Human papillomavirus quadrivalent vaccine: Drug information

Copyright 1978-2015 Lexicomp, Inc. All rights reserved.

(For additional information see "Human papillomavirus quadrivalent vaccine: Patient drug
information" and see "Human papillomavirus quadrivalent vaccine: Pediatric drug information")
For abbreviations and symbols that may be used in Lexicomp (show table)

Brand Names: US

Gardasil

Brand Names: Canada

Gardasil

Pharmacologic Category

Vaccine;

Vaccine, Inactivated (Viral)

Dosing: Adult
Immunization regimen:
US labeling: IM: Adults 26 years: 0.5 mL per dose for a total of 3 doses; administer the second and
third doses at 2 and 6 months after initial dose
Canadian labeling: IM: Adults 45 years: 0.5 mL per dose for a total of 3 doses; administer the
second and third doses at 2 and 6 months after initial dose

CDC/ACIP recommended immunization schedule: 0.5 mL per dose for a total of 3 doses; administer
the second and third doses at 1 to 2 and 6 months after initial dose. There should be a 4-week
minimum interval between the first and second dose; a 12-weeks minimum interval (16 weeks
preferred) between the second and third dose; a 24-week minimum interval between the first
and third dose. Begin series in females 26 years or males 21 years if not previously
vaccinated or completed the 3-dose series (typically administer first dose at age 11 to 12
years). Vaccination for males 22 through 26 years of age is recommended if
immunocompromised (including HIV) and for men who have sex with men and may be
considered for any other male in this age group. Second and third doses may be given after
age 26 years to complete a previously initiated series. The HPV vaccine series should be
completed with the same product whenever possible (CDC/ACIP [Kim 2015]; CDC/ACIP
[Markowitz 2014]).

Dosing: Pediatric

(For additional information see "Human papillomavirus quadrivalent vaccine: Pediatric drug
information")
Immunization: IM:
US labeling: Children 9 years and Adolescents: 0.5 mL per dose for a total of 3 doses;
administer the second and third doses at 2 and 6 months after initial dose
Canadian labeling: Children 9 years and Adolescents: 0.5 mL per dose for a total of 3 doses;
administer the second and third doses at 2 and 6 months after initial dose

CDC/ACIP recommended immunization schedule: 0.5 mL per dose for a total of 3 doses; administer
the second and third doses at 1 to 2 and 6 months after initial dose. There should be a 4-week
minimum interval between the first and second dose; a 12-weeks minimum interval (16 weeks
preferred) between the second and third dose; a 24-week minimum interval between the first
and third dose. Typically, administer first dose at age 11 to 12 years but may administer as
young as 9 years; begin series in adolescents (13 years) if not previously vaccinated or who
have not completed the 3-dose series (CDC/ACIP [Markowitz 2014]; CDC/ACIP [Strikas
2015]).

Dosing: Renal Impairment

There are no dosage adjustments provided in the manufacturers labeling.

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturers labeling.

Dosage Forms: US
Excipient information presented when available (limited, particularly for generics); consult specific
product labeling.
Injection, suspension [preservative free]:
Gardasil: HPV 6 L1 protein 20 mcg, HPV 11 L1 protein 40 mcg, HPV 16 L1 protein 40 mcg,
and HPV 18 L1 protein 20 mcg per 0.5 mL (0.5 mL) [contains aluminum, polysorbate 80;
manufactured using S. cerevisiae (baker's yeast)]

Generic Equivalent Available: US

No

Medication Guide and/or Vaccine Information Statement (VIS)

In the U.S, the appropriate CDC-approved Vaccine Information Statement (VIS) must be provided to
the patient prior to administering each dose of this vaccine; VIS is available
at http://www.cdc.gov/vaccines/hcp/vis/vis-statements/hpv-gardasil.html.

Administration
Shake suspension well before use. Inject the entire dose IM into the deltoid region of the upper arm
or higher anterolateral thigh area. To prevent syncope related injuries, adolescents and adults

should be vaccinated while seated or lying down (NCIRD/ACIP 2011). US law requires that the date
of administration, the vaccine manufacturer, lot number of vaccine, and the administering person's
name, title, and address be entered into the patient's permanent medical record.

For patients at risk of hemorrhage following intramuscular injection, the vaccine should be
administered intramuscularly if, in the opinion of the physician familiar with the patient's bleeding
risk, the vaccine can be administered by this route with reasonable safety. If the patient receives
antihemophilia or other similar therapy, intramuscular vaccination can be scheduled shortly after
such therapy is administered. A fine needle (23 gauge or smaller) can be used for the vaccination
and firm pressure applied to the site (without rubbing) for at least 2 minutes. The patient should be
instructed concerning the risk of hematoma from the injection. Patients on anticoagulant therapy
should be considered to have the same bleeding risks and treated as those with clotting factor
disorders (NCIRD/ACIP 2011).

Compatibility
Do not mix with other vaccines or injections. Separate needles and syringes should be used for
each injection.

Use
Prevention of human papillomavirus infection:
US labeling:
Females 9 to 26 years of age:
For the prevention of the following diseases: cervical, vulvar, vaginal, and anal
cancer caused by HPV types 16 and 18; genital warts (condyloma
acuminatum) caused by HPV types 6 and 11;
For the prevention of the following precancerous or dysplastic lesions caused by
HPV types 6, 11, 16, and 18: cervical intraepithelial neoplasia (CIN) grade 2/3
and cervical adenocarcinoma in situ; CIN grade 1; vulvar intraepithelial
neoplasia grade 2 and 3; vaginal intraepithelial neoplasia grade 2 and 3; and
anal intraepithelial neoplasia grades 1, 2, and 3.
Males 9 through 26 years of age:
For the prevention of the following diseases: anal cancer caused by HPV types 16
and 18; genital warts (condyloma acuminata) caused by HPV types 6 and 11;
For the prevention of anal intraepithelial neoplasia grades 1, 2, and 3 caused by
HPV types 6, 11, 16, and 18.
Limitations of use: Does not provide protection against vaccine HPV types to which a
person has already been previously exposed, or HPV types not contained in the
vaccine; does not prevent CIN grade 2/3 or worse in women >26 years of age. Not
intended for the treatment of active external genital lesions or cervical, vulvar,
vaginal, and anal cancers.
Canadian labeling:

Females 9 years and 26 years of age: Prevention of anal cancer caused by HPV types
16 and 18; anal intraepithelial neoplasia caused by HPV types 6, 11, 16, and 18
Females 9 years and 45 years of age: Prevention of cervical, vulvar, and vaginal
cancer caused by HPV types 16 and 18; genital warts caused by HPV types 6 and
11; cervical adenocarcinoma in situ, vulvar, vaginal, or cervical intraepithelial
neoplasia caused by HPV types 6, 11, 16, and 18
Males 9 years and 26 years of age: Prevention of anal cancer caused by HPV types
16 and 18; anal intraepithelial neoplasia caused by HPV types 6, 11, 16, and 18;
genital warts caused by HPV types 6 and 11

The Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination for
females and males 11 to 12 years of age; can be administered as young as 9 years; catch-up
vaccination is recommended for females 13 to 26 years of age and males 13 to 21 years of age.
Vaccination for males 22 through 26 years of age is recommended if immunocompromised
(including HIV) and for men who have sex with men and may be considered for any other male in
this age group (CDC/ACIP [Markowitz 2014]; CDC/ACIP [Strikas 2015]).

Medication Safety Issues

Sound-alike/look-alike issues:
Papillomavirus vaccine types 6, 11, 16, 18 (Gardasil) may be confused with Papillomavirus
vaccine types 16, 18 (Cervarix)
Papillomavirus vaccine types 6, 11, 16, 18 (Gardasil) may be confused with Papillomavirus
vaccine 9-valent (Gardasil 9)

Adverse Reactions Significant

All serious adverse reactions must be reported to the U.S. Department of Health and Human
Services (DHHS) Vaccine Adverse Event Reporting System (VAERS) 1-800-822-7967 or online
at https://vaers.hhs.gov/esub/index. In Canada, adverse reactions may be reported to local
provincial/territorial health agencies or to the Vaccine Safety Section at Public Health Agency of
Canada (1-866-844-0018).

>10%:
Central nervous system: Headache (12% to 28%), fever (8% to 13%)
Local: Injection site: Pain (61% to 84%), erythema (17% to 25%), swelling (14% to 25%)
1% to 10%:
Central nervous system: Dizziness (1% to 4%), malaise (1%), insomnia (1%)
Gastrointestinal: Nausea (2% to 7%), diarrhea (3% to 4%), vomiting (1% to 2%), toothache
(2%)
Local: Injection site: Bruising (3%), pruritus (3%), hematoma (1%)

Neuromuscular & skeletal: Arthralgia (1%), myalgia (1%)

Respiratory: Pharyngolaryngeal pain (3%), cough (2%), nasal congestion (1%)
<1% (Limited to important or life-threatening): Acute disseminated encephalomyelitis, alopecia
areata, anaphylactic/anaphylactoid reaction, appendicitis, arrhythmia, arthritis, asthma,
autoimmune hemolytic anemia and other autoimmune diseases, bronchospasm, cellulitis,
cerebrovascular accident, chills, DVT, fatigue, gastroenteritis, Guillain-Barr syndrome,
hypersensitivity reaction, hyper-/hypothyroidism, injection site joint movement impairment, ITP,
JIA, lymphadenopathy, motor neuron disease, pancreatitis, paralysis, pelvic inflammatory
disease, pulmonary embolus, RA, renal failure (acute), seizure, sepsis, syncope (may result in
falls with injury or be associated with tonic-clonic movements), transverse myelitis, urticaria,
weakness

Contraindications
Hypersensitivity, including severe allergic reactions to yeast (a vaccine component), or a previous
dose of the vaccine

Warnings/Precautions
Concerns related to adverse effects:
Anaphylactoid/hypersensitivity reactions: Immediate treatment (including epinephrine 1:1000)
for anaphylactoid and/or hypersensitivity reactions should be available during vaccine
use (NCIRD/ACIP 2011).
Syncope: Syncope has been reported with use of injectable vaccines and may result in
serious secondary injury (eg, skull fracture, cerebral hemorrhage); typically reported in
adolescents and young adults and within 15 minutes after vaccination. Procedures
should be in place to avoid injuries from falling and to restore cerebral perfusion if
syncope occurs (NCIRD/ACIP 2011).
Disease-related concerns:
Acute illness: The decision to administer or delay vaccination because of current or recent
febrile illness depends on the severity of symptoms and the etiology of the disease.
Consider deferring administration in patients with moderate or severe acute illness (with
or without fever); vaccination should not be delayed for patients with mild acute illness
(with or without fever) (CDC/ACIP [Markowitz 2014]; NCIRD/ACIP 2011).
Bleeding disorders: Use with caution in patients with a history of bleeding disorders
(including
thrombocytopenia)
and/or
patients
on
anticoagulant
therapy;
bleeding/hematoma may occur from IM administration; if the patient receives
antihemophilia or other similar therapy, IM injection can be scheduled shortly after such
therapy is administered (NCIRD/ACIP 2011).
Human papillomavirus (HPV) infection: There is no evidence that individuals already infected
with HPV will be protected; those already infected with 1 or more HPV types were
protected from disease in the remaining HPV types. Not for the treatment of active

disease; will not protect against diseases not caused by HPV vaccine types 6, 11, 16,
and 18.
Concurrent drug therapy issues:
Vaccines: In order to maximize vaccination rates, the ACIP recommends simultaneous
administration (ie, >1 vaccine on the same day at different anatomic sites) of all ageappropriate vaccines (live or inactivated) for which a person is eligible at a single clinic
visit, unless contraindications exist (NCIRD/ACIP 2011).
Special populations:
Altered immunocompetence: May be administered to those who are immunosuppressed
(CDC/ACIP [Markowitz 2014]). Use with caution in severely immunocompromised
patients (eg, patients receiving chemo/radiation therapy or other immunosuppressive
therapy [including high dose corticosteroids]); may have a reduced response to
vaccination (CDC/ACIP [Markowitz 2014]; NCIRD/ACIP 2011). In general, household
and close contacts of persons with altered immunocompetence may receive all ageappropriate vaccines (IDSA [Rubin 2014]; NCIRD/ACIP 2011); inactivated vaccines
should be administered 2 weeks prior to planned immunosuppression when feasible
(IDSA [Rubin 2014]).
Pregnancy: Not recommended for use during pregnancy.
Dosage form specific issues:
Polysorbate 80: Some dosage forms may contain polysorbate 80 (also known as Tweens).
Hypersensitivity reactions, usually a delayed reaction, have been reported following
exposure to pharmaceutical products containing polysorbate 80 in certain individuals
(Isaksson 2002; Lucente 2000; Shelley, 1995). Thrombocytopenia, ascites, pulmonary
deterioration, and renal and hepatic failure have been reported in premature neonates
after receiving parenteral products containing polysorbate 80 (Alade, 1986; CDC, 1984).
See manufacturers labeling.
Yeast: Product may contain yeast.
Other warnings/precautions:
Appropriate use: Use of this vaccine for specific medical and/or other indications (eg,
immunocompromising conditions, hepatic or kidney disease, diabetes) is also addressed
in the ACIP Adult Recommended Immunization Schedule (CDC/ACIP [Kim 2015]).
Specific recommendations for use of this vaccine in immunocompromised patients with
asplenia, cancer, HIV infection, cerebrospinal fluid leaks, cochlear implants,
hematopoietic stem cell transplant (prior to or after), sickle cell disease, solid organ
transplant (prior to or after), or those receiving immunosuppressive therapy for chronic
conditions are available from the IDSA (Rubin 2014).
Effective immunity: Vaccination may not result in effective immunity in all patients. Response
depends upon multiple factors (eg, type of vaccine, age of patient) and may be improved
by administering the vaccine at the recommended dose, route, and interval. Vaccines

may not be effective if administered during periods of altered immune competence

(NCIRD/ACIP 2011).
Maximum efficacy: The entire 3-dose regimen should be completed for maximum efficacy.

Metabolism/Transport Effects
None known.

Drug Interactions
(For additional information: Launch Lexi-Interact Drug Interactions Program)
Belimumab: May diminish the therapeutic effect of Vaccines (Inactivated). Management: Patients
should receive inactivated vaccines prior to initiation of belimumab therapy whenever possible,
due to the risk for an impaired response to the vaccine during belimumab therapy. Risk D:
Consider therapy modification
Fingolimod: May diminish the therapeutic effect of Vaccines (Inactivated). Management: Vaccine
efficacy may be reduced. Complete all age-appropriate vaccinations at least 2 weeks prior to
starting fingolimod. If vaccinated during fingolimod therapy, revaccinate 2 to 3 months after
fingolimod discontinuation. Risk D: Consider therapy modification
Immunosuppressants: May diminish the therapeutic effect of Vaccines (Inactivated). Management:
Vaccine efficacy may be reduced. Complete all age-appropriate vaccinations at least 2 weeks
prior to starting an immunosuppressant. If vaccinated during immunosuppressant therapy,
revaccinate at least 3 months after immunosuppressant
discontinuation. Exceptions: Cytarabine (Liposomal). Risk D: Consider therapy modification

Pregnancy Risk Factor

B (show table)

Pregnancy Implications
Teratogenic effects were not observed in animal reproduction studies. In clinical trials, women who
were found to be pregnant before the completion of the 3-dose regimen were instructed to defer any
remaining dose until pregnancy resolution. Pregnancies detected within 30 days of vaccination had
a higher rate of congenital anomalies (pyloric stenosis, congenital megacolon, congenital
hydronephrosis, hip dysplasia, club foot) than the placebo group. Pregnancies with onset beyond 30
days of vaccination had a rate of congenital anomalies consistent with the general population.
Overall, the types of teratogenic events were the same as those generally observed for this age
group. Administration of the vaccine in pregnancy is not recommended; until additional information
is available, the vaccine series (or completion of the series) should be delayed until pregnancy is
completed. Pregnancy testing is not required prior to administration of the vaccine (CDC/ACIP
[Petrosky 2015]).

A registry has been established for women exposed to the HPV vaccine during pregnancy (1-877888-4231).

Lactation
Excretion in breast milk unknown/use caution

Breast-Feeding Considerations
It is not known if this vaccine is excreted into breast milk. Infants had a higher incidence of acute
respiratory illness when breast-fed by mothers within 30 days postvaccination. The manufacturer
recommends that caution be exercised when administering papilloma virus vaccine to nursing
women. Lactating women may receive vaccine (CDC/ACIP [Markowitz 2014]).

Monitoring Parameters
Screening for HPV is not required prior to vaccination. Monitor for syncope for 15 minutes following
administration (NCIRD/ACIP 2011). If seizure-like activity associated with syncope occurs, maintain
patient in supine or Trendelenburg position to reestablish adequate cerebral perfusion.

Females: Gynecologic screening exam, papillomavirus test; screening for cervical cancer should
continue per current guidelines following vaccination

International Brand Names

Gardasil (AE, AR, AT, AU, BE, BG, BH, CH, CL, CO, CR, CZ, DE, DK, EC, EE, ES, FI, FR,
GB, GR, GT, HK, HN, HR, ID, IE, IL, IS, IT, JP, KR, KW, LB, LT, MT, MY, NI, NL, NO, NZ, PA, PE,
PH, PL, PT, QA, RO, RU, SA, SE, SG, SK, SV, TH, TR, TW, UY, VN)

Mechanism of Action
Contains inactive human papillomavirus (HPV) proteins HPV 6 L1, HPV 11 L1, HPV 16 L1, and
HPV 18 L1 which produce neutralizing antibodies to prevent cervical cancer, cervical
adenocarcinoma, cervical, vaginal and vulvar neoplasia, and genital warts caused by HPV. The
vaccine has not been shown to provide cross-protective efficacy to HPV types not contained in the
vaccine. Immunogenicity has been measured by the percentage of persons who became
seropositive for antibodies contained in the vaccine; the minimum anti-HPV antibody concentration
needed to protect against disease has not been determined. The population benefit to vaccination is
influenced by the prevalence of HPV within the geographic area and subject characteristics (eg,
lifetime sexual partners).

Efficacy: Vaccination with HPV4 reduced the incidence of CIN 2/3 and AIS by 98% to 100% in
several randomized clinical trials. Efficacy against vulvar or vaginal intraepithelial neoplasia grades
2/3 was 100%. Against HPV 6- and 11-related genital warts, HPV4 vaccination reduced incidence in
women by 99% in several clinical trials. In men and boys, HPV4 vaccination reduced the incidence
of the following end points: external genital warts , 89% penile intraepithelial neoplasia of any
severity, 100%; anal intraepithelial neoplasia (AIN) of any severity, 78%. (CDC/ACIP [Markowitz
2014])

Pharmacodynamics and Pharmacokinetics

Onset: Peak seroconversion was observed 1 month following the last dose of vaccine

Duration: Not well defined; at least 8 years

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REFERENCES
1.

Alade SL, Brown RE, Paquet A Jr. Polysorbate 80 and E-Ferol toxicity. Pediatrics.
1986;77(4):593-597. [PubMed 3960626]

2.

Centers for Disease Control (CDC). Unusual syndrome with fatalities among premature
infants: association with a new intravenous vitamin E product. MMWR Morb Mortal Wkly Rep.
1984;33(14):198-199. http://www.cdc.gov/mmwr/preview/mmwrhtml/00000319.htm. [PubMed 64239
51]

3.

Centers for Disease Control and Prevention (CDC). Syncope after vaccination -- United
States, January 2005-July 2007. MMWR Morb Mortal Wkly Rep. 2008;57(17):457460. [PubMed 18451756]

4.

Einstein MH, Baron M, Levin MJ, et al, Comparison of the Immunogenicity and Safety of
Cervarix and Gardasil Human Papillomavirus (HPV) Cervical Cancer Vaccines in Healthy
Women Aged 18-45 Years, Hum Vaccin, 2009, 5(10):507-19. [PubMed 19684472]

5.

FUTURE II Study Group, Quadrivalent Vaccine Against Human Papillomavirus to Prevent

High-Grade Cervical Lesions, N Engl J Med, 2007, 356(19):1915-27.[PubMed 17494925]

6.

Gardasil [prescribing information]. Whitehouse Station, NJ: Merck & Co; April 2015.

7.

Garland SM, Hernandez-Avila M, Wheeler CM, et al, Quadrivalent Vaccine Against Human
Papillomavirus to Prevent Anogenital Diseases, N Engl J Med, 2007, 356(19):192843. [PubMed 17494926]

8.

Giuliano AR, Palefsky JM, Goldstone S, et al, Efficacy of Quadrivalent HPV Vaccine
Against HPV Infection and Disease in Males, N Eng J Med, 2011, 364(5):401-11.

9.

Isaksson M, Jansson L. Contact allergy to Tween 80 in an inhalation suspension. Contact

Dermatitis. 2002;47(5):312-313. [PubMed 12534540]

10.

Kim DK, Bridges CB, Harriman KH; Advisory Committee on Immunization Practices (ACIP);
ACIP Adult Immunization Work Group; Centers for Disease Control and Prevention (CDC). Advisory
committee on Immunization Practices recommended immunization schedule for adults aged 19
years or older - United States, 2015. MMWR Morb Mortal Wkly Rep. 2015;64(4):9192. http://www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf [PubMed
25654609]

11.

Koutsky LA, Ault KA, Wheeler CM, et al, A Controlled Trial of a Human Papillomavirus
Type 16 Vaccine, N Engl J Med, 2002, 347(21):1645-51. [PubMed12444178]

12.

Lucente P, Iorizzo M, Pazzaglia M. Contact sensitivity to Tween 80 in a child. Contact

Dermatitis. 2000;43(3):172. [PubMed 10985636]

13.

Mao C, Koutsky LA, Ault KA, et al, Efficacy of Human Papillomavirus-16 Vaccine to
Prevent Cervical Intraepithelial Neoplasia: A Randomized Controlled Trial,Obstet Gynecol, 2006,
107(1):18-27. [PubMed 16394035]

14.

Markowitz LE, Dunne EF, Saraiya M, et.al; Centers for Disease Control and Prevention
(CDC). Human papillomavirus vaccination: recommendations of the Advisory Committee on
Immunization Practices (ACIP). MMWR Recomm Rep. 2014;63(RR-05):1-30. [PubMed 25167164]

15.

Muoz N, Manalastas R Jr, Pitisuttithum P, et al, Safety, Immunogenicity, and Efficacy of

Quadrivalent Human Papillomavirus (Types 6, 11, 16, 18) Recombinant Vaccine in Women Aged
24-45 Years: A Randomised, Double-Blind Trial, Lancet, 2009, 373(9679):194957. [PubMed 19493565]

16.

National Advisory Committee on Immunization (NACI), Statement on Human

Papillomavirus Vaccine. An Advisory Committee Statement (ACS), Can Commun Dis Rep, 2007,
33(ACS-2):1-31. [PubMed 17520773]

17.

National Centers for Immunization and Respiratory Diseases (NCIRD). General

recommendations on immunizationrecommendations of the Advisory Committee on Immunization
Practices (ACIP) [published correction appears in MMWR Recomm Rep. 2011;60:993]. MMWR
Recomm Rep. 2011;60(2):1-64. [PubMed21293327]

18.

Petrosky E, Bocchini JA, Hariri S, et al; Centers for Disease Control and Prevention (CDC).
Use of 9-valent human papillomavirus (HPV) vaccine: Updated HPV vaccination recommendations
of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep.
2015;64(11):300-304. [PubMed 25811679]

19.

Reisinger KS, Block SL, Collins-Ogle M, et al, Safety, Tolerability, and Immunogenicity of
Gardasil Given Concomitantly With Menactra and Adacel, Pediatrics, 2010, 125(6):114251. [PubMed 20439595]

20.

Rubin LG, Levin MJ, Ljungman P, et al. 2013 IDSA clinical practice guideline for vaccination
of the immunocompromised host. Clin Infect Dis. 2014;58(3):e44-e100.[PubMed 24311479]

21.

Saslow D, Castle PE, Cox JT, et al, American Cancer Society Guideline for Human
Papillomavirus (HPV) Vaccine Use to Prevent Cervical Cancer and Its Precursors, CA Cancer J
Clin, 2007, 57(1):7-28. [PubMed 17237032 ]

22.

Shelley WB, Talanin N, Shelley ED. Polysorbate 80 hypersensitivity. Lancet.

1995;345(8980):1312-1313. [PubMed 7746084]

23.

Steinbrook R, The Potential of Human Papillomavirus Vaccines, N Engl J Med, 2006,

354(11):1109-11. [PubMed 16540608]

24.

Strikas RA; Centers for Disease Control and Prevention (CDC); Advisory Committee on
Immunization Practices (ACIP); ACIP Child/Adolescent Immunization Work Group. Advisory
Committee on Immunization Practices recommended immunization schedule for persons aged 0
through 18 yearsUnited States, 2015.MMWR Morb Mortal Wkly Rep. 2015;64(4):9394. http://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf. [
PubMed24500290]

25.

Vesikari T, Van Damme P, Lindblad N, et al, An Open-Label, Randomized, Multicenter

Study of the Safety, Tolerability, and Immunogenicity of Quadrivalent Human Papillomavirus (Types
6/11/16/18) Vaccine Given Concomitantly With Diphtheria, Tetanus, Pertussis, and Poliomyelitis
Vaccine in Healthy Adolescents 11 to 17 Years of Age, Pediatr Infect Dis J, 2010, 29(4):3148. [PubMed 19952980]

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