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Column originally published Dec 29, 2020

Gardasil 9 Vaccine Provides Better Coverage Against Human Papillomavirus Infections

Question: I am a woman in the mid-40s. My mom and my older sister both died of cervical cancer; I am terrified of it. I have been getting regular Pap tests, and they were fine. About 10 years ago, I got the Gardasil vaccine. Recently, my friend told me that there is a new version that is more protective. With my family history, should I get this updated vaccine?


I am very glad that you got the original Gardasil vaccine, and have regular Pap tests. Both of these are important for prevention of cervical and other cancers. You may want to consider the new updated Gardasil 9 vaccine. Let me explain this to you.

Gardasil is one of the vaccines developed to prevent Human Papillomavirus (HPV) infection. There are over 100 types of HPV that can infect human. Some can cause warts on hands and feet, others produce warts in the genitalia.

A number of them have been found to cause cancer, especially in the cervix and vagina of women, and the penis in men. They are also responsible for cancers in the anus and rectum, as well as around the head and neck. With the exception of warts on hands and feet, HPV infections are usually transmitted through sexual contact.

The highest incidence of HPV transmission occurs in adolescents and young adults, shortly after they started sexual activities. Recent research shows that HPV infection is increasing in older adults, when they engage in new relationships following divorce or death of a spouse. They are also less likely to use protection like condom, and most didn’t receive HPV vaccine.

There are two HPV vaccines available in Canada: Cervarix and Gardasil 9. Cervarix and the original Gardasil protect against two types of cancer-causing HPV, 16 and 18. The new Gardasil 9 vaccine protects against 5 additional types (31, 33, 45, 52, and 58) that can cause cancer. Furthermore, both the original Gardasil and Gardasil 9 vaccines also protect against HPV 6 and 11: these are responsible for most of the genital warts.

Although HPV vaccines can prevent infection caused by the specific types of virus covered by the vaccines, they cannot get rid of an infection that had already happened before vaccination. For example, if you have been infected with HPV type 33 before vaccination, getting Gardasil 9 will not eliminate this particular virus from your body. That is why HPV vaccines are most effective when given to young girls and boys, before they become sexually active.

The new Gardasil 9 vaccine does protect against most, although not all, types of HPV that can cause cancer in both women and men. This broader coverage can be important for those with a strong family history of HPV-related cancer. The manufacturer did vaccinate several hundred individuals with Gardasil 9 who were previously immunized with the original Gardasil; there was no significant serious side effect in these individuals. Therefore, it is safe for you to receive this new Gardasil 9 vaccine.

However, at the present time, there is no official recommendation from Health Canada for someone like yourself, whether you should receive this updated Gardasil 9 vaccine. You have to balance the pros and cons, as well as the cost of this vaccine. You should discuss this further with your healthcare provider.

Regardless of your decision, you should continue to have regular Pap test, and use protection like condom if this is appropriate.