevent infection with the human papillomavirus (HPV). Gardasil-9 (manufactured by Merck) is a nonavalent HPV vaccine that protects against nine types of HPV (types 6, 11, 16, 18, 31, 33, 45, 52, and 58). Studies have shown that types 16 and 18 are the high-risk types that cause about 70% of cases of cervical cancer. Types 6 and 11 are highly relevant for the incidence of genital warts. After vaccination, the HPV vaccine can stimulate the immune system to produce protective antibodies. These antibodies then exist in the human body. If the HPV virus appears, the antibodies will immediately play a role in its removal, thus preventing an HPV infection.

I’m currently in the middle of a course of a different type of HPV vaccine (bivalent or quadrivalent HPV vaccine) and I don’t want to continue it now that the nonavalent vaccine has arrived. How should I deal with my HPV vaccination schedule if I only want to get the Gardasil-9 HPV vaccine now?

At present, there is no clinical data supporting the use of different types of HPV vaccine to complete your schedule. Therefore, it is suggested that you use the same HPV vaccine to complete the three doses required in your vaccination course. This means that we do not recommend using the nonavalentHPV vaccine to replace the second or third dose of your bivalent or quadrivalent HPV vaccination course. 

If you are a woman within the suitable age range (16-26), you may consider starting a new course of three doses of the nonavalentHPV vaccination. Please consult your doctor to get more information on vaccination schedules and when to start.

Who can get the nonavalent HPV vaccine?

The WHO recommends that all girls between the ages of 9 and 14 get an HPV vaccination. It is generally believed that young, adolescent women are the preferred population for HPV vaccination, and it is best to complete all three doses before becoming sexually active. Compared to older adolescents and young women, pre-adolescent girls have a higher immune response to HPV vaccines, resulting in higher levels of antibodies and greater protection against infection. We suggest that you follow the recommendations for your age group in order to get as broad a level of protection as early as possible.

Currently, in China, the approved listings are:

- The bivalent HPV vaccine (Cervarix) is recommended for women aged 9-45.

- The quadrivalent HPV vaccine (Gardasil) is recommended for women aged 20-45.

- The nonavalent HPV vaccine (Gardasil-9) is recommended for women aged 16-26. (Please note that this means that you need to complete three doses of the nonavalent HPV vaccine before your 27th birthday.) 

Can I still get an HPV vaccination if I have been sexually active or am older than 26 years old?

HPV vaccines can effectively prevent future possible HPV infection. In clinical studies of sexually active women, results have shown that HPV vaccines were still effective. Therefore, you can still get protection from HPV with an HPV vaccine, whether or not you are sexually active or younger than 26. Women who are older than 26 can consider getting the quadrivalent HPV vaccination.

Who should NOT get an HPV vaccine?

• Anyone who has had a severe (life-threatening) allergic reaction to a dose of an HPV vaccine should not get another dose. 

• Anyone who has a severe (life-threatening) allergy to any component of the HPV vaccine should not get the vaccine. Tell your doctor if you have any severe allergies that you know of, including a severe allergy to yeast. 

• HPV vaccines are not recommended for pregnant women. If you learn that you were pregnant when you were vaccinated, there is no reason to expect any problems for you or your baby. If you learn that you were pregnant after the first dose, you may continue the series after giving birth. 

• If you have a mild illness, such as a cold, you can probably get the vaccine today. If you are moderately or severely ill, you should probably wait until you recover. Your doctor can advise you.

Is the nonavalent HPV vaccine only suitable for women? Can men also get vaccinated?

In China, there is currently no HPV vaccine approved to be used for men. However, HPV infections are common in both men and women. There is roughly an 80% chance that a person will get an HPV infection in their lifetime. HPV vaccination can help men prevent genital diseases linked to HPV infection. These include anal cancer, penile cancer, and genital warts, among others. At the same time, if men get vaccinated against HPV, they can effectively avoid the transmission of HPV to sexual partners or family members. In many overseas countries, the quadrivalent HPV vaccine (Gardasil) and nonavalent HPV vaccine (Gardasil-9) are used in men.

How long am I protected? 

HPV vaccines provide long-term, sustained protection against HPV infection and HPV-related diseases. Clinical trials from abroad show that they can provide protection for at least eight to 10 years.

Do I need a booster after 10 years?

There are currently no clinical trials that study the need for a booster shot after 10 years. We will get more data on this as the follow-up studies on the vaccine and clinical trials continue. 

Do I still need cervical cancer screening in the future after getting an HPV vaccination?

Just like women who have not been vaccinated, women who have been vaccinated against HPV still need to be screened for cervical cancer in accordance with the recommendations for each age group. 

Is it true that people who are allergic to protein cannot get vaccinated against HPV? 

The absolute contraindication of an HPV vaccination is that you are severely allergic to HPV vaccines or any of their components. This does not include people who are allergic to protein. However, if a person has a severe allergy to protein, s/he is also likely to be allergic to other things. Therefore it’s better to let your doctor decide whether you can be vaccinated or not.

Does the nonavalent HPV vaccine have any side effects? What are the common side effects after HPV vaccination?

All HPV vaccines have the similar side effects to other vaccines. The most common side effects include redness, swelling, or soreness in the arm where the shot was given; a mild headache or fatigue; nausea or vertigo; and muscle or joint pain. However, overall, most vaccinated individuals do not have any symptoms or adverse reactions.

This article was written by United Family Hospital's Pharmacy Manager, Kathleen Tao. She is a registered pharmacist in China, the UK, and Australia. If you want to make an appointment to get the bivalent Cervarix or quadrivalent Gardasil HPV vaccines, please call the BJU Service Center at 4008-919191. If you would like to get the nonavalent Gardasil-9 vaccine, watch this space and we'll let you know when it's available!

References:

1. 中国癌症基金会《认识HPV疫苗》

2. Human Papillomavirus (HPV) and cervical cancer http://www.who.int/mediacentre/factsheets/fs380/en/

3. Genital HPV Infection-Fact Sheet http://www.cdc.gov/STD/HPV/STDFact-HPV.htm

• What is an HPV vaccine anyway? Kathleen Tao answers your questions here. 

• Wait, didn't BJU have a new HPV vaccine really recently? Yes we did! That was the quadrivalent HPV vaccine. Learn more here. 

• Want to learn more about not getting STDs? Read about what our Gynecology, Emergency Medicine, and Dermatology doctors have to say here.