The GARDASIL 9 vaccine protects against cancer and disease caused by the Human Papilloma Virus (HPV).
It protects you against 9 types of HPV, concentrated into a little injection syringe.
HPV is a virus that can be categorised into 2 major groups. One group that causes cancers and another group that causes warts or papillomas.
There are over a hundred strains of HPV and they are each given a designated number eg HPV 6 or HPV 16 or HPV52. Now, HPV strains that cause warts will NOT cause cancers and HPV strains that cause Cancer will NOT cause warts.
HPV are attracted to and are able to live only in certain cells in the body called squamous epithelial cells. These cells are found on the surface of the skin and on moist surfaces (called mucosal surfaces) like:
- The vagina, anus, cervix, vulva (around the outside of the vagina)
- The inner foreskin and urethra of the penis
- The inner nose, mouth, throat
- The trachea (the main breathing tube) and bronchi (smaller breathing tubes branching off the trachea)
- The inner eyelids
Hence infection of these surfaces causes warts and cancerous cells to form.
GARDASIL 9 helps prevent infection caused 9 different types of HPV, hence it’s appropriately named Gardasil 9. Out of the 9 HPV type in the vaccine, two are for wart prevention (HPV 16 and 18) and the remaining seven are for Cancer prevention (HPV 16, 18, 31, 33, 45, 52, 58).
With regards to cancers, HPV causes most cases of cervical cancer, as well as many vaginal, vulvar, anal, penile, and oropharyngeal cancers (cancers of the throat and tongue).
How is this vaccine different from the older vaccines Cervarix and Gardasil?
GARDASIL 9 gives you protection against a wider range of HPV compared to Gardasil.
Gardasil 9 helps prevent infection with the same 4 types of HPV as Gardasil, PLUS there is the additional 5 other high-risk types: 31, 33, 45, 52 and 58.
Together these types cause about 90% of cervical cancers.
Both Gardasil and Gardasil 9 give you protection against the cancer-causing HPV 16 and 18 and the wart-causing HPV 6 and 11.
Cervarix, on the other hand, gives you protection only against the commonest cancer-causing HPV 16 and 18. There is no wart protection with Cervarix.
Can Gardasil 9 be taken by women and men?
Yes GARDASIL 9 can be taken by both men and women, boys and girls.
On a side note, Cervarix is only approved for use in women and girls.
What is the earliest age at which vaccination can be given?
Gardasil 9 can be given earliest at age 9. The vaccine is most effective when given prior to any exposure to HPV.
For women specifically how is Gardasil 9 important?
Cervical cancer is the 3rd leading cause of cancer deaths in women aged 15-44 in Singapore. Every month 6 women are dying due to cervical cancers.
Cervical cancer can be easily prevented through vaccination hence it is strongly encouraged in women.
Remember the prevention of cervical, vaginal, vulvar, anal or oral cancers is not 100% but it gives you your best chance of protection. There are other HPVs and other causes of these cancers.
Check our What is pap smear?
What about men? How is Gardasil 9 important in men?
Let’s break this up into 2 major groups of men based on sexual activity. Men who engage in penetrative anal sex and men who do not.
Men who engage in penetrative anal sex and are on the receiving end, are generally at greater risk of HPV related anal cancer as the HPV deposits on the anal mucosal surfaces.
Early vaccination in boys or young men helps to prevent this increased risk of anal cancers regardless of sexual preferences in the future. Unlike women, there is no current well-established guideline approved screening program like pap smear for men who engage in anal sex.
Men who do not engage in receptive anal sex can still benefit from the vaccine. The vaccine can lower their risk of oral cancers and penile cancers. HPV can be deposited on the penis during vaginal sex or during oral sex. Similarly, HPV can also be deposited in the oral cavity during oral sex.
Many heterosexual men might ask, ‘Considering HPV more commonly causes Cervical cancer, it seems to be a woman’s problem not so much a man’s.’
Think about it though, the more men there are vaccinated, the bigger the pool of immune individuals and hence reducing the risk of transmission of HPV to women, in whom HPV poses a larger risk of life-threatening cancers. This is called the “herd immunity”.
And conversely, as more women get vaccinated, more men have conferred the protection from the “herd immunity”, as the prevalence of HPV falls, reducing a man’s risk of HPV related diseases.
So we should also encourage our boys and men to get vaccinated with GARDASIL 9 to reduce the overall risk and incidence of HPV related cancers and warts. In countries like Australia, HPV vaccination has been introduced into their National Immunization Program-sponsored school-based initiative, to widely vaccinate boys aged 12 to 13.
How is the vaccine administered and what is the dosing schedule?
GARDASIL 9 is a tiny injection given into a muscle on your arm or your thigh or your buttocks.
3 doses are required for complete vaccination. The 3 doses should ideally be spread out across a period of 6 months. For examples, if you take your first dose today, your 2nd dose will be in 2 months from today and your 3rd dose will be 6 months from today.
Even if you do forget or delay your subsequent doses, effective immunity can still be achieved as long as you complete all 3 doses within a 12 months period.
With GARDASIL 9, do women then still need to do their pap smears?
Yes. Although GARDASIL 9 covers for more HPV type than the older vaccines, it still does not cover for ALL the strains of cancer-causing HPV only 7 of them. And remember there are 15 known strains of HPV that cause cancer and perhaps more that we are not yet aware of.
Pap smear should be done at least once every 3 years. If your pap smears are abnormal your doctors might ask you to return every 6-12 months to repeat your pap smear for purpose of closer monitoring.
**Currently GARDASIL 9 approval for use with Medisave for Singaporean and PRs 26 yrs or younger is still pending