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STIEF News May 2017

Thorny Issue Corner - Gardasil 4 vs Gardasil 9

Dr. Min Lo, STIEF Director and Editor in Chief of the NZ HPV Project HPV Guidelines, was recently asked the following question:

Is it unethical for existing stocks of Gardasil 4 to continue to be offered by health care providers (outside of the school-based vaccination programme) until they can be replaced with Gardasil 9? Whilst Gardasil 4 supplies have now been exhausted in New Zealand, this article provides the key facts for people who are seeking clarity regarding the differences between the two HPV vaccines. 

How much better is Gardasil 9 compared to Gardasil 4?

Keep in mind that Gardasil 4 is already an excellent product and the new Gardasil 9 is the icing on an already very good cake. The short answer is Gardasil 9 is about 20% better and it is mostly females who will benefit (which was not the aim of the exercise, it is just how it turned out). Key points:

  • The extra 5 HPV types in Gardasil 9 target mainly cervical disease raising the level of protection against cervical cancer from 70% to more than 90%.
  • Anal and oropharyngeal disease are mainly caused by HPV types 16 and 18 (which is in both Gardasil 4 and Gardasil 9).

What does this mean for males and females?

Males (who are mostly affected by anal and orpharyngeal disease) are getting most of the protection they need from Gardasil 4 and don’t necessarily need Gardasil 9 (but if they do, then all the better!).

Females who get Gardasil 9 benefit from protection against cervical cancer in excess of 90%.

The table below shows what 'extra bang for your buck' you are getting with Gardasil 9 (Reference: Joura EA et al. N Engl J Med 2015;372:711-7230).

How much extra cover does Gardasil 9 provide?

Lesion Type

4vHPV vaccine

Gardasil 4

9vHPV vaccine

Gardasil 9

Cervical Cancer

70%

90%

AIS

95%

>95%

CIN 2/3

50%

75-85%

CIN 1

30-35%

50-60%

Vulval cancer

70-75%

85-90%

VIN 2/3

80-85%

90-95%

Vaginal cancer

65%

80-85%

VaIN 2/3

60-65%

75-85%

Anal cancer

85-90%

90- 100%

AIN 2/3

80-85%

85-90%

Penile cancer

75-85%

85%

PIN 2/3

80%

90%

 

The take home point is that the extra 5 HPV types in Gardasil 9 increases the protection against cervical disease from 70% to more than 90%.

If the Ministry of Health had stuck with Gardasil 4, and increased the age range and coverage to both boys and girls, this in itself would have been a major improvement in disease prevention.  It is therefore excellent that the Ministry of Health has switched to Gardasil 9, increased the age range, allowed a two dose schedule for the young people and included the boys. New Zealand is now only the third country in the world to have Gardasil 9 in a gender neutral program, the other two countries being USA and Austria.

Do I encourage people to wait for Gardasil 9 whilst stocks of Gardasil 4 are being used up?

Patients only get one funded course - it feels intuitive to say wait for Gardasil 9. However, there is a theoretical concern of being unvaccinated and getting infected by HPV whilst waiting for stock of Gardasil 9 to become available later in the year. I think, on balance, this decision depends on individual circumstances and if it was me, I would be encouraging patients to get on with vaccination - especially young males. 

Would I pay to have my children vaccinated with Gardasil 9 if they have already had Gardasil 4?

No.  BUT, we know that less than 3 doses is immunogenic.  You could consider 1-2 doses.  

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New HPV Vaccine Pamphlet Available Now

The new NZ HPV Project pamphlet ‘Preventing HPV Cancers by Vaccination: What Everyone Should Know’ is available to download from www.hpv.org.nz. It is also fresh from the printers and FREE copies are available to order from [email protected]


NZ H Friends – Support Group

Being diagnosed with genital herpes is often life changing; some cope well while others struggle. In the face of the associated social stigma, many feel overwhelmed, hopeless, ashamed and, above all, isolated. Sexual health organisations are a godsend, offering expert advice and support (as is the NZ Herpes Foundation Tollfree Helpline 0508 11 12 13 managed by a nurse counsellor). But there's nothing to compare with talking to someone who can truly empathise. That's why NZ H Friends was formed.

NZ H Friends is a support group for those with genital herpes (HSV-1, HSV-2) living throughout Aotearoa. Our primary focus is to offer advice and empathy within a safe, confidential and non-judgmental forum. The group is embedded within Meetup.com, and as such, the emphasis is on actually getting together within a relaxed social environment. The internet site does, however, provide a discussion board, and members can also use the secure messaging facility. Current membership includes people at different stages of both their life and H journeys, many with a wealth of experience to share. We are fully inclusive and all are welcome, irrespective of sexual orientation, religion, ethnic origin etc. We are well established in Greater Auckland, but have members spread throughout NZ and fledgling 'satellite' groups in Wellington and Dunedin. Our vision is to create a nation-wide collaborative community so that no-one should feel helpless and alone.

We are keen to promote our group further, with the newly diagnosed and struggling particularly in mind. As such we would relish the opportunity to link with health care professionals in achieving our vision. If you would like to work with us we are happy to provide flyers/posters for practice areas. But you are the experts, and we are willing to collaborate in any way that will reach fellow sufferers. So if you would like to contact us or have any queries please do so via [email protected].

Many thanks for your attention,

Sue, 51, married, stroke nurse specialist, HSV2.

Disclaimer: NZ H Friends support group is independent to, and not endorsed by, STIEF.