In the United States,<unk>  is indicated for: * girls and women 9 through 45 years of age for the prevention of the following diseases: * Cervical, vulvar, vaginal, anal, oropharyngeal and other head and neck cancers caused by Human Papillomavirus (HPV) types 16, 18, 31, 33, 45, 52, and 58. * Genital warts (condyloma acuminata) caused by HPV types 6 and 11. * girls and women 9 through 45 years of age for the following precancerous or dysplastic lesions caused by HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58: * Cervical intraepithelial neoplasia (CIN) grade 2/3 and cervical adenocarcinoma in situ (AIS). * Cervical intraepithelial neoplasia (CIN) grade 1. * Vulvar intraepithelial neoplasia (VIN) grade 2 and grade 3. * Vaginal intraepithelial neoplasia (VaIN) grade 2 and grade 3. * Anal intraepithelial neoplasia (AIN) grades 1, 2, and 3. * boys and men 9 through 45 years of age for the prevention of the following diseases: * Anal, oropharyngeal and other head and neck cancers caused by HPV types 16, 18, 31, 33, 45, 52, and 58. * Genital warts (condyloma acuminata) caused by HPV types 6 and 11. * boys and men 9 through 45 years of age for the following precancerous or dysplastic lesions caused by HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58: * Anal intraepithelial neoplasia (AIN) grades 1, 2, and 3. In the European Union,<unk>  is indicated for active immunization of individuals from the age of nine 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.<unk>  is a vaccine to prevent HPV, that, for maximum effect, is recommended for individuals prior to their becoming sexually active. Moreover, evidence supports the conclusion that women who were already infected with one or more of the four HPV types targeted by the vaccine (HPV types 6, 11, 16, or 18) were protected from clinical disease caused by the remaining HPV types in the vaccine. HPV types 16 and 18 cause an estimated 70% of cervical cancers, and are responsible for most HPV-induced anal cancers.<unk>  also protects against vulvar and vaginal cancers caused by HPV types 16 and 18, as well as most penile cancers caused by these two HPV types. Since<unk>  will not prevent infection with all of the HPV types that can cause cervical cancer, the vaccine is not considered a substitute for routine pap smears. In addition, protection against HPV types 6 and 11 May eliminate up to 90% of the cases of genital warts. Common plantar warts—e.g., caused by HPV types 1, 2, and 4—are not prevented by this vaccine. In 2010,<unk>  was approved by the FDA for prevention of anal cancer and associated precancerous lesions due to HPV types 6, 11, 16, and 18 in people aged 9 through 26 years. HPV infections, especially HPV 16, contribute to some head and neck cancer (HPV is found in an estimated 26–35% of head and neck squamous cell carcinoma). In principle, HPV vaccines may help reduce incidence of such cancers caused by HPV, but this has not been demonstrated. In June 2020, the FDA approved the use of<unk>  for the prevention of head and neck cancers. The FDA approved<unk>  9 for women and men aged 27 to 45 based on the vaccine being 88% effective against persistent HPV infections that cause certain types genital warts and cancers in females. Vaccine efficacy in males in this age group was inferred. Efficacy A 2020 longitudinal study tracking over 1,600 Swedish girls and women over an eleven year period found half as many cervical cancer cases in all women who had been vaccinated, and amongst women who had been vaccinated before the age of 17 a 78% reduction in cervical cancer, "a substantially reduced risk of invasive cervical cancer at the population level." An alternative vaccine known as Cervarix protects against two oncogenic strains of HPV, 16 and 18. The National Cancer Institute says, "To date, protection against the targeted HPV types has been found to last for at least 10 years with<unk> , at least 9 years with Cervarix, and at least 6 years with<unk>  9. Long-term studies of vaccine efficacy that are still in progress will help scientists better understand the total duration of protection."<unk>  has been shown to be partially effective (approximately 38%) in preventing cervical cancer caused by ten other high-risk HPV types. Antibody levels at month 3 (one month post-dose number two) are substantially higher than at month 24 (18 months post-dose number three), suggesting that protection is achieved by month 3 and perhaps earlier. In 2014, the World Health Organization (WHO) recommended that countries offer the vaccine in a two dose schedule to girls aged under 15, with each dose at least six months apart. The United Kingdom, Switzerland, Mexico, and Quebec province of Canada are among the countries or territories that have implemented this . The CDC recommended the vaccines be delivered in two shots over six months. Males<unk>  is also effective in males, providing protection against genital warts, anal warts, anal cancer, and some potentially precancerous lesions caused by some HPV types.<unk>  vaccine has been shown to decrease the risk of young men contracting genital warts. In the United States, the FDA approved administration of the<unk>  vaccine to males between ages 9 and 26 in 2009. The FDA approved administration of the<unk>  9 vaccine to males between ages 9 and 15 in 2014, and extended the age indication, by including males between ages 16 and 26, in 2015. In the UK, HPV vaccines are licensed for males aged 9 to 15 and for females aged 9 to 26. Men who have sex with men (MSM) are particularly at risk for conditions associated with HPV types 6, 11, 16, and 18; diseases and cancers that have a higher incidence among MSM include anal intraepithelial neoplasias, anal cancers, and genital warts. HPV type 16 is also responsible for almost 90% of HPV-positive oropharyngeal squamous-cell carcinoma (OPSCC), a form of cancer that affects the mouth, tonsils, and throat; the prevalence of HPV-positive oropharyngeal cancers is higher in males than females. A 2005 study found that 95% of HIV-infected gay men also had anal HPV infection, of whom 50% had precancerous HPV-caused lesions. Administration<unk>  is given in three injections over six months. The second injection is two months after the first, and the third injection is six months after the first shot was administered. Alternatively, in some countries it is given as two injections with at least six months between them, for individuals aged 9 years up to and including 13 years.
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