HPV Vaccine Comparison

Vaccine Composition and Coverage

Cervarix is a bivalent vaccine that protects against HPV types 16 and 18, which are responsible for approximately 70% of cervical cancers 1, 2
Gardasil is a quadrivalent vaccine that protects against HPV types 6, 11, 16, and 18, covering both cancer-causing types (16, 18) and types that cause genital warts (6, 11) 1, 2
Both vaccines are based on virus-like particles (VLPs) containing the L1 capsid protein of HPV, which contain no DNA and are not live/attenuated viruses 1, 3

Gardasil is FDA-approved for use in both males and females aged 9-26 years 4, 3
Cervarix is approved for use only in females 4, 3
Both vaccines are ideally administered before the onset of sexual activity to maximize effectiveness 4, 3

Both vaccines demonstrated 100% efficacy in preventing persistent type-specific HPV infections and CIN2/3 (cervical intraepithelial neoplasia grade 2/3) in clinical trials when administered to HPV-naive individuals 1, 2
Gardasil additionally protects against genital warts and vulvar/vaginal neoplasia caused by HPV types 6 and 11 1, 4

Both vaccines have similar overall safety profiles with few serious adverse events reported 1, 5
The most common systemic adverse experiences for both vaccines include fever, headache, and nausea 5

The choice between vaccines should consider the target population (male vs. female) and desired protection against genital warts 4, 3
For broader protection including against genital warts, Gardasil offers advantages due to its coverage of HPV types 6 and 11 1, 4

The American Academy of Pediatrics recommends the 9-valent vaccine (Gardasil-9), which covers 9 HPV strains: types 6, 11, 16, 18, 31, 33, 45, 52, and 58, as the currently available HPV vaccine in the United States 6, 7
The Centers for Disease Control and Prevention (CDC) previously recommended the quadrivalent vaccine (Gardasil), which covered 4 strains - HPV types 6, 11, 16, and 18 8, 9, 10

The 9-valent vaccine provides protection against cancer-causing (high-risk) types, including HPV 16 and 18, which are responsible for approximately 70% of cervical cancers worldwide, and HPV 31, 33, 45, 52, and 58, which are responsible for an additional 14% of HPV-related cancers in women and 4% in males 6, 7, 11
The 9-valent vaccine also provides protection against genital wart-causing (low-risk) types, including HPV 6 and 11, which are responsible for 90% of genital warts 6, 7

The 9-valent vaccine's expanded coverage represents a significant advancement, with the 9 strains collectively protecting against approximately 84% of HPV-related cancers in women (70% from types 16/18 plus 14% from the five additional types) 6
The vaccine demonstrated 97% efficacy in preventing cervical, vulvar, and vaginal cancer precursor lesions related to the five additional types (31, 33, 45, 52, 58) 6
The antibody response against the original 4 types (6, 11, 16, 18) in the 9-valent vaccine was non-inferior to the quadrivalent vaccine 6

The CDC notes that the vaccine does not cover all cancer-causing HPV types, and cervical cancer screening remains essential even in vaccinated individuals 8, 9, 10

The American Cancer Society acknowledges that VLP vaccines for all important carcinogenic HPV types may theoretically be produced, supporting ongoing vaccine development 12, 13

The reduction of cervical cancer risk depends on multiple factors, including degree of vaccination coverage, number of carcinogenic HPV types targeted, durability of protection, and continued adherence to screening guidelines, as noted by the American Cancer Society 12, 13, 14
Screening will continue to be necessary for the foreseeable future to protect against non-vaccine HPV types and to protect those who were already infected before vaccination, according to the American Cancer Society 12, 14, 15