, Volume 74, Issue 11, pp 1253-1283
Date: 15 Jul 2014

Quadrivalent Human Papillomavirus (Types 6, 11, 16, 18) Recombinant Vaccine (Gardasil®): A Review of Its Use in the Prevention of Premalignant Anogenital Lesions, Cervical and Anal Cancers, and Genital Warts

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Quadrivalent human papillomavirus (HPV) [types 6, 11, 16, 18] recombinant vaccine (Gardasil®; Silgard®) is composed of virus-like particles formed by self-assembly of recombinant L1 capsid protein from each of HPV types 6, 11, 16 and 18. It is indicated for use from the age of 9 years as a two- or three-dose vaccination course over 6 months for the prevention of premalignant anogenital lesions, cervical and anal cancers, and genital warts caused by the vaccine HPV types. In placebo-controlled trials, quadrivalent HPV vaccine provided high-level protection against infection or disease caused by the vaccine HPV types over 2–4 years in females aged 15–45 years who were negative for the vaccine HPV types, and provided a degree of cross-protection against certain non-vaccine HPV types. The vaccine also provided high-level protection against persistent infection, anogenital precancerous lesions and genital warts caused by the vaccine HPV types over 3 years in susceptible males aged 16–26 years. Protection has been demonstrated for up to 8 years. In subjects who were negative for the vaccine HPV types, high seroconversion rates and high levels of anti-HPV antibodies were observed in females of all age ranges from 9 to 45 years and in males aged 9–26 years. The vaccine was generally well tolerated and was usually predicted to be cost effective in girls and young women. Therefore, quadrivalent HPV vaccine offers an effective means to substantially reduce the burden of HPV-related anogenital disease in females and males, particularly cervical cancer and genital warts.

The manuscript was reviewed by: R. Herrero, Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France; E.A. Joura, Department of Gynaecology and Obstetrics, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; S. Majewski, Department of Dermatology and Venereology, Center for Diagnostics and Treatment of Sexually Transmitted Diseases, Medical University in Warsaw, Warsaw, Poland; M. Petras, Preventative Medicine, Charles University in Prague—2nd Faculty of Medicine, Prague, Czech Republic; S.-E. Olsson, Karolinska Institute at Danderyd Hospital, Stockholm, Sweden.