{"id":664,"date":"2015-04-01T11:00:20","date_gmt":"2015-04-01T11:00:20","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=664"},"modified":"2017-08-21T11:52:11","modified_gmt":"2017-08-21T11:52:11","slug":"primary-care-corner-with-geoffrey-modest-md-hpv-vaccine-recommendation-update","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/04\/01\/primary-care-corner-with-geoffrey-modest-md-hpv-vaccine-recommendation-update\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: HPV vaccine recommendation update"},"content":{"rendered":"

By: Dr. Geoffrey Modest<\/strong><\/p>\n

The Advisory Committee on Immunization Practices of the CDC \u00a0just updated their HPV vaccination recommendations to include a 9-valent vaccine (see\u00a0here<\/a>\u200b). There are now 3 approved vaccines: Cervarix, a bivalent one against strains 16,18; Gardisil, a 4-valent one against 6,11,16,18; and now Gardisil-9, against 6,11,16,18,31,33,45,52,58. the 4-valent (4vHPV) and 9-valent (9vHPV)\u00a0ones are licensed for use in men and women.<\/p>\n

Data:<\/p>\n

–Background: in the US 64% of invasive HPV-associated cancers are attributable to strains 16 or 18, and 10% are\u00a0attributable to the new strains covered in\u00a09vHPV.<\/p>\n

–Phase III study comparing\u00a09vHPV with 4vHPV\u200b in 14K females 16-26\u00a0yo found\u00a096.7% efficacy to prevent >=CIN2 caused by the covered strains of 31,33,45,52,58 (there were very few caused by 6,11,16,18, but immunogencity against these strains was not inferior to that of\u00a04vHPV)<\/p>\n

\"Untitled\"<\/p>\n

–Seroconversion rates against all nine strains was >99%<\/p>\n

–Safety profiles of\u00a09vHPV and 4vHPV\u200b were similar, most adverse events were injection site-related (pain, swelling, erythema), though these local reactions were more common with\u00a09vHPV (40.3% vs 29.1%). Males have fewer injection-site reactions than females.<\/p>\n

–Recommendations: routinely\u00a0begin at age 11-12, but can start at age 9. Vaccine also\u00a0recommended for\u00a0females aged 13-26, males 13-21. Males 22-26 may be vaccinated when MSM or immunocompromised (including HIV)<\/strong>.<\/p>\n

–Injection intervals: the same for all 3 vaccines: minimal interval of 1-2 months between 1st and 2nd dose, then 3 months minimum between 2nd and 3rd dose but maintain\u00a06 months between 1st and 3rd dose. \u00a0No data on the immunogenicity of <3 doses of vaccine (this should be studied, given the cost and adverse reactions to this vaccine. I\u00a0have seen studies in the past looking at 2 doses of the earlier vaccines showing reasonable immunogenicity)<\/p>\n

–Not recommended in pregnancy, but no need to get a\u00a0pregnancy test to give the vaccine and no intervention needed if given during pregnancy (though the CDC would like to track these patients, and it is reassuring that there were\u00a0no pregnancy-related\u00a0issues with the prior 2 vaccines, including 4vHPV\u200b which is made basically the same way)<\/p>\n

So, seems reasonable. Lots of details are remaining, such as what to do if there is a long interval between the vaccines (is there any time delay\u00a0where one has to restart the process?). Or what to do if the patient has already started one of the previous vaccine regimens, though in any case the CDC recommends completing the series, since all of them get the big villains (strains 16,18). But given the lack of immunogenicity studies with fewer than 3 doses of\u00a09vHPV, it is hard to say that there is any utility of switching midstream to\u00a09vHPV\u200b — ie, there would only be 1 or 2 doses covering the new strains and is this clinically efficacious? Also,\u00a0the new vaccine is applicable only to those never vaccinated (ie, don’t give the new vaccine if the patient has had either of the 2 other approved ones).<\/p>\n","protected":false},"excerpt":{"rendered":"

By: Dr. Geoffrey Modest The Advisory Committee on Immunization Practices of the CDC \u00a0just updated their HPV vaccination recommendations to include a 9-valent vaccine (see\u00a0here\u200b). There are now 3 approved vaccines: Cervarix, a bivalent one against strains 16,18; Gardisil, a 4-valent one against 6,11,16,18; and now Gardisil-9, against 6,11,16,18,31,33,45,52,58. the 4-valent (4vHPV) and 9-valent (9vHPV)\u00a0ones […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":148,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[14283],"tags":[],"class_list":["post-664","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/664","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=664"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/664\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=664"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=664"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=664"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}