Three HPV vaccines are available to prevent HPV infection. They target the most common oncogenic HPV subtypes including 6, 11, 16, and 18. The newest nonavalent vaccine protects against an additional 15% of cervical cancers attributed to 5 HPV subtypes: 31, 33, 45, 52, and 58, extending protection against 80% of all cervical cancer. To examine the public health impact of replacing the bi- or quadrivalent vaccine with the nonavalent (targeting 9 serotypes) vaccine, studies have modeled data based upon current HPV vaccination rates, sexual behavior, and cervical cancer progression. Switching to the nonavalent compared to the bi- or quadrivalent vaccine, if current vaccination rates in the United States were maintained, would decrease the incidence of cervical cancer by 73% versus 63%, respectively, and reduce cervical cancer-associated mortality by 49% versus 43%.8 The nonavalent vaccine is also cost-effective, resulting in the same health benefit, at current rates of vaccination, as covering an additional 11% of women with the bi- or quadrivalent vaccine with a projected savings of $2.7 billion.
Estimates indicate that 60% of girls in the United States start HPV vaccination but only half complete the series, resulting in a nationwide vaccination rate of approximately 33%.9 Parental obstacles to HPV vaccination include lack of information about the vaccine, perception that it is unnecessary, concern about side effects, and lack of doctor recommendation.10
Education coupled with the October 19, 2016 Advisory Committee on Immunization Practice recommendation to the CDC that only 2 HPV vaccinations, at least 6 months apart, confer adequate immunization for young adolescents (ages 9–14) may improve vaccination rates in the United States.11 Data from Victoria, Australia, which has achieved an 80% 3-dose HPV coverage rate through a nationally funded, school-based vaccination program, have demonstrated a decreased incidence of high-grade cervical lesions by 0.38% in girls younger than 18, proving that an ounce of prevention is worth a pound of cure.12
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