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Gardasil 9 vaccine is funded on the National Immunisation Schedule for all aged 9 years to under 27 years. Gardasil 9 covers the same four human papillomaviruses (HPVs) as Gardasil plus an additional five types known to cause approximately 20% of cervical cancers (HPV 31, 33, 45, 52, 58).
The vaccine is designed to protect men and women from HPV infection that can cause genital warts, precancerous cell changes and cancer in the throat, cervical cancer and anal, vaginal, vulval or penile cancers.
On 1 January 2017 nonavalent Gardasil 9 replaced quadrivalent Gardasil on the National Immunisation Schedule. Gardasil and Gardasil 9 are fully interchangeable to complete a course of vaccination against serotypes 6, 11, 16 and 18.
Eligibility for funded immunisation was extended to include all eligible males and females aged from 9 years–under 27 years*.
* Non-resident males and females must be aged under 18 years to start a funded HPV vaccine course. They can go on to complete the course when aged 18 years or older.
* Males and females eligible for funded healthcare in New Zealand must be aged under 27 years to start a funded HPV vaccine course. They can go on to complete the course when aged 27 years or older.
Ideally the vaccine course is completed before the recipient becomes sexually active and is at risk of being exposed to HPV infection. However, those who are already infected with one or more types of HPV may still benefit from Gardasil 9 immunisation for the HPV types in the vaccine they have not been infected with. Immunisation will not make existing HPV infection worse. HPV vaccine is delivered to year 8 students through the school-based immunisation programme in most parts of NZ. It is funded, and may be delivered, from 9 years through primary healthcare providers.
Males and females aged 27 years or older may still benefit from receiving a course of three Gardasil 9 vaccine doses. Individuals starting Gardasil 9 aged 27 years or older will need to purchase the vaccine doses through their family doctor or Family Planning Clinic.
Individuals who have completed a course of Gardasil (HPV4) and would like to broaden their protection against the additional five HPV serotypes in Gardasil 9 (HPV9) need to receive a full age appropriate course of Gardasil 9. Individuals who were previously fully vaccinated with funded Gardasil are not eligible to receive funded Gardasil 9. Non-funded Gardasil 9 doses need to be prescribed by a doctor and purchased from Healthcare Logistics.
Not HIV-positive, or post-solid organ or stem cell transplantation
HIV-positive, or post-solid organ or stem cell transplantation
Gardasil and Gardasil 9 are fully interchangeable. When the vaccine course has been interrupted it may be resumed without repeating prior doses. Resume the standard schedule for the remaining doses.
Store between +2°C to +8°C. Protect from light. The expiry date of the vaccine is the last day of the month in the year indicated on the packaging.
Gardasil 9 can be administered concurrently with other vaccines, including all the National Immunisation Schedule vaccines. Separate syringes and different injection sites should be used.
For all vaccines, similar to most medications, an extremely rare allergic reaction called ‘anaphylaxis’ can occur. Anaphylaxis after immunisation occurs about 1–3 times in every one million vaccine doses. All vaccinators will have training and equipment to deal with this situation in the unlikely event of it occurring. No other serious responses to the vaccine have been identified.
In clinical trials Gardasil vaccine demonstrated high efficacy against all endpoints in both males and females, as well as effectiveness in reducing the risk for subsequent HPV related disease. With the availability of effective vaccines, placebo-controlled trials are no longer an ethical approach for studying HPV vaccines. The efficacy of Gardasil 9 (HPV9) had to be assessed against Gardasil (HPV4). For serotypes 6, 11, 16 or 18, protection against precancerous vulval, vaginal and cervical lesions in women vacinated when aged 16 years through 26 years ranged from 96–100% and for women vaccinated aged 24 years through 45 years when vaccinated 84.7–96.3%. In men vaccinated when aged 16 years through 26 years, protection against penile and anal cancers ranged from 73–100%. For the additional five HPV serotypes in Gardasil 9, types 31, 33, 45, 52 and 58, protection against persistent infection was around 96% and against precancerous vulval, vaginal and cervical lesions ranged from 92.9–98.9% in women vacinated when aged 16 years through 26 years.
Between January 2013 and June 2016 over 130 studies were published documenting HPV vaccine effectiveness and impact. Successful implementation of HPV vaccination programmes were associated with significant reductions in the prevalence of vaccine-type HPV, particularly among the cohorts eligible for vaccination, their sexual partners, and where coverage is highest. There were no changes observed in groups ineligible for funded HPV vaccine programmes.
In countries with high HPV vaccine coverage, such as Australia and Denmark, there has been a profound reduction in the number of genital wart cases. Data from Australia suggest elimination is possible. Countries with more moderate coverage, such as NZ, have also observed significant reductions, for example, the incidence of genital warts in men and women has decreased by 75% since the introduction of the vaccine to girls in 2008. By reducing the incidence of genital warts, fewer infants are at risk of contracting HPV infection during birth and developing recurrent respiratory papillomatosis.
Effectiveness is optimum when the vaccine is given under 15 years of age, and prior to sexual interactions.
