The HPV vaccines - Which to prefer?

This review presents an unbiased comparison between the two vaccines available against human papillomavirus (HPV). We conducted a PUBMED and Google search for the years 1998 to October 2008 using the terms: cervical cancer vaccine, HPV vaccine, Gardasil, and Cervarix; and also reviewed abstracts from international meetings. Both vaccines are intended to protect against cervical cancer and high-grade CIN caused by HPV 16 and HPV 18. Only the quadrivalent vaccine is designed to prevent condylomata acuminata and low-grade CIN caused by HPV 6 and HPV 11. It has been approved by the FDA for women aged 9 to 26 years against vulvar and vaginal cancer, and against cervical cancer and precancer. The adjuvant of the bivalent vaccine more significantly accelerates an immune reaction. Both vaccines demonstrate cross-protection, although against different HPV types. The bivalent vaccine is registered for above age 26 in Australia and Israel, and the quadrivalent vaccine in the Philippines and Ecuador. Time will verify claims and reveal differences. In the meantime, both vaccines are safe and effective for their approved indications and, recommendations should be based on individual patient characteristics. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader should be able to describe the viral targets of the two HPV vaccines, explain the potential benefits of HPV vaccination to patients, and compare the data regarding the two HPV vaccines.