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HPV vaccines

The 3 HPV vaccines available in Canada are Gardasil, Cervarix and Gardasil 9. All 3 protect against infection with the 2 types of HPV most commonly associated with cancer (HPV-16 and HPV-18). HPV-16 and HPV-18 are responsible for 70% of all cervical cancers. These types of HPV are also linked to cancer of the anus, vulva, vagina and penis, as well as some oral cavity and oropharyngeal cancers.

Gardasil also protect against HPV-6 and HPV-11, which are responsible for 90% of genital warts.

Gardasil 9 also protects against HPV-6 and HPV-11, as well as 5 other types of HPV that can cause cancer.

VaccineIndications

Gardasil

Gardasil was the first HPV vaccine approved in Canada. It is a quadrivalent vaccine that protects against 4 different HPV types: HPV- 6, HPV-11, HPV-16 and HPV-18.

Gardasil helps protect females between 9 and 45 years of age against:

  • precancerous conditions of the cervix, vagina and vulva
  • cervical, vaginal and vulvar cancer

In females and males between 9 and 26 years of age, Gardasil also helps prevent:

  • precancerous conditions of the anus (anal epithelial neoplasia or AIN)
  • anal cancer

Gardasil also helps protect females (9–45 years of age) and males (9–26 years of age) against anogenital warts.

Cervarix

Cervarix is a bivalent vaccine that protects against 2 high-risk HPV types: HPV-16 and HPV-18.

Cervarix helps protects females between 10 and 25 years of age against:

  • precancerous conditions of the cervix
  • cervical cancer

Cervarix does not protect against genital warts.

Gardasil 9

Gardasil 9 is the newest HPV vaccine approved in Canada. It protects against 9 different HPV types:

  • HPV- 6
  • HPV-11
  • HPV-16
  • HPV-18
  • HPV-31
  • HPV-33
  • HPV-45
  • HPV-52
  • HPV-58

Gardasil 9 helps protect females between 9 and 45 years of age against:

  • precancerous conditions of the cervix, vagina and vulva
  • cervical, vaginal and vulvar cancer

In females and males between 9 and 26 years of age, Gardasil 9 also helps prevent:

  • precancerous conditions of the anus (anal epithelial neoplasia or AIN)
  • anal cancer

Gardasil 9 also helps protect females (9–45 years of age) and males (9–26 years of age) against anogenital warts.

How the vaccines work

The vaccines work by stimulating the body to produce antibodies against the types of HPV they target. The aim of the vaccines is to prevent HPV infections and therefore the diseases associated with these HPV types (prophylactic vaccines). The HPV vaccines do not treat HPV infections, diseases or cancers related to HPV infections.

The vaccines work best when given to young people before they become sexually active (which includes sexual intercourse, genital skin-to-skin contact and oral sex). The goal is to protect young people before they are exposed to the HPV types that the vaccines cover.

The vaccines are not live (they do not contain the active virus), so a person cannot get HPV from the vaccine.

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Effectiveness of the vaccines

Studies have shown that Gardasil, Cervarix and Gardasil 9 are highly effective in preventing infection with the types of HPV they target. Evidence from many clinical trials shows that the vaccines are highly effective in preventing persistent infection from HPV-16 and HPV-18, as well as precancerous cervical lesions associated with these types of HPV.

In clinical trials, researchers have found that Gardasil is effective in preventing precancerous conditions of the vagina, vulva and anus. It is also very effective in preventing anal and genital (anogenital) warts caused by HPV-6 and HPV-11. At this time, Cervarix is not approved for preventing precancerous conditions of the vagina, vulva or anus.

Some research shows that Gardasil and Cervarix vaccines may also provide partial protection against other high-risk types of HPV, such as HPV-31, HPV-33 and HPV-45, which are similar to HPV-16 and HPV-18. This is called cross protection. However, more research is needed to determine the degree of effectiveness and the duration of protection against these other HPV types.

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National Advisory Committee on Immunization (NACI) recommendations

Gardasil and Cervarix have been approved by Health Canada and recommended by Canada’s National Advisory Committee on Immunization (NACI). Health Canada approves vaccines based on their effectiveness and safety, while NACI makes recommendations for the use of vaccines including identifying groups of people at risk for diseases that can be prevented with vaccines. The most recent NACI recommendations on HPV vaccination were made in 2015. NACI hasn’t yet made recommendations for Gardasil 9.

Vaccination of girls and women

NACI recommends that either HPV vaccine (Gardasil or Cervarix) be given to prevent cervical cancer and precancerous cervical changes in:

  • females 9–26 years of age
    • The vaccines are most effective when given to females before they are sexually active.
  • females 15–26 years of age who have been sexually active, have had genital warts or previous abnormal Pap tests, including cervical cancer
    • Vaccination could still help these females because they may not have been infected with all the HPV types covered by the vaccine.
  • females over 26 years of age
    • The effectiveness of Cervarix has not been directly tested in this age group, but there is some evidence from immune responses in younger women to suggest that the vaccine would have similar effectiveness in older women.

Only Gardasil is approved for girls and women aged 9–45 to prevent vaginal and vulvar cancer and the precancerous conditions associated with these cancers, as well as anal and genital (anogenital) warts. Gardasil is also the only vaccine approved for girls and women ages 9–26 to prevent anal cancer and the precancerous condition associated with this cancer.

Vaccination of boys and men

NACI recommends Gardasil for boys and young men to prevent anal cancer, its precancerous condition and anogenital warts. The vaccine is most effective when given to males before they become sexually active. NACI recommends that Gardasil be used for:

  • males between 9 and 26 years of age
  • males 9 years of age and older who have sex with other males

There is some evidence that Gardasil may also prevent penile, perianal and perineal precancerous conditions (intraepithelial neoplasias) and their associated cancers, although it is currently not approved for this use.

Research is being done to see if vaccinating boys and young men before they become sexually active can prevent them from passing on HPV to females. In turn, this could help reduce cervical cancer risk in women.

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How the vaccines are given

Gardasil, Cervarix and Gardasil 9 are given by an injection into an arm muscle. The vaccines are given 2 or 3 times over a 6 to 12 month period. The schedule of doses makes sure the vaccines are as effective as possible. If all doses of the vaccine are not given, or they are not given at the right time, you may not get the full benefit of the vaccine.

Who can have 2 or 3 doses of an HPV vaccine

Males and females can have 2 or 3 doses of Gardasil or Cervarix if they are between the ages of 9 and 14.

Who should have 3 doses of an HPV vaccine

Males and females should have 3 doses of the HPV vaccine if they:

HPV vaccineVaccination schedule with 2 dosesVaccination schedule with 3 doses

Gardasil

  • first dose on day 1
  • second dose 6–12 months after the first dose
  • first dose on day 1
  • second dose 2 months after the first dose
  • last dose 6 months after the first dose

Cervarix

  • first dose on day 1
  • second dose 6–12 months after the first dose
  • first dose on day 1
  • second dose 1 month after the first dose
  • last dose 6 months after the first dose

Gardasil 9

  • Gardasil 9 is not given in 2 doses.
  • first dose on day 1
  • second dose 2 months after the first dose
  • last dose 6 months after the first dose

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Vaccine safety

Current evidence tells us that the vaccines are safe and well-tolerated. They have similar side effects as those commonly experienced with other vaccines. Of the side effects reported, most of these have not been serious. The most common side effects of the vaccines are soreness (pain), swelling, itching and redness at the injection site. Headache and fatigue have also been reported. The safety of both HPV vaccines is being followed in Canada and other countries on an ongoing basis.

The vaccines are not recommended for:

  • anyone under 9 years of age
  • pregnant women

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How long the vaccines work

The length of time that HPV vaccines provide protection for is not fully known. Information so far shows that protection can last at least 8 years for Gardasil and at least 9.4 years with Cervarix in females not previously infected with HPV.

Information from longer follow-up of both vaccines will answer questions about long-term effectiveness, the duration of protection and whether booster doses will be needed for continued protection against HPV.

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Vaccination programs

All provinces and territories have voluntary, school-based HPV vaccination programs for girls. Prince Edward Island and Alberta provide similar vaccination programs for boys.

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Screening for cervical cancer

The HPV vaccines prevent infection from the high-risk HPV types associated with only 70% of cervical cancers. This means that about 30% of cervical cancers will not be prevented by the vaccines. Getting vaccinated against HPV should be used as a complement to, not a replacement for, cervical cancer screening with Pap tests. All females – whether or not they receive an HPV vaccine – still need to follow the cervical cancer screening guidelines in their province or territory. Regular cervical cancer screening is important for finding precancerous changes in the cervix early, before cancer develops.

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Impact of HPV vaccines on cancer

The time between initial HPV infection and development of cervical cancer averages 20 years. Because of the long lead time between HPV infection and cancer developing, it will take many years before the full impact of HPV vaccination on the incidence and deaths related to cervical cancer is established. Canada will be collecting information on HPV infections, the number of people who get vaccinated and HPV-related diseases.

More research is needed to know if HPV vaccines will also prevent other cancers associated with HPV, such as oral cavity and oropharyngeal cancers.

The HPV vaccines do not protect against breast, ovarian, prostate and other reproductive cancers because these cancers are not caused by HPV.

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