HPV vaccines | NITAG RESOURCE CENTER

Benefits of the intervention

Serogroup or serotype coverage by vaccines considered (for serogroup- or serotype-specific vaccines)

As of 2022, authorised HPV vaccines provide protection against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58 (types 6 and 11 are responsible for most anogenital warts).^{Go to footnote 11}

The older bivalent (Cervarix) and quadrivalent (Gardasil) vaccines show partial protection against HPV types not included in the vaccine (cross-protection), when used in multidose schedules. The bivalent vaccine (targeting HPV-16/18) generally provides stronger and more consistent cross-protection, particularly against HPV31, 33 and 45. Some studies also report partial protection against HPV-35, 52 and 58, though the evidence is less robust and more variable.^{Go to footnote 22, Go to footnote 33, Go to footnote 44}

No data on cross protection is available for the newer vaccines. Less evidence is available on the extent of cross protection provided by HPV vaccine in single-dose schedule.

Efficacy and effectiveness estimates (e.g. against infection, disease, hospitalization, death), including in different populations

Three doses of the bivalent (Cervarix) and quadrivalent (Gardasil) vaccines offered significant protection against cervical adenocarcinoma in situ associated with HPV16 and HPV18 among young women (15–26 years of age): Efficacy 88% (95% CI: 30–98%).^{Go to footnote 55, Go to footnote 66}

Trials among vaccine recipients not already infected with HPV showed high efficacy against high-grade cervical, vulvar and vaginal lesions: 98% (95% CI: 93–100) for CIN2+ and 100% (95% CI 83–100) for vulvar and vaginal intraepithelial neoplasia grade 2+ caused by the HPV types in the quadrivalent vaccine.^{Go to footnote 66, Go to footnote 77}

Approval of the two-dose schedule in girls 9 to 14-years of age- was based on demonstration of non-inferiority of the immune response when compared with young adult women (16–26 years of age) in whom 3-dose efficacy has been proven (immunobridging).^{Go to footnote 66}

A one-dose schedule is supported by WHO in the general population based on evidence from post-hoc analyses of efficacy trials, post-licensure observational studies and an RCT (0 vs 1) among African females 15-20 years of age. These studies demonstrate that a single dose of HPV vaccine is sufficient to elicit a lasting, stable immune response, and provides protection against persistent HPV infection similar to that of multidose regimens.^{Go to footnote 55, Go to footnote 66}

Head-to-head RCTs comparing one and two-dose schedules of Cervarix and Gardasil-9 showed a non-inferior VE with a single-dose schedule within the specified margins.^{Go to footnote 88, Go to footnote 99}

Duration of protection and waning of immunity in general and risk groups

With a multidose schedule, antibody titres remain high for up to 16 years following the bivalent (Cervarix) vaccine for girls vaccinated at 16-17 years of age, up to 15 years following the quadrivalent (Gardasil) vaccine, and for at least six years following the more recently licensed nonavalent vaccine (Gardasil-9).^{Go to footnote 1010, Go to footnote 1111, Go to footnote 1212}

Geometric Mean Titres (GMT) following a single dose remain stable for at least 12-16 years.^{Go to footnote 1313, Go to footnote 1414, Go to footnote 99}

Sources

Go back to footnote reference 1
World Health Organization. Human papillomavirus vaccines: WHO position paper, December 2022. Wkly Epidemiol Rec. 2022;97(50):645–672 (https://www.who.int/publications/i/item/who-wer9750-645-672, accessed 21 September 2026)
Go back to footnote reference 2
Tsang, S., Sampson, J., Schussler, J., Porras, C., Wagner, S., et al. (2020). Durability of Cross-Protection by Different Schedules of the Bivalent HPV Vaccine: the CVT Trial. Journal of the National Cancer Institute. doi:10.1093/jnci/djaa010
Go back to footnote reference 3
Brown, D., Joura, E., Yen, G., Kothari, S., Luxembourg, A., et al. (2021). Systematic literature review of cross-protective effect of HPV vaccines based on data from randomized clinical trials and real-world evidence. Vaccine. doi:10.1016/j.vaccine.2020.11.076
Go back to footnote reference 4
Shing, J., Porras, C., Pinheiro, M., Herrero, R., Hildesheim, A., et al. (2024). Differential long-term bivalent HPV vaccine cross-protection by variants in the Costa Rica HPV vaccine trial. NPJ Vaccines, 9. doi:10.1038/s41541-024-00896-y
Go back to footnote reference 5
Cochrane (2022) Systematic review of one-dose HPV vaccine efficacy [report for WHO SAGE Meeting of March 2022]. (https://cdn.who.int/media/docs/default-source/immunization/position_paper_documents/human-papillomavirus-(hpv)/systematic-review-of-1-dose-of-hpv-vaccinec14d7ee3-e409-4a1a-afd9-c3e7e0dd2bd9.pdf?sfvrsn=174858f6_1, accessed June 24 2026).
Go back to footnote reference 6
World Health Organization. Human papillomavirus vaccines: WHO position paper – December 2022. Wkly Epidemiol Rec. 2022;97(50):645–672 (https://www.who.int/publications/i/item/who-wer9750-645-672, accessed 24 June 2026).
Go back to footnote reference 7
Kjaer SK, Sigurdsson K, Iversen OE, Hernandez-Avila M, Wheeler CM, et al. (2009). A pooled analysis of continued prophylactic efficacy of quadrivalent human papillomavirus (Types 6/11/16/18) vaccine against high‑grade cervical and external genital lesions. Cancer Prev Res (Phila). 2(10):868–878. doi:10.1158/1940-6207.CAPR-08-0194
Go back to footnote reference 8
Barnabas RV, Brown ER, Onono M, Bukusi EA, Baggaley RF, et al. (2022). Efficacy of single‑dose HPV vaccination among young African women. NEJM Evid. 1(5):EVIDoa2100056. doi:1056/EVIDoa2100056.
Go back to footnote reference 9
Kreimer AR, Porras C, Liu D, Hildesheim A, Carvajal LJ, et al. Noninferiority of One HPV Vaccine Dose to Two Doses. N Engl J Med. 2025 Dec 18;393(24):2421–2433. doi:10.1056/NEJMoa2506765.
Go back to footnote reference 10
World Health Organization (2022). Human papillomavirus vaccines: WHO position paper – December 2022. Wkly Epidemiol Rec. 97(50):645–672 (https://www.who.int/publications/i/item/who-wer9750-645-672, accessed 24 June 2026).
Go back to footnote reference 11
Olsson S-E, Van Damme P, Block SL, Castellsagué X, Gray GE, et al. (2020). Long-term immunogenicity, effectiveness, and safety of nine-valent human papillomavirus vaccine in girls and boys 9 to 15 years of age: interim analysis after 8 years of follow-up. Papillomavirus Res. 10:100203. h doi:10.1016/j.pvr.2020.100203.
Go back to footnote reference 12
Malvi, S.G., Esmy, P.O., Muwonge, R., Joshi, S., Poli, U.R.R., et al, 2024. A prospective cohort study comparing efficacy of 1 dose of quadrivalent human papillomavirus vaccine to 2 and 3 doses at an average follow up of 12 years postvaccination. J Natl Cancer Inst Monogr 2024, 317–328. doi:/10.1093/jncimonographs/lgae042
Go back to footnote reference 13
Restrepo J, Scherer EM, Smith RA, Gallego DF, Carter JJ, et al. (2023). Ten-year follow-up of 9-valent human papillomavirus vaccine: immunogenicity, effectiveness, and safety. Pediatrics. 152:e2022060993. doi:10.1542/peds.2022-060993.
Go back to footnote reference 14
Porras, C., Romero, B., Kemp, T., Fantin, R., Herrero, R., et al. Costa Rica HPV Vaccine Trial Study Group, 2024. HPV16/18 antibodies 16-years after single dose of bivalent HPV vaccination: Costa Rica HPV vaccine trial. J Natl Cancer Inst Monogr 2024, 329–336. doi:10.1093/jncimonographs/lgae032.