In practice

• For cervical cancer prevention, increasing the number of highly carcinogenic genotypes in the HPV vaccine prevents a few more cases of high-grade dysplasia than the vaccine containing only the two main high-risk genotypes, HPV 16 and 18.
   
• But the 9-valent vaccine is less well tolerated, and severe injection site reactions were more frequent.
   
• Given the strong reservations about HPV vaccination in general, and the weak arguments in favour of vaccination compared with organised cervical cancer screening, this vaccine offers nothing new other than the risk of increased reluctance over HPV vaccination.
   
• As of early 2018, it is better to focus on promoting organised screening for cervical cancer, especially as this has still not been implemented at the national level in France.
   
•  NOTHING NEW  A human papillomavirus (HPV) vaccine containing 9 HPV genotypes (Gardasil 9°) has been authorised in the European Union. In France, the company that markets this vaccine expects it to replace the vaccine containing 4 genotypes (Gardasil°). A trial in about 14 000 women aged 16 to 26 years compared these two vaccines. The 9-valent vaccine appeared to reduce the number of diagnoses of high-grade cervical dysplasia caused by one of the additional genotypes: about 15 fewer cases per year per 10 000 vaccinated women who had not been infected with one of these genotypes before vaccination. The 9-valent vaccine provokes more, sometimes severe, injection site reactions, which could intensify existing misgivings about HPV vaccination.
  

©Prescrire 1 June 2018

"Human papillomavirus 9-valent vaccine (Gardasil 9°) and cervical cancer" Prescrire Int 2018; 27 (194): 148-150. (Pdf, subscribers only)

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