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Take advantage of
every opportunity
to recommend¹

When to recommend HPV vaccination for adults

“Have your appropriate adult patients received their first dose of GARDASIL 9? Do they need to complete the series? For adults up to 26 years of age, catch-up HPV vaccination is recommended for those who are not adequately vaccinated. Shared clinical decision-making regarding HPV vaccination is recommended for adults ages 27 through 45 years.²“

Their next visit could be your chance to talk about HPV vaccination.3,4,5 Discuss GARDASIL 9 with your female patients during:

  • Routine OB/GYN visits³
  • Cervical cancer screenings⁵

And with your male and female patients during:

  • Sexual health-related visits, including:
    • STI prevention counselling and screenings⁵
    • Contraception discussions⁵
  • Routine physicals⁶
  • Adult vaccination appointments
    • Consider using appointments for adult vaccinations (such as those required for travelling), as opportunities to recommend HPV vaccination.⁴

When to recommend HPV vaccination for adolescents

“Before every routine visit, check if your patient is old enough to receive their first dose of GARDASIL 9 or is up-to-date on their HPV vaccination.”

Considerations for every routine well-visit:

  • The GARDASIL 9 series can be started in boys and girls at 9-years-old.
  • A good time to recommend HPV vaccination may be while the patient is scheduled to receive other vaccinations.⁴
    • GARDASIL 9 can be administered concomitantly at a separate injection site with meningococcal, TDap, and dTap-IPV vaccines.a,b

You play an important role in helping to
prevent certain HPV-related cancers.5,7,8

Learn more



HPV=human papillomavirus

aResults from clinical studies indicate that GARDASIL 9 may be administered concomitantly with Menactra [Meningococcal (Groups A, C, Y and W-135) Polysaccharide Diphtheria Toxoid Conjugate Vaccine], Adacel [Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine Adsorbed (Tdap)], and Repevax [Diphtheria, Tetanus, Pertussis (acellular, component) and Poliomyelitis (inactivated) Vaccine (adsorbed, reduced antigen(s) content)] (dTap-IPV).

bMenactra [Meningococcal (Groups A, C, Y and W-135) Polysaccharide Diphtheria Toxoid Conjugate Vaccine], Adacel [Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccine Adsorbed (Tdap)], and Repevax [suspension for injection, in pre-filled syringe Diphtheria, Tetanus, Pertussis (acellular, component) and Poliomyelitis (inactivated) Vaccine (adsorbed, reduced antigen(s) content)] are the trademarks of their respective owners and are not trademarks of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.

References:

  1. World Health Organization (WHO). Human papillomavirus vaccines: WHO position paper, May 2017. Wkly Epidemiol Rec. 2017;19(92):241-268.
  2. Meites E, Gee J, Unger E, Markowitz L. Epidemiology and Prevention of Vaccine-Preventable Diseases (Pink Book). 14th edition. Chapter 11: Human Papillomavirus. Centers for Disease Control and Prevention (CDC). Updated October 2020. Accessed August 25, 2021. https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/hpv.pdf.
  3. Guo F, Hirth JM, Berenson AB. Human papillomavirus vaccination and pap smear uptake among young women in the United States: Role of provider and patient. Journal of Women’s Health. 2017:26(10)1114-1122.
  4. World Health Organization. Vaccine-preventable diseases and vaccines (2019 update). In: World Health Organization. International Travel and Health. World Health Organization; 2019; 1-53.
  5. Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Morb Mortal Wkly Rep. 2021;70(4)1-192.
  6. Barrow RY, Ahmed F, Bolan GA, Workowski KA. Recommendations for provided quality sexually transmitted diseases clinical services, 2020. MMWR Morb Mortal Wkly Rep. 2020;68(5)1-20.
  7. Gilkey MB, Calo WA, Moss JL, Shah PD, Marciniak MW, Brewer NT. Provider communication and HPV vaccination: the impact of recommendation quality. Vaccine. 2016;34(9):1187-1192. doi:10.1016/j.vaccine.2016.01.023.
  8. Wheldon CW, Garg A, Galvin AM, Moore JD, Thomson EL. Decision support needs for shared clinical decision-making regarding HPV vaccination among adults 27-45 years of age. Patient Educ Couns. 2021. doi.org/10.1016/j.pec.2021.04.016i.

GARDASIL 9 – SELECTED SAFETY INFORMATION

Therapeutic uses
Gardasil 9 is indicated for active immunization of individuals from the age of 9 years against the following HPV diseases:
• Premalignant lesions and cancers affecting the cervix, vulva, vagina, and anus caused by vaccine HPV types.
• Genital warts (Condyloma acuminata) caused by specific HPV types.

Dosage and administration
GARDASIL 9 should be administered intramuscularly as 3 separate 0.5-mL doses according to the following schedule: Individuals 9 to and including 14 years of age at time of first injection Gardasil 9 can be administered according to a 2-dose (0, 6 – 12 months) schedule. The second dose should be administered between 5 and 13 months after the first dose. If the second vaccine 2 dose is administered earlier than 5 months after the first dose, a third dose should always be administered. GARDASIL 9 can be administered according to a 3-dose (0, 2, 6 months) schedule. The second dose should be administered at least one month after the first dose and the third dose should be administered at least 3 months after the second dose. All three doses should be given within a 1-year period.
Individuals 15 years of age and older at time of first injection Gardasil 9 should be administered according to a 3-dose (0, 2, 6 months) schedule. The second dose should be administered at least one month after the first dose and the third dose should be administered at least 3 months after the second dose. All three doses should be given within a 1-year period. It is recommended that individuals who receive a first dose of GARDASIL 9 complete the vaccination course with GARDASIL 9

Contraindications
GARDASIL 9 is contraindicated in patients with hypersensitivity to either GARDASIL 9 or GARDASIL™ or any of the inactive ingredients in either vaccine. Individuals who develop symptoms indicative of hypersensitivity after receiving a dose of GARDASIL 9 or GARDASIL should not receive further doses of GARDASIL 9.

Warnings and precautions
As for any vaccine, vaccination with GARDASIL 9 may not result in protection in all vaccine recipients.
The vaccine is for prophylactic use only and has no effect on active HPV infections or established clinical disease. The vaccine has not been shown to have a therapeutic effect. The vaccine is therefore not indicated for treatment of cervical, vulvar, vaginal, and anal cancer, high-grade cervical, vulvar, vaginal, and anal dysplastic lesions, or genital warts. It is also not intended to prevent progression of other established HPV-related lesions. As with all injectable vaccines, appropriate medical treatment should always be readily available in case of rare anaphylactic reactions following the administration of the vaccine.
Syncope (fainting) may follow any vaccination, especially in adolescents and young adults. Syncope, sometimes associated with falling, has occurred after HPV vaccination. Therefore, vaccinees should be carefully observed for approximately 15 minutes after administration of GARDASIL 9.
The decision to administer or delay vaccination because of a current or recent febrile illness depends largely on the severity of the symptoms and their etiology. Low-grade fever itself and mild upper respiratory infection are not generally contraindications to vaccination.
Individuals with impaired immune responsiveness, whether due to the use of immunosuppressive therapy, a genetic defect, Human Immunodeficiency Virus (HIV) infection, or other causes, may have reduced antibody response to active immunization.
This vaccine should be given with caution to individuals with thrombocytopenia or any coagulation disorder because bleeding may occur following an intramuscular administration in these individuals.

Use in special populations
Pregnancy should be avoided during the vaccination regimen for GARDASIL 9. Gardasil 9 can be used during breast-feeding. The safety and efficacy of GARDASIL 9 have not been evaluated in children younger than 9 years. The safety immunogenicity, and efficacy of GARDASIL 9 have not been fully evaluated in HIV-infected individuals.

Adverse reactions
The most common (>10%) vaccine-related adverse experiences were observed among recipients of GARDASIL 9 were temperature and injection-site pain, swelling, erythema, headache. And common (>1%) vaccine-related adverse experiences observed reported were pruritus, bruising, pyrexia, nausea, dizziness, pain in extremity, hematoma, and fatigue.

Post-marketing reports:
The following adverse experiences have been spontaneously reported during post-approval use of GARDASIL and may also be seen in post-marketing experience with GARDASIL9. Cellulitis, idiopathic thrombocytopenic purpura, lymphadenopathy, acute disseminated encephalomyelitis, dizziness, Guillain-Barré syndrome, headache, syncope sometimes accompanied by tonic-clonic movements; nausea, vomiting; arthralgia, myalgia; asthenia, chills, fatigue, malaise; hypersensitivity reactions including anaphylactic/anaphylactoid reactions, bronchospasm, and urticaria. These experiences were reported voluntarily from a population of uncertain size. It is not possible to reliably estimate their frequency or to establish a causal relationship to vaccine exposure.

Before administering GARDASIL®9, please read the complete Prescribing Information.