Gardasil Syringe<unk> s are used to prevent<unk>  infection and therefore cervical cancer. Good evidence supports that vaccination of large percentage of people within a population decreases rates of<unk>  infections with part of the benefit from herd immunity. Some types are recommended in the United States for women and men who are 9–26 years of age, and are approved for those who are 27–45 years of age. Since the vaccines only cover some high-risk types of<unk> , cervical cancer screening is recommended even after vaccination. In the U.S., the recommendation is for women to receive routine Pap smears beginning at age 21. In Australia, the national screening program has changed from the two yearly cytology (pap smears) to being based on tests for<unk>  DNA, based on work by Karen Canfell and others. Efficacy The<unk>  has been shown to prevent cervical dysplasia from the high-risk<unk>  types 16 and 18 and provide some protection against a few closely related high-risk<unk>  types. However, there are other high-risk<unk>  types that are not affected by the vaccine. The protection against<unk>  16 and 18 has lasted at least eight years after vaccination for Gardasil and more than nine years for Cervarix. It is thought that booster vaccines will not be necessary. Gardasil and Gardasil 9 protect against<unk>  types 6 and 11 which can cause genital warts. Cervarix is just as effective at protecting women against persistent<unk>  16 and 18 infection in the anus as it is at protecting them from these infections in the cervix. Overall, about 30 percent of cervical cancers will not be prevented by these vaccines. Also, in the case of Gardasil, ten percent of genital warts will not be prevented by the vaccine. Neither vaccine prevents other sexually transmitted diseases, nor do they treat existing<unk>  infection or cervical cancer.<unk>  types 16, 18 and 45 contribute to 94% of cervical adenocarcinoma (cancers originating in the glandular cells of the cervix). While most cervical cancer arises in the squamous cells, adenocarcinomas make up a sizable minority of cancers. Further, Pap smears are not as effective at detecting adenocarcinomas, so where Pap screening programs are in place, a larger proportion of the remaining cancers are adenocarcinomas. Trials suggest that<unk> s may also reduce the incidence of adenocarcinoma. Two doses of the vaccine may work as well as three doses. The Centers for Disease Control and Prevention (CDC) recommends two doses in those less than 15 years and three doses in those over 15 years. A single dose might be effective. A study with 9vHPV, a 9-valent<unk>  that protects against<unk>  types 6, 11, 16, 18, 31, 33, 45, 52, and 58, came to the result that the rate of high-grade cervical, vulvar, or vaginal disease was the same as when using a quadrivalent<unk> . A lack of a difference may have been caused by the study design of including women 16 to 26 years of age, who may largely already have been infected with the five additional<unk>  types that are additionally covered by the 9-valent vaccine. Males<unk> s are approved for males in several countries, including Switzerland, Portugal, Canada, Australia, Ireland, South Korea, Hong Kong, the United Kingdom, New Zealand, and the United States. In males, Gardasil may reduce their risk of genital warts and precancerous lesions caused by<unk> . This reduction in precancerous lesions might be predicted to reduce the rates of penile and anal cancer in men. Gardasil has been shown to also be effective in preventing genital warts in males. While Gardasil and the Gardasil 9 vaccines have been approved for males, a third<unk> , Cervarix, has not. Unlike the Gardasil-based vaccines, Cervarix does not protect against genital warts. As with females, the vaccine should be administered before infection with the<unk>  types covered by the vaccine occurs. Vaccination before adolescence, therefore, makes it more likely that the recipient has not been exposed to<unk> . Since penile and anal cancers are much less common than cervical cancer,<unk> tion of young men is likely to be much less cost-effective than for young women. Gardasil is also used among men who have sex with men, who are at higher risk for genital warts, penile cancer, and anal cancer. Recommendations by national bodies Australia introduced<unk> tion for boys over 12 from 2013 onwards, while UK and Ireland introduced<unk> tion for boys aged 12 and 13 as part of their National Immunization Plan in 2019. Portugal introduced universal<unk> tion for boys aged 10 years and above as part of its National Immunization Plan in 2020. On 9 September 2009, an advisory panel recommended that the Food and Drug Administration (FDA) of the USA license Gardasil in the United States for boys and men ages 9–26 for the prevention of genital warts. Soon after that, the vaccine was approved by the FDA for use in males aged 9 to 26 for prevention of genital warts and anal cancer. In 2011, an advisory panel for the Centers for Disease Control and Prevention (CDC) recommended the vaccine for boys ages 11–12. This was intended to prevent genital warts and anal cancers in males, and possibly prevent head and neck cancer (though the vaccine's effectiveness against head and neck cancers has not yet been proven). The committee also made the vaccination recommendation for males 13 to 21 years who have not been vaccinated previously or who have not completed the three-dose series. For those under the age of 27 who have not been fully vaccinated the CDC recommends vaccination. Harald zur Hausen's support for vaccinating boys (so that they will be protected, and thereby so will women) was joined by professors Harald Moi and Ole-Erik Iversen in 2011. Older age When Gardasil was first introduced, it was recommended as a prevention for cervical cancer for women that were 25 years old or younger. Evidence suggests that<unk> s are effective in preventing cervical cancer for women up to 45 years of age. In 2018, the Food and Drug Administration released a summary basis for regulatory action and approval for expansion of usage and indication for the 9-valent<unk>  to include men and women 27 to 45 years of age. Public health The National Cancer Institute states "Widespread vaccination has the potential to reduce cervical cancer deaths around the world by as much as two-thirds if all women were to take the vaccine and if protection turns out to be long-term. In addition, the vaccines can reduce the need for medical care, biopsies, and invasive procedures associated with the follow-up from abnormal Pap tests, thus helping to reduce health care costs and anxieties related to abnormal Pap tests and follow-up procedures." preventive vaccines protect against the two<unk>  types (16 and 18) that cause about 70% of cervical cancers worldwide. Because of the distribution of<unk>  types associated with cervical cancer, the vaccines are likely to be most effective in Asia, Europe, and North America. Some other high-risk types cause a larger percentage of cancers in other parts of the world. Vaccines that protect against more of the types common in cancers would prevent more cancers, and be less subject to regional variation. For instance, a vaccine against the seven types most common in cervical cancers (16, 18, 45, 31, 33, 52, 58) would prevent an estimated 87% of cervical cancers worldwide. Only 41% of women with cervical cancer in the developing world get medical treatment. Therefore, prevention of<unk>  by vaccination may be a more effective way of lowering the disease burden in developing countries than cervical screening. The European Society of Gynecological Oncology sees the developing world as most likely to benefit from<unk> tion. However, individuals in many resource-limited nations, Kenya for example, are unable to afford the vaccine. In more developed countries, populations that do not receive adequate medical care, such as poor or minorities in the United States or parts of Europe also have less access to cervical screening and appropriate treatment, and are similarly more likely to benefit. In 2009, Dr. Diane Harper, a researcher for the<unk> s, questioned whether the benefits of the vaccine outweigh its risks in countries where Pap smear screening is common. She has also encouraged women to continue pap screening after they are vaccinated and to be aware of potential adverse effects. According to the CDC, in 2012, use of the<unk>  had cut rates of infection with<unk> -6, -11, -16 and -18 in half in American teenagers (from 11.5% to 4.3%) and by one third in American women in their early twenties (from 18.5% to 12.1%).
HPV vaccine
Pap test
Cervical screening
Anal Pap smear
Polio vaccine
BCG vaccine
Hepatitis B vaccine
MMR vaccine