# Nonavalent HPV vaccine

Source: https://onco.cc/drugs/gardasil-9/  
OnCo record `gardasil-9` (Treatment). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A vaccine against nine HPV types that prevents about 90% of cervical cancers, and now works with a single dose.

## Summary

Approved 2014 (US), covering HPV 6, 11, 16, 18, 31, 33, 45, 52, 58. Population data from Sweden (NEJM 2020) and Scotland (JNCI 2024) show ~90% and near-100% reductions in invasive cervical cancer in women vaccinated at 12-13. WHO recommends one- or two-dose schedules since 2022 (KEN SHE, IARC India); FDA label remains two doses under 15 and three doses at 15-45. Also prevents anal, oropharyngeal, vulvar, vaginal, and penile cancers and genital warts. Global coverage of girls with at least one dose was ~27% in 2023, the binding constraint on elimination.

## Fields

- Kind: Treatment
- Status: approved
- Last checked: 2026-09-07
- Brand: Gardasil 9
- Modality: Prophylactic vaccine (virus-like particles)
- Mechanism: Recombinant L1 capsid proteins self-assemble into virus-like particles that induce high-titre neutralising antibodies preventing persistent oncogenic HPV infection.
- Approvals: US 2014: Prevention of HPV-related cancers and precancers, ages 9-26; extended to 45 in 2018; WHO 2022: Single-dose schedule recommended for girls 9-20
- Dosing: Intramuscular; 1 dose (WHO, age 9-20) or 2 doses 6-12 months apart (age 9-14); 3 doses at 15-45 (US label)

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Gardasil
- FDA label (DailyMed): https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=Nonavalent%20HPV%20vaccine

## Connected records

- cancers: [Anal cancer (squamous cell carcinoma)](https://onco.cc/cancers/anal/), [Anal high-grade squamous intraepithelial lesions (precursor)](https://onco.cc/cancers/anal-hsil-precursor/), [Cervical cancer](https://onco.cc/cancers/cervical/), [Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/), [HPV-associated vulvar squamous cell carcinoma](https://onco.cc/cancers/hpv-associated-vulvar-cancer/), [HPV-positive oropharyngeal cancer](https://onco.cc/cancers/hpv-positive-oropharyngeal-cancer/), [Localised penile cancer (organ-confined, node-negative)](https://onco.cc/cancers/localised-penile-cancer/), [Penile cancer](https://onco.cc/cancers/penile/), [Rare cancers of childhood (NCI PDQ umbrella)](https://onco.cc/cancers/rare-childhood-cancers/), [Vaginal cancer](https://onco.cc/cancers/vaginal/), [Vaginal squamous cell carcinoma (HPV-associated)](https://onco.cc/cancers/vaginal-squamous-cell-carcinoma/), [Vulvar cancer](https://onco.cc/cancers/vulvar/)
- technologies: [HPV & HBV vaccination](https://onco.cc/technologies/hpv-vaccine/)
- companies: [Merck & Co. (MSD)](https://onco.cc/companies/merck/), [Serum Institute of India](https://onco.cc/companies/serum-institute-of-india/)
- trials: [IARC India HPV vaccine dose study (one, two or three doses)](https://onco.cc/trials/iarc-india-hpv-dose-study/), [KEN SHE (single-dose HPV vaccine)](https://onco.cc/trials/ken-she/)
- key papers: [Vaccine efficacy against persistent HPV 16/18 infection at 10 years after one, two and three doses of quadrivalent HPV vaccine in girls in India](https://onco.cc/key-papers/paper-basu-single-dose-hpv-lancet-oncol-2021/)
- ideas: [Single-dose HPV vaccination plus HPV self-sampling to reach WHO elimination in low-income countries](https://onco.cc/ideas/idea-single-dose-hpv-self-sampling-elimination/)
- people: [Douglas R. Lowy](https://onco.cc/people/douglas-lowy/), [Harald zur Hausen](https://onco.cc/people/harald-zur-hausen/), [Ian Frazer](https://onco.cc/people/ian-frazer/), [Jian Zhou](https://onco.cc/people/jian-zhou/)
- bottlenecks: [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/), [Prevention we already have is not deployed](https://onco.cc/bottlenecks/b-prevention-adoption/)
- pathways: [Oncogenic viruses](https://onco.cc/pathways/oncogenic-viruses/)
- drugs: [CERVAVAC (quadrivalent HPV vaccine, India)](https://onco.cc/drugs/cervavac/), [HPV bivalent vaccine (types 16 and 18)](https://onco.cc/drugs/hpv-bivalent-vaccine/), [HPV quadrivalent vaccine (types 6, 11, 16 and 18)](https://onco.cc/drugs/hpv-quadrivalent-vaccine/)
- roadmaps: [Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers](https://onco.cc/roadmaps/prevention-roadmap/)
- collections: [NHS HPV vaccination programme](https://onco.cc/collections/nhs-hpv-vaccination/), [Vaccines for Children program (US)](https://onco.cc/collections/us-vaccines-for-children/)

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