HPV and
Gardasil 9
Megan Elliott, Pharmacy Student
Learning Objectives
● Human Papillomavirus
○ Transmission and protection
○ HPV and Cancer
● Gardasil 9 Vaccine
○ Efficacy
○ Dosing
○ Adverse Effects
○ Public Programs
Human Papillomavirus
● Viral infection (DNA virus)
● > 100 different HPV types
○ ~30 HPV types are linked to genital lesions
○ Types 6 and 11 are most commonly associated with genital warts
● Up to 75% of sexually active individuals have been infected with HPV
○ Genital infections with HPV often subclinical
● Warts can be large, multifocal, uncomfortable; often will regress after 1-2 years
● Reinfection is common (especially in young populations)
HPV Transmission
● HPV is transmitted through sexual contact
○ Sexual intercourse
○ Genital skin-to-skin contact
○ Oral sex
● HPV can infect various parts of genital region, as well as the mouth and throat
● Using barrier methods can reduce the risk of transmission of HPV
○ Areas not covered by barrier can still be susceptible to skin-to-skin contact
HPV and Cancer
● Infection with HPV is a major risk factor for development of cervical cancer
○ Close to 100% of cervical cancers are due to HPV
○ HPV-16 and HPV-18 are major HPV types associated; other types of HPV are also
linked
● HPV can lead to other types of cancers and precancers, including anal, penile, vulvar, and
vaginal, as well as head and neck cancer
● Both men and women are at risk of HPV infection
○ As a result, also at risk of cancer due to HPV
Global Burden of HPV-Related Cancers
Gardasil 9
● Indicated in individuals over the age of 9
● Protects against HPV strains 6, 11, 16, 18, 31, 33, 45, 52, and 58
○ These strains can also cause abnormal and precancerous cervical, vaginal, and vulvar
lesions
● HPV types 16, 18, 31, 33, 45, 52, and 58 can cause cervical, vulvar, anal, and vaginal cancers
○ Men are also candidates for vaccination
● Types 6 and 11 can cause genital warts
Gardasil 9 - Efficacy
● Gardasil 9 protects against 9 types of HPV
● Will not protect against other types of HPV or viral infections
● Will not protect individuals from types of HPV that they already have
● HPV vaccine will not cure individuals of HPV infections that they already have
Month 0: 1st Dose
Gardasil 9 Dosing ● 0.5mL IM injection
Schedule (Ages 15 Month 2: 2nd Dose
and over) ● Not earlier than 1 month after first
dose
Month 6: 3rd (final) Dose
Dosed at 0, 2, and 6 months
● Not earlier than 3 months after 2nd
dose
All three doses given in a one year period
Adverse Effects of Gardasil 9
● Similar to other injections
○ Bump at injection site, pain, swelling, redness, bruise, or bleeding
● May experience a headache, fatigue, sore throat, diarrhea, dizziness, fever, nausea
● Risk of fainting with injections
● Risk of allergic reactions
● Gardasil 9 should be avoided in pregnancy
Publicly Funded Gardasil 9 Vaccinations
● Grade 6 students – routine immunization program
● Students eligible to receive vaccine in Grade 6 continue to be eligible to receive
the vaccine until the end of Grade 12 if they present to public health
● Individuals 17 to 26 years of age biologically male at birth who have sex with individuals
biologically male at birth
https://open.alberta.ca/dataset/aip/resource/aaec771b-7add-4d50-97e8-9a7b5f8c9ddf/download/AIP-BP-HPV-9.pdf
Coverage for NAIT Students
● Currently, Gardasil 9 is not covered for NAIT students through
● Cost of Gardasil 9
○ $198.37 per injection
○ 3 injections total
NAIT Population - Why is Gardasil 9 Important?
● University-age population is likely to be sexually active, possibly with different partners
○ Increased risk of contracting HPV
● Significant opportunities for education, health promotion within this population
○ Improve education surrounding importance of men receiving Gardasil 9
● Individuals who receive Gardasil 9 should still receive regular pap tests, as scheduled by
guidelines
New NACI (National Advisory Committee on
Immunization) Recommendations
● New recommendations state that, in both men and women, HPV9 vaccine (Gardasil 9) can
be administered to anyone over the age of 26 who have not previously been vaccinated or
completed the vaccine series
Questions?
● HPV
● Smoking cessation
● Opioids
References
● Knodel, L.C., Duhon, B., and Argamany, J. Sexually Transmitted Diseases. Pharmacotherapy: A
Pathophysiologic Approach (10th Edition)
● https://myhealth.alberta.ca/alberta/Pages/immunization-human-papillomavirus.aspx
● Information and images from slides from Dr. Steven Shen (Merck Medical Sciences Liaison,
Vaccines)
● Updated Recommendations on Human Papilloma Virus (HPV) Vaccines: 9-valent HPT vaccine and
clarification of minimum intervals between doses in the HPV immunization schedule
● Gardasil 9 Product Monograph and information brochures
● Thank you to Dr. Steven Shen for providing slide decks with research regarding Gardasil 9
