Introduction And Epidemiology
- Human papillomavirus (HPV) belongs to Papillomaviridae family.
- Small, non-enveloped double-stranded deoxyribonucleic acid (DNA) virus.
- Transmitted primarily through sexual contact.
- Causes cervical, anal, penile, oropharyngeal, vulvar, and vaginal cancers.
- India accounts for approximately 25% of global cervical cancer deaths.
- Cervical cancer ranks as second most common cancer among Indian women.
- One Indian woman dies every 8 minutes from cervical cancer.
Serotypes And Clinical Manifestations
- High-risk oncogenic types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 58, 59, 66.
- Types 16 and 18 cause 70-80% of invasive cervical cancers worldwide.
- Low-risk non-oncogenic types: 6, 11.
- Types 6 and 11 cause 90% of anogenital warts and recurrent respiratory papillomatosis.
Available Human Papillomavirus Vaccines
| Feature | Bivalent (Cervarix) | Quadrivalent (Gardasil-4) | Quadrivalent (Cervavac) | Nonavalent (Gardasil-9) |
|---|
| Serotypes Covered | 16, 18 | 6, 11, 16, 18 | 6, 11, 16, 18 | 6, 11, 16, 18, 31, 33, 45, 52, 58 |
| Manufacturer | GSK | MSD (Merck) | Serum Institute of India | MSD (Merck) |
| Approved Gender | Females | Females only (India) | Males and Females | Males and Females |
| Approved Age | 9-45 years | 9-45 years | 9-26 years | 9-26 years (Females) / 9-14 years (Males) |
| Adjuvant | AS04 | Amorphous aluminum hydroxyphosphate sulfate | Aluminum ion | Amorphous aluminum hydroxyphosphate sulfate |
Immunization Schedule And Guidelines
Indian Academy Of Pediatrics Recommendations
| Age Group | Doses Required | Schedule | Minimum Intervals |
|---|
| 9-14 years (Boys & Girls) | 2 doses | 0, 6 months | 5 months between dose 1 and 2 |
| 15-26 years (Boys & Girls) | 3 doses | 0, 2, 6 months | Dose 1-2: 4 weeks. Dose 2-3: 12 weeks. Dose 1-3: 5 months |
| Immunocompromised (Any Age) | 3 doses | 0, 2, 6 months | As per standard 3-dose schedule |
Administration Details
- Dose: 0.5 mL.
- Route: Intramuscular injection.
- Site: Deltoid muscle (left upper arm).
- Co-administration: Safe with other vaccines (hepatitis B, Tdap, meningococcal) at different anatomical sites.
- Maximum age for catch-up: 45 years for females (Gardasil-4), 26 years for females/males (Gardasil-9, Cervavac).
- Interrupted schedule: Do not restart series. Continue from missed dose.
Nationwide Vaccination Campaign
- Launched February 28, 2026, in India.
- Target population: 14-year-old girls (approx. 1.15 crore annual cohort).
- Vaccine utilized: Gardasil-4.
- Schedule: Single-dose regimen (0.5 mL).
- Provision: Free of cost at Government Health Facilities.
- Registration: U-WIN digital platform.
Special Circumstances
Pregnancy And Lactation
- Routine pregnancy testing not required before vaccination.
- Contraindicated during pregnancy.
- Inadvertent administration during early pregnancy requires no termination.
- Withhold remaining doses until postpartum period.
- Safe during lactation.
Immunocompromised And HIV Patients
- Administer 3-dose schedule irrespective of age.
- Recommended for human immunodeficiency virus (HIV) infected individuals.
Sexual Assault Victims
- Integrate vaccination into initial sexual assault management.
- Mandatory 3-dose series regardless of victim age.
- Administer first dose during initial examination.
Previous Human Papillomavirus Infection Or Abnormal Pap Smear
- Human papillomavirus DNA testing not recommended prior to vaccination.
- Vaccine provides protection against unacquired serotypes.
- Offers no therapeutic effect against pre-existing infection or neoplastic processes.
- Routine cervical cancer screening must continue post-vaccination.
Safety Profile And Adverse Effects
- Outstanding safety profile with over 500 million doses administered globally.
- Common adverse effects: Injection site pain, swelling, erythema, mild fever.
- Adolescent syncope occurs frequently post-vaccination.
- Mandatory observation in seated or supine position for 15 minutes post-vaccination.
- No association with infertility, autoimmune conditions, or premature ovarian failure.
- Contraindications: Severe allergic reaction or anaphylaxis to yeast or previous vaccine dose.
Efficacy
- Prevents 93-100% of cervical cancers caused by vaccine serotypes.
- Nonavalent vaccine prevents up to 90% of all cervical cancers.
- Demonstrates strong herd effect, reducing viral circulation among unvaccinated populations.
- Most immunogenic when administered prior to sexual debut.
