Update on Human Papillomavirus (HPV) Vaccines: An Advisory Committee Statement (ACS) National Advisory Committee on Immunization (NACI) †.

Abstract

In July 2006, a quadrivalent human papillomavirus vaccine (HPV4) (Gardasil®, Merck Canada, Inc.) was authorized in Canada for use in females 9 to 26 years of age for the prevention of infection caused by the HPV types 6, 11, 16, and 18 and the following diseases associated with these HPV types: • Cervical cancer • Vulvar and vaginal cancers • Genital warts (condyloma acuminata) • Cervical adenocarcinoma in situ (AIS) • Cervical intraepithelial neoplasia (CIN) grades 1, 2 and 3 • Vulvar intraepithelial neoplasia (VIN) grades 2 and 3 • Vaginal intraepithelial neoplasia (VaIN) grades 2 and 3 In February 2010, Gardasil® was authorized to expand its indications to include males 9 to 26 years of age for the prevention of infection caused by HPV types 6, 11, 16, and 18 and for genital warts (condyloma acuminata) caused by HPV types 6 and 11. (1) In April 2011, Gardasil® was approved for use in women up to the age of 45 years. In May 2011, Gardasil® was indicated in females and males 9 through 26 years of age for the prevention of: • Anal cancer caused by HPV types 16 and 18 • Anal intraepithelial neoplasia (AIN) grades 1, 2, and 3 caused by HPV types 6, 11, • 16, and 18. Also in February 2010, a bivalent HPV vaccine (HPV2), Cervarix™ (GlaxoSmithKline Inc.), was authorized for use in Canada in females 10 through 25 years of age. Cervarix™ is indicated for the prevention of cervical cancer by protecting against the following dysplastic lesions caused by oncogenic HPV types 16 and 18: (2) • CIN grades 1, 2 and 3 • Cervical AIS This statement will: • Review existing National Advisory Committee on Immunization (NACI) recommendations on HPV vaccines; • Review the epidemiology of HPV among females and males, including the burden of anogenital warts and HPV-associated cancers; • Provide information on the HPV2 (Cervarix™) vaccine and recommendations for its use; • Provide updated information on the use of HPV4 (Gardasil®) vaccine and new information specific to its use in males. Overview of past National Advisory Committee on Immunization recommendations for HPV vaccine NACI issued a statement in 2007 (3) recommending the use of HPV4 in: • Females between 9 and 13 years of age • Females between the ages of 14 and 26 years (even if they are already sexually active, with or without previous Papanicolaou test (Pap) abnormalities, including cervical cancer, or have had genital warts or known HPV infection). For females >26 years of age, studies of Gardasil® vaccine use were ongoing at the time of publication in 2007. It was noted in the previous statement that use of the vaccine in females >26 years of age could be considered in individual circumstances.