ACIP Discusses Nine-Valent HPV Vaccination

Patients who have already completed an HPV vaccine series do not need to restart series.

At their June meeting, members of the Advisory Committee on Immunization Practices said that the 9-valent human papillomavirus vaccination could be used to complete the series for patients who have already completed or started an HPV vaccine series.

The ACIP discussed a set of question-and-answer guidelines to help providers and patients determine if additional human papillomavirus, or HPV vaccination, is needed.

The 9vHPV vaccine can be used to continue or complete a vaccine series that was started with a different vaccine, such as the 4vHPV or 2vHPV vaccines. For those who have already completed a vaccine series with a different product, no further vaccination is necessary, committee members said.

The 9vHPV vaccine was licensed by the FDA on Dec. 10, 2014. 

Through 2014, 99% of people who had been vaccinated had been given the quadrivalent HPV vaccine. At their Februrary 2015 meeting, the ACIP recommended that the 9vHPV vaccine be used in the currently recommended age groups. Although immunogenicity trials for males aged 16 to 26 are not yet completed, the panel recommends using the vaccine in males through age 21.

Lauri Markowitz, MD, from the CDC, led the panel in a discussion about 9vHPV safety and efficacy. 

In a study, participants who had already received the 4vHPV series as well as vaccine-naïve participants were given three doses of 9vHPV. The safety profile was deemed acceptable, and >98% of all prior-vaccine participants were seropositive to the five additional HPV types. After receiving the 9vHPV vaccine, people who had already received the 4vHPV vaccine had higher rates of injection site reactions compared with vaccine-naïve participants.

The committee heard data suggesting that routine 9vHPV vaccination is cost effective; however, additional 9vHPV vaccination (for those who have already received the 4vHPV vaccine) is not cost effective, at a rate upward of $100,000 per quality-adjusted life-year gained.

For patients who wanted to get additional vaccination, the panel discussed the possibility of making a Category B recommendation to mitigate out-of-pocket expenses.

The panel agreed to reconvene the HPV workgroup to discuss whether the 9vHPV vaccine should have a Category B recommendation.

The full recommendations will be posted on the CDC’s website.


  1. Various presenters. Presented at: Meeting of the Advisory Committee on Immunization Practices. June 17, 2015. Atlanta.